3rd World Care Glasses

It is the 65^th anniversary of D-Day, the historic amphibious invasion of Normandy, the largest of its kind in history- 2700 ships and craft.  As we approach the Pacific coast of Colombia, hundreds of newly minted Shellbacks aboard, this is nothing to the scale of courage and fear that those brave men faced decades ago.  We should all take a moment to give thanks to those thousands of men who gave their lives that day, and thank any veterans and servicemen and servicewomen you know.   Onboard COMFORT there is a feeling of optimism and excitement as we get mentally prepared to work for approximately ten days straight caring for and treating patients in the rural and impoverished area of Tumaco, Colombia.  Many of the Afro-Colombian villagers there have never seen any type of medical personnel, and have little to no health and prevention education.  Last minute preparations are taking place, manifests being made for the helicopter transits, medication being stocked, medical Spanish being practiced, guns being loaded for force protection against insolent parties ashore.   The sequence in way things work once we get to a location is this- setup of central location for treatment (such as a school), force protection does a bomb sweep and then sets up positions of cover, preventive medicine does safety checks on the site, screening of potential surgery patients first which fills the surgical schedule onboard the ship, then basic urgent care needs commence with gusto for the remainder of the time.   

An interesting discussion was had this evening at the Medical Indoctrination Brief.  In the Wardroom (where the Officers eat), CAPT Cole explained the mindset that one must have in order to make the greatest impact in a country like this.  Cole, a seasoned veteran of this type of work is an athletic middle-aged doctor who doesn’t say much, but when he does he speaks with wisdom and authority.  He is the kind of guy who listens and observes- those who talk too much, those who often have no clue what they are talking about, those that are making a concerted effort to help- then intervenes with leadership to guide the way.  I like the guy.  He’s a great mentor.     

A non-governmental organization volunteer doctor stated that she would prefer to take a half of an hour with each patient and see twelve patients total for her day and see them back the following day with lab results and x-ray.   

This sparked a great debate about requesting follow-up care for the patients that we see, and Cole insisted that we cannot stand to do this in most cases.  “These people have never had any medical care.  They all are plagued by malnutrition, parasites, and many may have terminal medical conditions. Be prepared for what you are about to see and manage your expectations accordingly.  You are not going to single handedly go in there and save the country.  We are not in the U.S. any more folks. You are providing urgent primitive care.  That’s it! “  

“The more people we see, the more basic aid we give, whether it is Tylenol or Motrin for pain, Albendazol for parasitic worms, or even just Multivitamins- the more impact we have here.” 

“What about a patient with lung cancer, or breast cancer,” the woman asked. 

“We can see what we can do to get them to the ship for surgery if it is early enough, but in many cases that is not possible.  I know it sounds odd, but in this environment we are actually working ABOVE the standard of care by providing pain medication to allow them to be pain free for several months before they unfortunately pass away.  That is the reality here.  They have no standard of care to begin with, and are overjoyed to get any aid possible to make their lives a bit better.  That is why it is important to see as many patients as possible.”  

As I sipped on my coffee and sat back and thought about it, he was right.   We all needed to shift our lens from a 1^st world view to a 3^rd world view and set our expectations accordingly.   I remember witnessing this in my humanitarian mission to Laos in 2006.  One patient that stands out in my mind- a short (they all were from worms and malnutrition) man who came to me in the jungle with a big smile on his face and I asked him what was wrong.  He told me that he had constant rash and itch all over his body.  His friend that was with him kept telling the man to pull down his drawers and show me something.  The patient finally complied and when he dropped his pants the left side of the man’s scrotum was hanging way down due to a large mass.  I palpated it and at first touch began to think it was a testicular tumor.  But I then switched my 1^st world lens to a 3^rd world lens and realized that what this gentleman had was a massive hernia with a loop of his bowel in his private parts.  In the United States this is a medical emergency because it can cut off the blood supply to that part of the bowel and if it dies can lead to death.  I immediately put my stethescope on the area to see if I could hear any bowel sounds.  There they were- Gurgle gurgle.  Wow!  I asked this man how long it had been like that.  He replied nonchalantly- 4 years! I stepped back and thought.  Here we were in the jungle.  There was no way that I could get this guy out of there for surgery and I surely couldn’t do it there in the dirt.  That is a complex operation.  What this guy really wanted was some relief from his itching.  So, I looked past this condition, which would have taken priority in the States, and gave the man some simple Benadryl, and Cortisone cream for his rash.   Upon doing so his smile got even bigger and he came forward to give me a hug.  “Pull your pants up man!”, I shouted.    

As we go forth into this impoverished area of Colombia, I am making sure that I have my 3^rd world doctor glasses on.   The more patients we treat the more smiles (and hugs) await.