ENT in the DR

Assumptions can be misleading. I found this to be the case upon first arriving at the ILAC center as part of the ENT medical mission trip to the DR. I had envisioned sleeping in small huts, possibly with dirt floors, an open air clinic, surgery suites that were little more than a wall and some ancient surgical instruments. I figured the ILAC center would be similar to the other "hospitals" I had encountered in my prior medical relief trips to developing countries. Some 6 years ago I went on my very first international medical relief trip. We went to the DR to help the sick. Our time consisted of setting up clinics in small tin roofed buildings, thatched huts, and abandoned school buildings. It was an eye-opening experience and one that led me to join several relief trips during medical school. So, when signing-on to join the ENT department's trip to the DR, I had figured that the settings of the ILAC center would run in line with my expectations drawn from these past experiences.

When we arrived, I found the living situation to be entirely different from what I expected. Simply put, the ILAC center was a beautiful gated compound. It had two story buildings, a flowered courtyard, a cafeteria, and lush gardens. They had wireless internet access, four available computer stations, warm showers, and even air conditioned rooms for the attending physicians to stay in. In a sentence, I thought I had landed in a resort. After absorbing the initial shock of being able to flush my toilet paper, I began to wonder if this was more a vacation than a medical service trip. My first thought was "what kind of people are we going to be treating here?" Surely if such a wonderful compound can be maintained, there are more than enough health care professionals willing to join and see patients. Were we really going to be seeing people who lacked access to care? Were we going to be treating people who had problems with their health, or was this just a medical tourism trip?

My pessimism regarding the efficacy of our trip bothered me most of the night before our first clinic day. It continued into the next morning as were were escorted to the clinic and OR site. The clinic was actually a real clinic, complete with individual consultation rooms, examination table, along with otoscopes we had brought from the states. The patients we consulted with, however, were definitely different. As one can read from Matt's posts below, we encountered all sorts of interesting and extreme pathology. From the thyroglossal duct cyst to massive thyroid goiters and everything in between, our patients were far from well-to-do. And, so I am happy to say that my initial impression was wrong.

So what does it matter? Well, the learning point in this whole thing is easily found. My primary fault was in linking the facilities of our stay with the health care of the community. My past experiences with global health trips had etched in my mind the idea of only offering true help to patients in areas where no health infrastructure existed. The first day of our trip showed me that infrastructure and drugs do not guarantee excellent health care. Indeed, I had not realized that the necessities we shared were our skilled hands, minds, and teamwork.

The people needed to properly outfit, run, and process a surgical trip are vastly different from the medical trips I had been on in the past. Some 40+ people comprised of pre/post op nurses, scrub nurses, CRNAs, surgeons, anesthesiologists, residents, translators, surgical tech staff, and medical students were all absolutely vital to the trip running smoothly. The first couple days of the trip really taught me how different a surgical trip can be in its needs and requirements. In the end, our first day in the OR showed me how absolutely necessary our team was. This was nowhere close to a medical tourism trip, nor was it a vacation. The skill provided by the doctors, nurses, and ancillary staff was needed to take care of patients in a surgical setting that is not found in the DR. We were treating patients who should have had their thyroid, tonsils, or congenital pathology removed years ago. People who would have to wait a year until we returned to get their procedure done. And so, the learning experience I found was in not making assumptions. My assumption was that the value of a medical trip was inversely related to the conditions in which we imparted our care. I have learned that this is not a good barometer. Instead, if we measure our worth in the skill and experience imparted to our patients, we will find a much more accurate view of the impact of our medical trip.

Brian D'Anza MS4

Santiago, DR