I’ve been in Guatemala for the last week on a medical service trip, delivering health care to Mayans in three highland villages. I’ll be blogging about managing health care costs over the next few days, but I wanted to share my experience briefly first.
The Guatemala trip was arranged by the Tufts University chapter of the Timmy Foundation, which works to establish sustainable health care in developing countries. The Timmy Foundation is currently active in Ecuador and Guatemala, and has chapters at 8 colleges. The Foundation has medical “brigades” from different schools every two months to each site, and its trips include college students and volunteer physicians and pharmacists. It always partners with a local organization to make the efforts sustainable. In Guatemala, Timmy partners with Pop Wuj, a Spanish language immersion cooperative school that runs health clinics, sponsors scholarships for promising indigenous children, and has other development projects. One current project provides wood stoves to Mayan families, to allow them to cook in their houses without open fires. This can lower the incidence of asthma and other lung diseases.
We saw patients in the villages of Buena Vista, Xeabaj, Pacaxcoj and in the city of Quetzeltenango, also known as Xela. Two of these communities had no running water, and one had no electricity. In some of the communities, few patients spoke Spanish, so we had translation from English to Spanish to Quiché back to Spanish and finally to English.
The Tufts Timmy Foundation Chapter raised about $20,000 which will help Pop Wuj employ a permanent physician and a coordinator to provide care between visits of college students and volunteer clinicians. Our trip included 20 undergraduate students, four physicians and a pharmacist. The students were hyperorganized, great translaters, and incredibly perceptive – I enjoyed learning from them. Over a quarter of the group got traveler’s diarrhea during the trip – I’m fondly calling the trip “Sunshine, Service and Cipro.”
A few observations:
1) The three villages had little access to medical care, but they needed basic necessities, especially running water even more than western-style medical care. I felt like our fluoride treatments for kids from ages 5-12 and our antiparasitic treatments for all villagers might have been our most important contribution. Prevention is much more effective than our medical care.
2) Dental hygiene is terrible in the villages; many women in their early 20s had such bad teeth that they had trouble eating. In the US, stressed Medicaid programs often cut dental benefits first – my Guatemala experiences reminds me of the importance of access to dental care and fluoride.
3) Candy and prepared food is available just about everywhere – and is cheap compared to fresh food. Soda (with sugar or corn syrup) is also omnipresent, while clean water is difficult to find. There is good evidence that poor food choices are a cause of increased morbidity in impoverished neighborhoods in the US as well.
4) US efforts to protect intellectual property through the Central American Free Trade Agreement (CAFTA) have delayed the introduction of generic drugs in Guatemala. (See Replogel, Lancet Volume 363, Issue 9421, 15 May 2004, Pages 1612-1613). Of note, the US government denies that CAFTA will have that effect.
5) I think a lot about uncertainty in medical care, and how far we go in diagnostic testing to eliminate all uncertainty here in the US. We often use too many laboratory tests and too many imaging studies in an effort to get all the answers we can, even when those answers don’t change care. In Guatemala, the only diagnostic tests our medical brigade had to offer were our physical examinations, urinalysis, and glucometer blood sugars. Obviously that’s clinically bad – I wanted to know the thyroid status of a woman on thyroid replacement, the HbAICs of diabetics, and I saw a woman with a thyroid nodule that I would have wanted to ultrasound to be sure it was a cyst. This trip helps remind me of the importance of having good access to laboratory and imaging capability. But while we need more capability in highland mountain villages in Guatemala, we still need to figure out how to consume fewer resources in the US.
If you’re interested in seeing pictures of our Guatemala trip, they are at this URL.
Thanks for reading on – I’ll be catching up on managing health care costs over the next few days.
