Imagine being a medical provider and seeing your patients—some of whom have walked for hours to get to your clinic—in a makeshift exam room with a dirt floor. You may or may not have a proper light, and your exam table could be an old wood table. And, you have no idea what kind of medical conditions you will encounter, or what medication and care will be required.
For Samuel Merritt University faculty and students who participate in medical missions, providing quality care in locations with limited equipment and supplies reflects this reality. Our faculty and students have been traveling to different locales for years, providing a variety of services and delivering much-needed medical supplies. From Vietnam to New Orleans, Laos to Haiti, the SMU community has been reaching out, volunteering, and helping people in need.
"These trips are the most effective and successful interprofessional training conducted at SMU," says Dr. Michael DeRosa, Physician Assistant program chair. "Students from all disciplines on the trip form connections and develop an understanding of the other’s professions by living and working with students they would not normally encounter on campus over a very intensive week in a difficult environment."
SMU Family Nurse Practitioner (FNP) Adjunct Assistant Professor Suzanne August has been on six medical trips to Panama; the latest one in April 2013.
“The indigenous populations of Panama have significantly less access to regular health care—there is a shortage of MDs in the rural areas,” says August. “Although all MD graduates from Panama must do one year in rural health care, very few stay to practice.”
Sharon Gorman, SMU Physical Therapy (PT) faculty, also took part in the April trip to Panama. The group included Physician Assistant (PA) students, Family Nurse Practitioners (FNPs) and FNP students, Doctors of Physical Therapy (DPTs) and a DPT student from SMU. The group set up their clinic in a remote region outside of Santiago in Veraguas Province in Panama.
“We drove to the end of a paved road, and got into 4x4 trucks. Then, we drove on dirt roads four hours to our destination.” says Gorman.
Their three-day clinic was housed in a government school building in a region called a Comarca, one of several in Panama inhabited largely by indigenous populations.
“Where we go, there is no ‘clinic’,” adds August. “We usually set up our makeshift clinic in a school where we will take over three or four rooms. We will have one room for intake and vital signs, one or two provider rooms where patients are seen, and one room for our pharmacy.” (Click here to see a panoramic view from the school/clinic.)
Because these facilities are not sterile, the group does what it can to keep the facilities safe and clean for patients.
“Our exam table was an old wood table,” says Gorman. “We covered it with paper to keep it clean between patients. We made a pillow out of a bag of cotton balls. A cinder block was the step stool to the table. Some of us were using headlamps and flashlights because the lighting was not always adequate. It is not a sterile environment, but we are conscientious to keep our equipment, and ourselves, as clean as possible.”
Equipment-wise, the groups only have access to what they bring with them. Before each trip, the participants fill two suitcases each with supplies.
“Whatever you bring – you have to make it work. That’s why we have to do a lot of fundraising,” says Gorman. “We are responsible for purchasing supplies, or arranging to have medical supplies donated.”
They often buy personal care and medical equipment by the pound from MedShare, a nonprofit that redistributes surplus medical supplies and equipment to those in need.
Medical mission groups typically take general medication with them, such as antibiotics, antifungals, Benadryl, vitamins, and cough syrup—as well as basic supplies such as bandages.
“By now, we have a good idea of what to bring, but that is because Dr. DeRosa and I have learned from past experience,” says August.
On location, the medical group has the unique challenge of not knowing exactly what type of conditions and injuries they will be seeing.
“As providers, you never see just one patient at a time, you see an entire family,” says August. “When we have podiatry or physical therapy with us, it is so wonderful to be able to refer to those services, because most of these people make a living as laborers and/or subsistence farmers and their bodies are often pushed beyond what we might be used to.”
For example, when Sharon Gorman and her group saw a patient with hemiplegia (paralysis of the arm, leg, and trunk on the same side of the body), they came up with a creative way to help with rehabilitation.
“We made a hand splint out of a piece of foam and a piece of metal we used from another brace, then we wrapped it all up with an ace bandage. We wanted to make this girl an ankle orthotic as well, but she had no shoes to help secure one. We made an ACL brace out of ace wrap and a theraband exercise band for another patient who had a partial tear to his anterior cruciate ligament," says Gorman.
Other common conditions that are typically treated include respiratory illnesses like asthma, bronchitis, pneumonia; parasites; diarrhea; rashes; eye infections; muscle conditions like tendonitis; back strain; headaches; dehydration; arthritis; knee problems; fevers; and fungal infections.
Participating in a medical mission provides hands-on practical experience for faculty and teaches students lessons about their vocation that will influence them for years to come. Students and faculty alike have expressed that the experience has made them better health providers, and opens their eyes to new ways of seeing, and treating, patients.
"Our students come back as friends and colleagues, with shared experiences and a much better understanding of what the other professions on campus have to offer patients," says DeRosa.
August says that serving in developing countries complements the work that students and faculty members perform in the Bay Area at Davis Street clinic, the Hayward Day Laborer's clinic, and the Physical Therapy and Occupational Therapy clinics at SMU.
“You get a great sense of perspective,” says August. "The people we are fortunate enough to be able to serve in Panama have dirt floors, often only eat once or twice a day if they are lucky, cook on open fires in their homes, and yet, they live their lives with grace and laughter and curiosity. I truly feel I get more out of these trips than they do.”