CommunityHealth Goes Global

A Medical Expedition

Early in the morning, on a cold and dreary December 26, 2005, I found myself wondering why I was in the atrium of a medical school building, along with 18 very young and enthusiastic students of the Feinberg School of Medicine of Northwestern University, instead of enjoying a relaxed vacation during the holiday season. The answer was that I had been asked by these students, all members of the Northwestern University Alliance for International Development (NU-AID), to serve as one of their faculty teaching supervisors on a trip to provide medical care to impoverished people in the mountainous area of northeastern Nicaragua. I had accepted that invitation with some trepidation, and I must confess that my predominant emotion on that morning was anxiety. For several weeks prior to departure, I had been busy packing my personal medical equipment and necessary supplies, including a lot of hand disinfectants, and bringing my own immunizations up to date. Like everyone else, I also began my malaria prevention medication.

NU-AID was founded in 1999 by the Northwestern medical students themselves, and this organization has carried out two medical service trips per year to bring medical and health care to very poor people who have little or no access to such services. The missions of NU-AID are totally supported by donations, and all participants, students and faculty advisors alike, have to pay for their travel, food, and lodging. All care is provided absolutely free-of-charge, including all the medicines that are distributed to patients. These medications are obtained by NU-AID by direct contributions or are purchased by NU-AID with donated funds. One of our major tasks on the morning of departure, and throughout the trip, was to account for and organize forty large suitcases jammed with medicines and medical supplies.

The logistics of this trip were staggering because of twenty-one people and all that luggage, including our personal carry-on bags. Our flight from O'Hare to Managua, Nicaragua, via a transfer at Houston, took the better part of one day. The next day we spent several hours in a rickety bus to our care sites on narrow and pot-holed roads. Our hotels, on a scale of one to five, could only be described as minus one. The students slept dormitory-style, but because of my faculty position and presumably because of my age, I was given the only private room.

We were organized into two groups, each consisting of nine students and two faculty advisors, an Internist and a Pediatrician, except that one group lacked a Pediatrician. My group went to a town called Matagalpa, and the other group was stationed even more remotely in a town named Jinotega. In Matagalpa we saw patients in an aid station for women, but one day we drove into the countryside and provided care at a schoolhouse. The only water at the women's aid station came from a siphon that drained the tank of a single flush toilet; the school had absolutely no water.

Nicaragua is a third-world country in every sense of the word. It is one of the poorest nations in the western hemisphere. Forty percent of the population is illiterate, and almost no one goes beyond sixth grade. Unemployment is rampant and per capita income shockingly low. Although there is a government-sponsored health service, it is so under-funded that for all practical purposes adequate health care is available only to the small percentage of wealthy people who can afford private care. The present government has privatized the water supply and electrical power, with the result that most of the population lacks even these basic essential services.

The patients were uniformly polite and very grateful; they would wait for hours to be seen, without complaint. The cases we saw encompassed the full gamut of adult and pediatric medical problems, but there was an extremely high incidence of infectious diseases and parasitic infections, the latter due to lack of access to clean water and the absence of even rudimentary public sanitation and waste disposal. Fortunately, we were well-stocked with antibiotics and worm-killing drugs. For the first time in my long medical career, I saw two cases of huge tropical ulcers of the legs.

The patients were initially interviewed and examined by the medical students, and the Pediatrician and I as the Internist, acted as consultants to the students. There were no actual examination rooms, and at the schoolhouse there was only one three-legged table on which we examined patients and for which "privacy" was provided by a hanging blanket. Lighting was from hand-held flashlights. How I longed for the marvelous facility of CommunityHealth! The students even organized basic health and hygiene educational sessions, and until we ran out, we gave to all patients a health kit that contained soap, toothbrush, and toothpaste.

I am very pleased to report that a large number of these Nicaragua trip students are part of the Northwestern student contingent that sees patients at CommunityHealth on Wednesday nights.

Without a doubt, the most distressing part of the trip was the realization that although we worked very hard, and provided care to hundreds of people, we had only seen a tiny fraction of the huge population in need. Furthermore, there would be no follow-up care for the people we saw after our departure.

The most rewarding part of this trip was the same reward that I experience at CommunityHealth, namely the gratitude of these very lovely but poverty-stricken people. Since my return on January 1, 2006, I am more convinced than ever that we must all remain dedicated to the concept of constantly doing whatever we can, wherever we are, to help people in need.

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