In early October, Damien House received Dr. Tom Sichi, DO. During his two weeks in Ecuador, he shared his skills and abilities in many different forms including: spending time with patients at Damien, making rounds at the Infectious Disease Hospital, worked at a clinic in Duran and visited Hansen´s patients in the campo with us. Upon his return to the US, Dr. Tom shared with us this article he wrote about his experience. Dr. Tom traveled through the program, Physicians for Humanity (http://www.physiciansforhumanity.org). Below is Dr. Tom´s article, which he proudly gave us permission to share.
A few issues ago we reported on Physicians for Humanity(PFH), a non-profit group working in Ecuador co-founded by Dr. Nicholas Bower and Patrick Cain, DO one of our second year residents. I decided it would be a great experience to do an international rotation and see first hand what PFH was doing in Ecuador. The month was split between three main separate clinical settings.
I worked in an emergency department which specialized in infectious disease on a number of occasions. Like many of our EDs here in the states the facility was run down and overburdened but impressively efficient despite these structural obstacles. The infectious pathology had some similarities to the states with a much higher rate of HIV, a large number of cases of disseminated and extrapulmonary TB as well as Histoplasmosis, Dengue fever and Malaria. I was able to speak with some of the regional authorities in infectious disease/public health about the vector-host control programs. They are currently studying a previously unexplained decrease in Dengue which may possibly be due to a recent Yellow Fever vaccination program inadvertently conferring a significant amount of Dengue prophylaxis. This research may have the potential to lead to a vaccine for Dengue! The ED physicians working in this hospital have a full year of residency dedicated to ID and are able to see large volumes of patients with very little burden of documentation.
The second part of the clinical experience was a home stay and working in a local clinic named Dispensario San Franciso in Duran run by support from PFH. Duran is an outlying region of Guayaquil which houses many families who have moved from the more rural areas of Ecuador as part of the greater global rush towards urbanization. Like the Favelas of Brazil, much of the housing is thrown together on land with no official ownership, there are no addresses and no sewage or running water exists. Water is delivered by tanker truck that simply siphon from the nearest polluted bayou into open barrels for domestic use and unfortunately breeding mosquitoes. Living in the same neighborhood as the clinic allowed me to get to know many of the residents, diagnose disease and create treatment regimens which were realistic given the local conditions. Had I stayed in a sterile hotel I might not have had the same knowledge, empathy or rapport. In this population nearly all belly pain and diarrhea was empirically treated with anti-parasitic agents before any other work up was initiated.
The third part of the clinical experience was working with the local Hansen’s disease providers in various clinical settings. As with many parts of the world, most local physicians are not skilled in the diagnosis and treatment of Hansen’s. Echoes of Molokai still ring as stigma surrounding the disease lurks as a significant barrier to care. I had worked with Hansen’s in Tanzania in 2006 and the care in Ecuador greatly surpassed the care provided in rural Africa. The care was separated into a three tiered system mostly managed by Catholic Nuns. The first tier afforded perhaps my favorite clinical experience of the trip as I spent the day driving to remote cane homes of Hansen’s patients to aid Sister Lus handing out medication, giving dosing advice and preventing and tending to wound/skin care issues. It was heart wrenching to see a young woman who had stopped taking the Rifampin due to side effects because the dosing had not been adjusted by weight. My pediatric Tarascon’s never felt so valuable. The second tier of care located in Guayaquil at the Damien House was an outpatient dispensary for medications and again basic wound care. The third tier was a long term care facility run by Sister Annie Credidio named The Damien House after the esteemed Father Damien who tended to the quarantined Hansen’s community on the island of Molokai before succumbing to the disease himself. The facility cared for many patients who had been cured but suffered various sequelae or could not return to their home communities due being ostracized. One patient recently celebrated a happy centennial birthday after having been cured in the 1960s. The Damien House has recently had great success with reintegration of some of the long term patients into their home communities, this program both shines a visible light of hope on the patients and makes room for some of new patients identified by Sister Lus’s outreach programs. The care in this facility was multi-faceted and far exceeded many so called skilled nursing facilities here in the states while running on a very limited budget. I would greatly encourage anyone with the means to donate to this facility.
Kingman Regional Medical Center has a great policy allowing residents to do international rotations which simultaneously adds great diversity to the possible learning experiences and allows residents to help more than just the people of Arizona. I looked at many residency programs that tout international emergency medicine curricula but require residents to use limited vacation time to actually travel. The ability to simultaneously obtain academic credit and draw a salary while being involved in philanthropy is a rare opportunity and real asset to the KRMC residency. The trip provided profound inspiration and clinical experiences invaluable to any developing physician. I would especially like to thank the program director Dr.Micheal Sheehy, director of medical education Dr. Kelli Ward, Doreen Williams and Sheri Glass for their tremendously tenacious administrative support in making this trip a reality.
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| The hands of a hard working Hansen´s patient in the campo. |
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| The kitchen of a cane house in the campo. |
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| The telling "mancha" or stain commonly associated with Hansen´s. |
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| The feet of a laboring campesino in the fields. |
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| A recently diagnosed Hansen´s patient shows us his drug regimen. |
