What to Expect on a Brigade

What should I expect on a Medical Brigade?

An account by past Medical Brigade participants:

Primary Care in Quito
By Emily Unger, Member Student Advisory Board 08-09, Fundraising Committee

Everyday the primary care part of the mission to Quito was extremely different. The towns varied so much, the people you saw were so different, and the jobs you did through out the day changed. We would leave early in the morning, around 7:30, on a bus with the surgical team for the day, drop them off at Tierra Nueva Hospital and head for the hills. The drives ranged from 1-2 hours and were often spectacular. Our first morning we were on a plateau above Quito and everything below us was in the clouds. Around us there were just massive with snowy volcanoes peaking through. We worked in schools or designated clinics (that consisted of empty buildings), and when we arrived there were usually lines of people already waiting. We would designate an intake station, a height/wait station, blood pressure/pulse station, and a vision section. We would then use rooms for the pediatrician, Ecuadorian doctor, and the dentist. Once we were assigned to our jobs we stayed at those stations all morning and then switched in the afternoon. I personally translated for the Pediatrician “Dr. Jan” a majority of the time because I was one of the few students who spoke Spanish. Translating was a wonderful experience because I got to spend time with each child that came through the clinic. By the end of the first day of translating I could ask all the questions needed in a basic pediatric exam. “Dr. Jan” also loved teaching me about pediatrics. She let me look in kids ears so I could identify ear infections, listen to their heart and lungs, and even let me guess the diagnosis every time. Luckily the majority of the kids we saw had simple problems like colds or ear infections. However there were some kids with serious problems. One little girl had a heart condition that had caused her to be the frailest looking child I had ever seen. One little boy was severely epileptic, was developmentally delayed, and was from one of the poorest families we met. With more serious cases that would need continued monitoring, we referred them to a free health clinic run by a Dartmouth alum outside Quito where there could receive long-term care. The day I had the most fun was when a group of children came from a group home that cared for children whose mothers were in prison. My favorite case was a big teenage boy who was really hungry, we gave him a prescription for double the food and I think he was the happiest patient we saw. I also got to shadow the Ecuadorian doctor, who cared for the adults. This was fascinating because he was very different than the American pediatrician, and I learned a lot of Spanish and how to write charts using medical terminology. He even let me feel a pregnant woman’s belly and showed me how to find the head. The people in these towns were not as poor as in other areas. Because we were closer to Quito, they were definitely better off than those in Riobamba. In fact, in one village all the children had been vaccinated and an older woman who used to work for the ministry of health had monitored their growth on charts. But they were definitely struggling with simple things such as getting food on the table, especially meat. They did have plenty of vegetables though, and at the end of the first day the mayor of the town brought us corn and homemade cheese to say thank you. Once we had seen all the patients for the day, we would pack up and head home and have dinner at the Magic Bean.

Surgical Brigade in Quito
by Maya Granit, Dartmouth Student Chapter President, 08-09

One of the most moving parts of my experience with MEDLIFE this summer was during the surgical portion of the mission. Maria Isabel, an older woman, was the patient that I was assigned to follow. We waited together for over two hours before she went into the operating room for surgery on a severe umbilical hernia. Although I did not speak any Spanish, she patiently communicated with me; I somehow managed to understand that she had been living with this extremely painful and disabling hernia for more than ten years, and had it not been for MEDLIFE, her situation never would have changed. She was also extremely nervous for the surgery, and seemed to believe that there was more to the problem than just the hernia. In fact, Maria Isabel’s surgery was much more complicated than expected, and she was ultimately diagnosed with metastatic cancer.
Being able to be by her side before her surgery, during her stay in the hospital in Quito, and being welcomed into her and her family’s life changed my perception about global health in an irreversible way. The experience was profoundly personal because of the connections I made with people I never would have otherwise met. MEDLIFE made it possible for Maria Isabel and her family to better understand her illness, ease her pain throughout the process, and lengthen her life. As an undergraduate without any firsthand experience in global health, I didn’t expect to be part of an organization that could bring real and palpable change to other people’s lives. When I joined MEDLIFE, I never knew that it would become the endeavor that I care most about at Dartmouth, and more generally, one of the most crucial and inspiring events of my life.

Primary Care in Riobamba - A rural experience.
by Heather Bradford, MEDLIFE Student Organizer at UNE, 08-09

Our truck bumped along the winding dirt road as we snaked our way through the mountains of Ecuador—patchworks of green farmland still shrouded in the early morning fog. The lush countryside stood in stark contrast to the dilapidated cement buildings strewn over the landscape and the dusty towns in which stray dogs roamed. Broken terra cotta-tiled roofs and cracked walls seemed to unabashedly demonstrate the poverty that hangs over much of the country.
My anticipation mounted when we descended into the valley between steep slopes dotted with trees, alpaca and people, where the small two-room schoolhouse that was to be our clinic sat veiled in mist. Toothless old men, their brown skin lined with years of working the land, stuck out their hands to greet us. While we shuttled supplies into the sparse and dingy rooms, numerous faces peered through the doorway into the dimness, their breath visible in the chilly Andes air. Indigenous women, wrapped in woolen shawls of vivid red, purple and turquoise, delivered family histories as small children played about their skirts. Soon the din of native-spoken Quechua rose above the hurried instructions being given within the schoolhouse. Even before the last of the broken plastic chairs could be arranged to function as waiting space, we were inundated with the first wave of patients.
Dark, curious eyes stared up at me as I proceeded to assist my team in taking vital signs and weighing each patient. My halting Spanish, requesting the removal of hats and boots, brought a peal of laughter from the children whose dirty faces were accentuated by runny noses and wind burned cheeks. They had awaked before dawn to walk for hours to our clinic, and although many were malnourished and plagued by parasites, all were smiling. Perhaps they were simply happy to find a reprieve from the hardship of daily life in the form of a few coloring books that we had brought, if only temporary. As I looked over the adult histories, I read time and again the chief complaint “duele por todas partes, constantemente”—it hurts everywhere, constantly. This seemingly vague response managed to etch a lifetime of adversity into a single sentence. I found it hard to accept that the happy children I met would grow old in pain.
That afternoon, as I counted out antibiotics and carefully explained the proper method for taking an anti-parasitic to a group of mothers in the makeshift pharmacy, our mission physician summoned me to his examination table in the next room. There I met Hemenia, an energetic little girl with dark hair, bronze skin and bright eyes. I couldn’t imagine what was wrong with this beautiful child that had seemed so full of life just hours earlier when she sat in my lap, coloring contently and waiting to be seen. After speaking quietly with her, the doctor handed me his stethoscope and proceeded to assist me in auscultating her petite chest. In addition to the normal heart sounds, there was a distinct wooshing sound. The extra sound, he explained, was a heart murmur—one that might be caused by a congenital cardiac defect. I knew what would come next. Since our mission was focused on primary care, we were ill equipped to handle cases such as this. There was no way to tell if this murmur was in fact pathologic, or a benign one that would be outgrown. Hemenia would have her photo taken and we would return to the United States to raise money for her to see a specialist and undergo surgery, if required. Although there was a hospital in the nearest city, Riobamba, it was privately owned and most Andean natives could not afford a visit, especially a not a costly consult. How much I wanted to tell her she could come with us that day—that I would pay for her treatment. Listening to Hemenia’s impaired heart, my own heart ached. In that moment I knew I wanted to commit myself to learning more about illness and utilizing this knowledge to heal and educate others, to have a more enduring effect on this community.
That day, access to healthcare took on a different meaning for me. Here were a people isolated not only physically by the Andes Mountains but also economically and culturally from the healthcare system. Though I was aware that disparities in medicine existed internationally, I was still disturbed by their magnitude. I had hoped that our mission would provide the opportunity to level these inequities, but for all my American confidence in our ability to bring medical access to this remote village, I came to the realization that prescriptions will run out, others will become ill, and there will continue to be more Hemenias. Although MEDLIFE’s clinic to serve the region is in the planning stages, until they have a reliable source of medical attention and education the Andean natives will continue to go without treatment and our impact will be transient.
When the last patient had finally been seen, one of the community elders came forward to thank us for our work and wish us good health. This was remarkable to me, coming from a man who was struggling to acquire basic necessities for his village. Throughout the course of our mission I was also inspired by the resolve demonstrated and the effort I had seen put forth by our team physicians as well as our two medical students who, on the first day, were thrust into the role of a second care provider. Working tirelessly, they waded through the myriad of faces. They treated each individual as a unique case and I saw where desperate converged with optimistic. They had hope for these people—hope that the health of an entire community may yet be salvageable. Although we were only able to provide limited care to 359 patients over the course of five days, I left Ecuador with a definite sense of accomplishment. The University of New England’s first MEDLIFE mission was a success, and while the road to establishing a team was fraught with obstacles, they are nothing compared to those that our patients face each time they are in need of healthcare. I am already eager to find out what this year’s mission will bring.