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U.S. Hospital Outreach Efforts Treat Needy Around World

The line begins to form before dawn. Men, women, children, young and old, many dressed in their Sunday best, have traveled for hours—some on foot—from small, remote villages to reach the Honduran town of Comayagua. They are here to see “the American doctors”—a team of physicians, nurses and other personnel from the Virginia Hospital Center who travel every year on a medical mission brigade to Honduras.

Although many U.S. hospitals have international charitable programs and teams that visit other countries around the world, the Virginia Hospital Center has the largest comprehensive medical team ever assembled from any one hospital in the United States to travel from one city to another—a continent away. The hospital first began sending medical teams to Honduras—where the average per-capita income is less than a day—in the aftermath of 1999’s Hurricane Mitch.

Over the years, the hospital’s patients have included a 16-month-old girl, badly burned when the wind blew a candle into her crib; a man who was about to lose his hospital job because his failing eyes could no longer make out the labels on medicine containers; a 12-year-old girl with profound hearing loss; and literally dozens of women left with severe uterine prolapse—a condition in which the uterus drops downward into the vagina—after multiple pregnancies and limited obstetrical care.

In October 2006, the hospital sent its largest team yet—a crew of 77 doctors, surgeons, nurses and non-medical support personnel, each of whom donated a week of vacation time to treat 6,885 underserved Honduran citizens in Comayagua and four other poverty-stricken, outlying rural villages. During a blur of 12-hour days, the team provided primary care visits, eye exams, hearing screenings, and hundreds of surgical operations ranging from cesarean sections and hysterectomies to gall bladder operations and plastic surgery.

Each year, the hospital also ships large containers of donated medical and surgical supplies, including wheelchairs, crutches, walkers, glasses and hearing aids, as well as prescriptions for immediate and long-term use.

“We see some people who almost never see a doctor, and when they do, the doctors don’t have much to give them—people with horrible skin infections, severe gastric problems, and terrible respiratory problems such as severe asthma and pneumonia,” said Dr. Barry Byer, chief of family practice at the Virginia Hospital Center. “Every year, we see some things that we can help, and some things that just make us very sad because they hadn’t been treated in time and we can’t do anything about it.”

Among those sad cases in their 2005 trip were two children with congenital hypothyroidism. “I’d read about this condition in textbooks but had never seen a case before,” Byer said. “And here we had two. When this condition goes untreated, the child becomes mentally retarded and develops very flaccid muscles and hyper-mobile joints. There was nothing we could do about it because we saw these children too late. In this country, that would never happen.”

But for every heartbreaking story of help that came too late, there are others of lives saved and lives changed: the elderly man who had a golf ball-size tumor removed from his chest, and the gaping hole repaired by plastic surgeons. The woman who couldn’t see well enough to read—who sat in one of the clinics crying and reading her Bible after receiving a pair of donated prescription eyeglasses. And the tiny woman in her early 60s, who would finally be able to walk normally after surgeons repaired a uterine prolapse so severe that she had literally been walking around with her uterus and bladder outside her body. “Doctor,” she told her surgeon earnestly in Spanish, “you are my pearl from heaven.”

Care in the Cane Fields At the Children’s Hospital of Philadelphia (CHOP), a smaller team of doctors and nurses—about 10 each year—dedicates itself to caring for the migrant Haitian workers who spend their lives, generation after generation, picking sugar cane in the Dominican Republic. They live in shanty settlements called bateyes amid the sugar cane fields, usually miles away from other settlements and services, and they earn a few dollars a day from the multinational sugar and construction companies that employ them.

“They’re among the most disenfranchised people on earth,” said Geri O’Hare, a registered nurse practitioner who, along with pediatrician Dr. Rodney Finalle, directs CHOP’s Alliance for International Medicine, which sends teams to the Dominican Republic twice a year for two weeks at a time. “They’re treated very much like slave labor, and they live in deplorable conditions—in tin and cardboard or cinderblock huts with dirt floors, no potable water, poor sanitation, and little access to medical care.”

There are said to be about 500,000 Haitians and Dominicans of Haitian descent living and working in these bateyes, but no one really knows for sure, said O’Hare. What is known is that the children in these communities are in desperate need of health care: According to the Batey Relief Alliance, 38.4 percent of children under 5 suffer from chronic malnutrition, with one-third of them moderately to severely growth-retarded. Diseases such as kwashiorkor, rarely seen in the Western world, are also common in the bateyes. And nearly half of all children under 2 suffer from chronic diarrhea due to the unsanitary conditions.

The Alliance for International Medicine team—usually made up of two attending physicians, two residents, two registered nurses, a nurse practitioner and a medical student—sees about 700 patients over the course of each two-week visit to the area of Consuelo, where they work with local doctors from the Centro de Salud Divina Providencia.

“We treat mostly acute conditions such as pneumonia, ear infections, sinus infections, eye infections, lacerations and burns, as well as teenagers with sexually transmitted diseases,” explained O’Hare. “We’re constantly treating diarrhea and amoebas and de-worming.”

Both the Virginia Hospital Center team and the CHOP team also work with local health professionals to make sure that the care they deliver lasts beyond their annual visits.

In 2006, the Virginia Hospital Center brigade created the Remote Village Project, supported by the Honduran government. Six rural community leaders from two remote villages were trained as certified community health workers to provide year-round counseling on health improvements and preventive care. They were also given the equipment and training needed to actually diagnose and treat a pre-set, limited number of medical conditions common in the area, including infant diarrhea, ear infections, bronchitis, simple skin disorders and intestinal parasites.

Likewise, the Alliance for International Medicine trains community health promoters in the bateyes. “On each visit, we do one- or two-day workshops on pediatrics for all the health promoters,” said O’Hare. Using a curriculum designed by the World Health Organization, the medical team trains the local health advocates in nutrition, the importance of breastfeeding, treating diarrhea, how to take blood pressure, and how to do intramuscular injections.

‘Twinning’ Away at Cancer One of the largest and oldest hospital-based international outreach programs is found at St. Jude Children’s Research Hospital. Its goal: to improve the survival of children with catastrophic illnesses worldwide.

Founded in 1991, St. Jude’s International Outreach Program now partners with 16 countries: Brazil, Chile, China, Costa Rica, El Salvador, Ecuador, Guatemala, Honduras, Ireland, Jordan, Lebanon, Morocco, Mexico, Russia, Syria and Venezuela. Collaborations range from primarily humanitarian assistance to sophisticated clinical and laboratory programs, all of which are uniquely tailored to each country.

In a model called “twinning,” St. Jude works with local medical facilities in countries with limited resources—where childhood cancer survival rates lag behind developed nations—to establish or improve pediatric oncology units.

“In some countries, they have some resources and we do a needs assessment and help develop the program they need,” said Dr. Raul C. Ribeiro, director of the International Outreach Program. “If they don’t have anything, we have to start from scratch, as we did in creating Unidad Nacional de Oncología Pediátrica in Guatemala.”

In each country, St. Jude helps the local physicians identify a local foundation to spearhead the fundraising. “When we start, usually the St. Jude contribution represents almost everything the program has. As the program develops, the foundation becomes successful and other fundraising speeds up, our percentage of the total declines. Right now in Guatemala, seven years after the pediatric oncology unit was established, St. Jude’s contribution represents only 7 percent of the entire operation,” explained Ribeiro. “We invest in education, training and a transfer of knowledge that helps them to create the capacity for improved care. Twinning means a long-term commitment. We partner with these local institutions for a long time.”

The ultimate goal is to bring childhood cancer survival rates in these countries up to par with those in wealthier nations such as the United States. For example, the program in Recife, Brazil, brought survival rates for curable childhood cancers up from 30 percent to 60 percent between 1993 and 2000. “With most of our programs, we can reach a pediatric survival rate for cancer in five to 10 years that took us 30 or 40 years to achieve in the U.S.,” said Ribeiro. “In 1960, the childhood cancer survival rate [in the United States] was 5 percent. By 1990, it was 60 percent. Using relatively inexpensive chemotherapy and relatively noncomplex treatment procedures, we can reach that level much quicker. In each of our partner sites, they jump very quickly from 5 to 10 percent survival to 50 to 60 percent.”

St. Jude only pursues twinning programs in countries where they are invited by local physicians or the government, but the program is still in such high demand that St. Jude is now seeking other hospitals and cancer centers in the developed world to take on some of these requests, twinning with programs in Panama, Paraguay and Bolivia.

The new pediatric oncology units are changing how childhood cancer is viewed and managed in many countries. “Once you have a unit that can care for 100 or 150 patients, you can start training local physicians there, and then move on to training other people in other sites, so there’s increased access to training,” Ribeiro said. “As we implement diagnostic and treatment protocols, we expect the community and the government to expand those to other regions from the original site. As we resolve one problem, we have to continue to build and train more people and help them develop new modalities of treatment, to serve more and more kids with cancer.”

About the Author

Gina Shaw is the medical writer for The Washington Diplomat.

Last Edited on November 29, 1999