Four Weeks In: Sarakay Johnson in Munsieville

Sarakay Johnson writes about the progress made a month into her and fellow student Courtney Stanley's trip to Munsieville, South Africa

Sep 26 2012

Sarakay Johnson

East Tennessee State University

Munsieville, South Africa



This starts week number four of my internship here in Munsieville, and I cannot believe time is going by this fast!  Last week Courtney and I began work on a big project that I hope will have a lasting positive impact on the people of Munsieville.


As I mentioned in my last post, Courtney and I planted a small vegetable garden.  This served as a pilot to see how the vegetables that were planted would thrive in the climate and sun exposure.  Now that we understand what types of vegetables are appropriate to grow at this time of year and in this climate, we can take our project to the next level with the help of a product called Garden Soxx®.  We are encouraging the women of the community to grow their own vegetable gardens using this product.  Garden Soxx® was developed by a company called Filtrexx International and consists of a black mesh material filled with weed-free compost.  The mesh material can be cut to any desired size, and it creates perfect growing conditions for a garden without requiring a large piece of land or nutrient rich soil.  The compost-filled mesh can be placed anywhere and, with appropriate watering and care, will grow a small garden.  What Courtney and I would ultimately like to see is a community full of these homegrown gardens, with one at every home in Munsieville. 


We are piloting this project with five houses in Mshenguville that we think would most benefit from this initiative.  Mshenguville is an informal settlement within Munsieville, and the houses there were selected based on household income and the number of children living in each home.  On Tuesday and Wednesday of last week, Courtney and I walked through Mshenguville with Safira, one of the ladies working with The Thoughtful Path, so we could find the houses and talk to the families to get them interested in the idea of growing their own gardens.  We are thinking of making the garden growing into a competition so that the families will be encouraged to take care of and look after their gardens.  Ultimately, though, this project is about sustainability and teaching the women to garden for themselves and then going out and teaching their neighbors to do the same.  We had successful home visits in Mshenguville, and this week we will begin gathering the materials for the gardens and teaching the women how to start using their Garden Soxx®. Imagine how great it would be for every family in Munsieville to be growing their own vegetables!


There were some very surreal moments when I could not believe I was actually being invited to sit in someone’s house in Mshenguville.  While it is easy to refer to the structures there as shacks, it became very real to me that they are homes.  They are places where people cook meals, spend time with their family, and find rest.  There is a noticeable sense of pride from the residents, especially women, about where they live.  One lady even apologized to us for the messiness because she had not had a chance to clean that morning.  Another lady was doing her laundry and, when she saw us approaching, was quick to go inside and grab crates for us to sit on because that was all she had and she wanted us to be comfortable.  I was very touched by how welcoming these people were.  Even though they don’t have much, they offer what they do have in order for guests to feel more comfortable…in their homes.



Sarakay Johnson
Frist Global Health Leader

East Tennessee State University

Munsieville, South Africa


First Week in South Africa

Courtney Stanley writes about the first week of her and fellow student Sarakay Johnson in Munsieville

Sep 11 2012

By Courney Stanley
East Tennessee State University
Munsieville, South Africa

            My name is Courtney Stanley and I am a senior at East Tennessee State University College of Public Health.  I am currently earning my B.S. degree in Public Health with a concentration in Community and Behavioral Health.  I was fortunate to have the opportunity to travel to Munsieville, South Africa and complete my internship with The Thoughtful Path, along with my colleague and fellow student Sarakay Johnson.     

The first week of my internship with The Thoughtful Path has been tremendous, to say in the least.  I have been able to experience and accomplish more in my first week here than I ever expected.  The plane landed Thursday, September 6th at 3:00 pm, and by Friday morning Sarakay Johnson and I were walking through the informal settlements in Munsieville along with Betty Nkoana, the on-site director, and Abi Brooks.  The informal settlements, or townships, are where the lower income families and the individuals who have not received any government housing live.  The individuals residing in these settlements are at a great mental, physical and social risk.  To be able to visit and actually go into these houses and talk to the families living there was amazing.  It was overwhelming at first to experience such extreme poverty firsthand.  Despite all the education and training I have received as a future public health professional, there was a moment of questioning what I would ever be able to do.  Soon after this, however, the ideas started to flow. 

I especially began referring to concepts learned in the ESSENTIAL’S class I took over the summer.  There are so many basic improvements that can be made that would have an immense effect.  First off, is the issue of cooking with a paraffin stove.  The possibility exists of creating a brick oven to be used for cooking, or using the bricks to create a stable surface for the paraffin stoves to be placed.  There is a brick making site that has finished being constructed, so there is potential create a coalition between the individuals making the bricks and those that are working on home safety.  Another issue that I feel needs to be addressed is access to a proper hand washing station.  There are only a few pumps between the two different formal settlements that provide access to clean water.  I believe the tippy-taps I learned how to make in the ESSENTIAL’S class would serve very well as an affordable and achievable solution. 

After we finished with the walkthrough, Sarakay, Betty and I had a meeting to discuss the projects that we would be working on over the course of our internship.  They range from projects such as training adolescents and younger adults on how to educate young children in basic healthcare practices, to creating health education material to be available to everyone in Munsieville, and to creating home based, cost-efficient, nutritional gardens that we can train children to manage.  There are several others that I will go into detail at a later time.

            This first week Sarakay and I have also been assisting Yi He, a doctorial candidate also from ETSU, with the data capturing project started during his time here.  There was a slight confusion with how the surveys were being recorded.  After working with Yi and the surveying team however, we were able to get everything corrected. 

            Another rather large and slightly unexpected project that I have worked on this week was a health fair conducted in Mshenguville.  Mshenguville is one of the more disadvantaged informal settlements in Munsieville.  So, The Thoughtful Path decided to go to Mshenguville and conduct a health fair for the population residing there.  Betty requested that Sarakay and I create suitable health information and conduct a health class at the fair.  After meeting with the Health Promotion Unit, we decided to focus on hand washing and oral hygiene for younger children.  We created interesting and informational posters that would attract the children’s’ attention.  To make it fun and interactive we purchased the supplies for hand washing and had the children create their handprint a piece of paper, then showed them how to properly wash their hands afterwards.  We also held small tooth brushing classes intermittently throughout the day.  After the children completed the class we awarded them with a gold star.  That way when the other children saw the stars they would also want to participate in the class.  Another volunteer translated a rhyme while Sarakay and I demonstrated the proper technique, then we had the children repeat it with us.  After the children completed the class we awarded them with a gold star.  That way when the other children saw the stars they would also want to participate in the class.

            The rest of the time, we have been assisting in preparing for the visiting board members of Project Hope UK, Project Hope U.S., and other various partners of The Thoughtful Path.  This was an absolutely amazing experience.  We had the opportunity to meet with many influential people within these organizations.  I was able to have a discussion concerning the concentration paper and various projects I will be completing with Bradley Wilson, the chairman of Project Hope UK.  It was wonderful to be able to hear the opinion of someone who has so much experience with Project Hope.  Also, I attended a leadership lecture conducted by Dame Amelia Fawcett, a board member of Project Hope UK. 

            Needless to say, my first week of my internship with The Thoughtful Path has been teeming in extraordinary experiences.  I know that this trend will only continue for the next ten weeks and I cannot wait to continue to develop and demonstrate my public health knowledge with such a wonderful organization.      

Courtney Stanley
Frist Global Health Leader
East Tennessee State University
College of Public Health


First Week in Honduras

Alyssa Small talks about her struggles with Spanish, the similarities between Meharry and her new hospital, and getting out into the countryside

Aug 04 2012

By Alyssa Small
Meharry Medical College
Ciriboya, Honduras

This first week has been a lot of preparation. For the orgnization - preparing for the upcoming medical student brigade and the confrence, for me - learning Spanish and helping out where I can. I try to spend an hour in the morning in language school, which is me in front of the fan looking at my Spanish materials. I´m already more comfortable saying Spanish phrases and I can understand what people are saying to me every once in a while. So I guess I´m on the road to success.

I finished translating the document. It was a long 25 page paper that outlined the history of the Hospital and the student health brigade. It was actually really good for me to go through because I learned more about the activites of the Hospital. In short, The Primer Hospital Popular Garifuna de Honduras was founded by Dr. Luther Castillo Harry.  He was a graduate of the first class of medical students from the Latin American School of Medicine (ELAM) in Cuba.  He wanted to build a clinic to serve the Garifuna population who are medically and socially underserved. This population didn´t have any medical services and suffered from high morbidity, especially infant and maternal mortality. The mission of the Hospital and the workers reminds me a lot of Meharry Medical College, my medical school.  They both exist to provide needed health services to a disadvantaged group of people. He chose Ciriboya as the location for the main hospital because it sits on a site where people must pass through to go and come from the area.  This makes it very convient for the local population.

The Hospital also supports a network of clinic outpost in about 7 other communities.  The network is staffed by Garifuna doctors, nurses, and staff along with a Cuban medical team.  The Garifuna and Honduran medical students who are studying medicine in Cuba travel to Ciriboya and the surrounding villages during their holiday from school.  This year they are going to be building a health record system as well as educating people on diabetes, high blood pressure, and sickle cell anemia. Tomorrow morning we will leave La Ceiba bright and early at 6am and travel to Ciriboya. This afternoon we had a little conference of the members of the student health brigade Dr. Luther talked about the histoy of the program and Hospital as well as the plan for the brigade and another doctor spoke about the pathology and management of hypertension and diabetes.

Yesterday I got out and was able to see more of the city. It reminds me a lot of the cities and towns of the Caribbean islands. The buildings and the architecture are similar.

If it wasn´t for the mosquitoes feasting on me, this would have been a really good experience. This little waterfall was hidden away. I wish I had brought my real camera, but I was glad to be able to capture its beauty on my cell phone.

After we visited the community of Corozal, which is part of La Ceiba. It is mainly Garifuna, but I saw a mix of ethnicities. It´s a poorer community that sits right on the beach. The water was extremely warm and the beach was nice.  It seems they had a circus in town, but there was no action while I was there.

Random item of the week... I watched some blue crabs go from happy and snappy into dinner.

Off to go learn some Garifuna!


Alyssa Small is a 4th year medical student studying at Meharry Medical College. She was born and raised in Canada to a Caribbean family¨from Barbados and is a self proclaimed ¨Canadian born Bajan.  She credits her parents for instilling in her the importance of volunteerism and serving the community. She also recognizes the impact of seeing the disparities between the Caribbean and Canada for her interest in working with disadvataged groups. Her area of focus is the Caribbean and Central America. During her undergraduate career, Alyssa minored in Caribbean Studies (majored in neuroscience) and spent half a year doing study abroad at the University of the West Indies at the Cave Hill campus in Barbados. During medical school she spent a summer in Barbados studying the caregiver burder associated with HIV.

Alyssa is very excited to get some Latin American experience under her belt.  She is traveling to Ciriboya, Honduras a small coastal village, where she will work at the Primer Hospital Popular Garifuna de Honduras under the leadership of Dr. Luther Castillo Harry. This is a small general, mainly non surgical hospital. Alyssa will work with team seeing patients in the clinics and hospital.  She will also conduct a follow up self breast exam survey in the community of Ciriboya. Alyssa´s interest lie in women´s health and she will pursue a residency in ob-gyn after graduation in May 2012.

(The Week, July 2012)

These days, Washington can’t agree on anything. Thankfully, though, some brave lawmakers are still willing to cross the aisle to fight a deadly disease.

We live in fiercely contentious times. Every day, it seems, a new issue arises that Democrats and Republicans cannot agree on. Health care, taxes, energy, favorite flavor of ice cream — it seems our elected leaders must disagree at every turn. But one issue that has so far repulsed the partisan pressures of the times was highlighted in our nation’s capital last week: the fight against HIV/AIDS.

Washington, D.C., hosted the XIX International AIDS Conference. It was an energetic, passion-filled week. More than 23,000 attendees from across the globe heard and engaged speakers including both former President Bill Clinton and Secretary of State Hillary Clinton, cutting edge research scientists, activists, Nobel laureates, world leaders, and even a few celebrities. Perhaps even more important, many HIV positive men and women came together from dozens of countries to find a caring, supportive community.

The United States — and more specifically, the American taxpayer — has been the undisputed world leader in fighting this cagey virus for which there is no cure. This single virus has taken the lives of more than 580,000 Americans and 25 million globally since it emerged here in our country just over 30 years ago. The conference was a celebration of the remarkable success made because of this leadership, and a call for continued support.

When we stop the hollowing out of societies and inspire hope, there is no limit to what we can accomplish together.

As moderator for a panel on the congressional role, I witnessed what I felt to be an accurate portrayal of how we got to the point where we could celebrate so many successes. Fundamental to the progress has been bipartisanship. Participating were two Democrats, Reps. Barbara Lee (Calif.) and Sen. Chris Coons (Del.), and two Republicans, Sens. Marco Rubio (Fla.) and Mike Enzi (Wyo.).

Our panel’s balanced party identification was more than symbolism, as Rep. Lee acknowledged when she described the U.S. response as bipartisan, saying, “it never would have happened without … Republicans in the House and the Senate.” Indeed, the bold $15 billion PEPFAR commitment initiated by President George W. Bush and supported by Congress was quickly taken up and expanded under the Obama administration. All panel members were quick to praise the leadership and dedication of the other’s party.

And there is cause for such praise. PEPFAR, unprecedented in scope and size in its combatting of a single disease, has saved millions of lives, provided 4.5 million people with treatment, enabled hundreds of thousands of HIV positive mothers to give birth to healthy, disease-free children, and allowed tens of millions to receive testing, counseling and care. In 1995, 50,000 Americans died of AIDS. In 2009, that number was down to 20,000. Promisingly, partner countries are increasingly supporting this work internally. Last year, poorer countries invested $8.6 billion into the fight as international financing provided by wealthier nations amounted to $8.2 billion. As I have said for years, when we stop the hollowing out of societies and inspire hope, there is no limit to what we can accomplish together.

The results of this bipartisan American commitment are in, and they are undeniable. Our past investment has inspired others to contribute, saved lives at home and around the world, and empowered economic development with a healthier workforce. But the risk today in a more highly charged partisan environment and in more fiscally challenging times is to say we have done our job and it’s time to move on. That would be a huge mistake, and all our progress would be erased because we still don’t have a cure. Around the world and at home, the AIDS epidemic is far from over.

Rep. Lee noted that there are still American communities where “the percentages [of AIDS] are comparable to sub-Saharan Africa.” This is unacceptable, and you do not have to look far into the past to a time when both parties wholeheartedly understood this.

As Sen. Enzi recollected, in 2003 the PEPFAR bill “passed both the House and Senate unanimously, un-amended, in less than two months. That never happens.” But Enzi elaborated that five years later, when the time came for reauthorization under President Bush, the measure passed “again in a bipartisan way” — although “we didn’t have quite the same votes that we had the first time.”

However, hope for preserving this flame of bipartisan conviction was articulately reflected by the two other members of the panel, Sens. Rubio and Coons, each representing different parties, and neither of whom were in office during the original PEPFAR passage. They have emerged as powerful and knowledgeable voices on global health and HIV. Such leadership is vital when the focus of Congress, today filled with new members who were not around when PEPFAR originally passed, is understandably on domestic issues, the economy, jobs, and health care.

While living and working in Africa in the mid 1980s, Sen. Coons was inspired by the profound human tragedy he witnessed firsthand and has transformed these experiences into true leadership. But he warns that we “can’t take [continued U.S. leadership] for granted in what is an incredibly difficult, very partisan and very divided Congress at a time when our politics are in some ways the rockiest they’ve been in more than a generation.” But out of a world of mudslinging and disagreement, the Democratic senator says it “has been really refreshing to be able to work closely with Republicans” to fight this epidemic.

At a time when our national debt is skyrocketing, the typical American finds it difficult to understand how massive spending for people overseas, even if it is lifesaving, can be justified. But just how massive is this spending really? Not the 25 percent of our budget that most Americans think. In truth, our foreign aid spending is less than 1 percent of the federal budget. As Sen. Rubio, himself a favorite of the Tea Party, eloquently asserted, “If you zeroed out foreign aid it would do nothing for the debt, but it would be devastating not just for the world, but for America’s role in it.”

Progress has been mind-blowing. Science made possible by taxpayer investment through the NIH has brought miraculous new drugs to treat and, just this month, new medicines to prevent. Cost of treatment has fallen ten-fold and continues to plummet. Prevention strategies have turned the tide of devastation. But all this was accomplished because Americans came together, Republican and Democrat, working hand in hand in a bipartisan and meaningful way, rallying together to fashion solutions that are changing the course of history.

As Sen. Rubio declared, “the closer we get to the finish line is not the time to ease up, it’s the time to run through the tape.” Let’s continue to put our partisan differences aside and run this one together.

Goodbye to Kijabe

FGHL Rondi Kauffman reflects on his time in Kenya

Jul 13 2012

By Rondi Kauffman, MD
Vanderbilt University: Department of General Surgery
Kijabe, Kenya

It is hard to believe that my four weeks in Kijabe will be over tomorrow. It has been a wonderful trip- from the joys of getting to know a new culture and working alongside talented colleagues, to having the privilege to take care of the patients here in Kenya. I will carry many lessons home with me- how to accomplish much with limited resources, how to arrive at a diagnosis by means of a good physical exam and without the luxury of advanced imaging, and a new appreciation for the necessity of balancing cost of health care with benefit. For the many ways the delivery of medical care is different in Kenya- what treatments are available, how disease present, and  the populations affected, so much is the same. Healthcare providers striving daily to improve their practice and provide the best care possible, the look of gratitude on a mother’s face when I tell her we can help her child, the concern on a family member’s face when a relative is ill in the ICU.  My time in Kenya has been a privilege and an honor, and I am changed for the better.

Mass Casualty

Jun 05 2012

By Rondi Kauffman, MD
Vanderbilt University: Department of General Surgery
Kijabe, Kenya

I took my first weekend of call this past weekend.  As I was checking on a patient Sunday evening, I was informed by my junior resident that there was a “mass casualty” bus accident in a nearby town, and the police had called to say they were bringing a number of victims to Kijabe Hospital. No one knew any additional details, and as I arrived in the Casualty unit (Emergency Department), a tour-bus size vehicle pulled through the front gate. Within minutes, injured patients began being rapidly unloaded. As the most senior resident present, I was in charge of triaging, organizing resuscitations and directing patient care until an attending arrived. We very quickly identified several patients needing immediate attention, and moved quickly to stabilize them.

I was amazed at the efficiency of the staff in identifying what needed to be done, getting supplies, and working as a cohesive team to get patients taken care of. Medical interns had turned out by the dozens to assist, nurses not on duty quickly arrived to work on starting IVs, and every attending who was in town showed up to lend a hand. What an amazing team of professionals! Someone brought a portable Sono-Site ultrasound that allowed us to perform FAST exams to look for intra-abdominal fluid in the Emergency Department. Xray techs worked overtime to image cervical spines and fractures, and several operating theaters were rapidly made ready for the injured who required operations. 

By last count, we had received 35 patients, some critically ill and all requiring some intervention (an operation, laceration closure, xrays etc).  All were stabilized, treated and admitted or discharged as appropriate within 6 hours. That many injured patients arriving at once would overwhelm almost every trauma center, but the team at Kijabe did an excellent job coming together to provide excellent trauma care in a setting with limited resources. 

By Rondi Kauffman, MD
Vanderbilt University: Department of General Surgery
Kijabe, Kenya 

One of the great benefits of spending time in a place like Kijabe is the opportunity to “cross train”.   I am a general surgery resident. But this week, I have learned a bit about being a urologist, an otolaryngologist, and an obstetrician.

Specialists are in very short supply in the developing world, and therefore, one needs to remain flexible and willing to learn new trades in order to take care of the patient in front of you.  It strikes me that, as American surgery continues to be further compartmentalized into narrower and narrower sub-specialties, international surgery provides the opportunity to remain not only a true “general surgeon”, but a medical doctor- treating the wide range of non-surgical complaints that find their way into the surgical clinic.  

By Rondi Kauffman, MD
Vanderbilt University: Department of General Surgery
Kijabe, Kenya 

Being diagnosed with a malignancy in Kenya is a very different thing than being diagnosed with a malignancy in the United States. CT scans and PET scans as means to evaluate for metastases are not locally available. A patient must travel to Nairobi, and frequently, these imaging studies are too expensive for most patients to afford. Furthermore, many malignancies are very advanced when they first come to the attention of a physician. Patients may delay being evaluated because of the cost, because of the distance required to get to a clinic, or because they must choose between obtaining health care and their family eating.  Finally, chemotherapy and radiation therapy have limited availability.  At the private hospitals, the costs are prohibitive for many patients which means that the queue to access the limited government sponsored facilities is exceedingly long making access to treatment all the more difficult.  As a result, all of the procedures I have done in my first week in Kenya on patients with malignancies have been palliative in nature. This is emotionally challenging for clinicians who are accustomed to being able to offer surgery for cure.  Still, it is a way by which to provide improved quality of life for whatever time a patient may have left, and that is certainly valuable to both the individual and their family.

It has struck me though, the number of malignancies I have seen here. I have been surprised- having expected rather to see more infectious diseases. I wonder if public health campaigns to provide mosquito nets, community education projects to teach about modes of transmission of HIV, and global health programs to provide free immunizations haven’t started to lead to some progress in the battle against communicable diseases in the developing world. Not that there isn’t still work to be done, but perhaps we are getting somewhere.   Maybe it is time to bring the fight against cancer to the forefront of the global health platform. There is clearly a need.

By Rondi Kauffman, MD
Vanderbilt University: Department of General Surgery
Kijabe, Kenya

I delivered a baby today. Via Cesarean section. And an intern taught me how. Three remarkable statements to be made by a General Surgery resident about to begin her Chief year.

I am finishing my fourth clinical year in General Surgery, and feel as though I have had remarkable training thus far- both in its depth, breadth and quality. Vanderbilt is a wonderful place to train as a surgeon. I am about to begin my Chief year, where I should be honing my skills and functioning as a junior attending. And yet here I was, three days into my stay in Kijabe, learning a brand-new operation that I’ve never seen, much less been a part of, from someone who is 6 weeks into his intern year. How humbling, how awesome.  What a reminder that every day is another opportunity to learn, to grow, to be stretched a bit more. I have already been amazed at the interns with whom I have had the opportunity to work here in Kenya. They are eager, they are confident, and they are desperately wanting to learn everything that they can from me, so that they can be better clinicians.  I have already enjoyed our interactions- as we both have so much to teach one another- mine from more years of clinical experience, and them from their familiarity with disease processes and presentations not commonly seen back home. I am eager to experience the many more opportunities that I will have to work side by side these amazing Kenyan trainees in the coming weeks.  

By Rebecca Pfaff
Meharry Medical College 
Riobamba, Ecuador


My first day with the Cinterandes Foundation we left for a trip to Palmer.  The large truck with an operating room in the back had left the day before and we traveled in a small vehicle.  This trip was my first time out of the Andes since my arrival a month earlier.  We drove the Cajas National park where llamas run down the middle of the highway and alpine lakes dot the landscape before we began the decent; the humidity and heat increasing and the vegetation changing from alpine to tropical with every turn of the road.  The houses also changed from concrete Spanish houses to wood houses on stilts with hammocks on the porches.  

 Palmer is a small pueblo of less than 2000 people on the Pacific Ocean and most of the people there are considered very poor by Ecuadorian standards.  There is a public health clinic run by a German born nurse who finds cases appropriate for these trips and pre-screens the patients so that when we arrived all that was to be done was review lab results, EKGs, and perform quick physical exams.  

 Two patients were turned away because of fever and one because of irregular heart rate.  The patients need to be carefully selected so that there are minimal complications with recovery because the PACU consists of cots in the clinic and the team leaves at the end of the week.  Dr. Rodas calls all patients to insure that they are recovering well, but this system works best when there are minimal complications.  Sometimes the surgeons travel with a family physician who sees patients while they operate.  However on this trip the team included Dr. Rodas and Dr. Sacoto, two well experienced surgeons.  

 Dr. Rodas founded Cinterandes because he felt that Ecuadorian doctors could help their population just as traveling Americans could.  He was inspired by the ship Hope and trained in the US but was born and raised in Ecuador.  Dr. Sacoto, the other surgeon is the dean of a medical school in Cuenca.  During the ride to Palmer he and I had a long conversation about evidence based medicine and the pedagogy of medicine.  There was also Dr. Anita the anesthesiologist and executive director of the organization.  Her role on the trip made me think about anesthesia in a whole new way.  She not only anesthetized patients from 5-76 years old and with everything from local nerve blocks to general anesthesia but also serves as an extra set of unsterilized hands in surgery helping with everything from preparing the patient (cleaning) to helping set up the laparoscopic equipment.  

 In Ecuador anesthesiologists are at a premium.  Dr. Cruz, the pediatrician I worked with in Riobamba is trained as a surgeon but works as a generalist because there is no anesthesiologist at the children’s hospital.  While working with the ob/gyn and head of the department in the public hospital in Riobamba, we had to wait two hours for an anesthesiologist to arrive so that he could operate. In addition, Dr. Anita is involved in primary care, coordinating rural rotations for medical students.  

 The final physician was Dr. Valasco who, like many physicians in Ecuador, is working as a physician before residency and after his year of rural service. He serves as the scrub tech but also does much of the pre- and post-operative care.  

 Like the physicians, the two other staff members had multiple jobs.  Freddy knows where absolutely everything is on the tightly packed truck and throughout all the surgeries the doctors often shouted, “Freeeeeedy” and he would appear from nowhere and supply the necessary item.

 The final members of the team were us 6 American medical students (there are usually also Ecuadorian students but they had final exams). We assisted in all surgeries and helped with pre- and post-operative care.  

 There seems to be 2 purposes to these trips.  First and foremost, the foundation truly believes that it is far more humane to provide surgeries, for carefully selected patients, close to their homes so that they are spared the expense of travel and the trauma of time away from their families.  Many of our patients needed these surgeries and would not have received them without this foundation.

 But students, both foreign and Ecuadorian, also play a role.  Not only do we bring labor, supplies, and funds to the organization, but the team of doctors all clearly enjoy teaching and explicitly encourage students to learn how to provide humanitarian medicine (for example instructing us on how to tie knots so as to spare suture).  It is a symbiotic relationship in which the students gain important skills and the team gains extra hands to help with the work.

 The surgeries performed were hernia repairs, lipoma removals (lipomas are benign tumors that can be disfiguring and painful), and lots of cholystestectomies.  Cholystestectomies are common here, not only because of the frequent occurrence of gallbladder disease, but also because gastric cancer is common here (more common than colon cancer in the Andean region).  In fact, endoscopy of stomachs rather then colons are the preventative tests of choice here and choystestectomies for symptomatic patients are considered part of prevention.  

 We worked for 3 days operating from 8 in the morning until long after dark and then rounding on patients recuperating in the clinic.  Many of surgeries were laproscopic and, save for the fact that the drapes and gowns are cotton rather then disposable paper and the conversations being in Spanish, you would never know you were outside the U.S., let alone in the back of a truck.

 It was a privilege to work with physicians helping their own people in this unique and creative way.  The Cinterandes team is traveling to the Sudan this year to help establish a similar truck there.  Hopefully the idea will catch on because it is a great way to utilize urban specialists to help poor rural populations without the need for expensive infrastructure development.

Truck 2RPfaff op room 3

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