We plan to set up mobile clinics and perform home visits to provide primary care to patients in rural Peru. We will coordinate our trip with a local community heath organization to maximize our benefit and have a more lasting impact on the community. We will be coming as a multiple disciplinary group of doctors, nurses, and physical therapists to serve patients for primary care conditions such as hypertension, diabetes, arthritis, skin disease, ocular disease, STDs, and parasitic infections.
We will serve the local Peruvian population in Andajualyllilas, who are mainly of Quechuan descent. The people living in Andajualyllilas have very little access to health care because of its rural location, so we will be providing primary care for them. We will also be doing home visits for patients who need more hospice or palliative level of care. Over the past few years Kaiser has developed a relationship with this community from our annual trips.
I hope to improve the health care of the people living in Andajualyllilas. I also hope to improve my medical Spanish so I can be more effective with my Spanish speaking patients in San Diego. I will get to learn about providing care in a different clinical setting and with a different patient population than I am used to. This will help me grow as a physician. I also plan to blog about my trip and give a presentation to my residency program so that other people can learn from my experiences and ensure this trip continues to happen for many years to come.
Kaiser Permanente Family Practice, Medical Mission to Peru
In April 2019, our interdisciplinary group of attending physicians, resident physicians, physical therapists, nurses, and medical students flew from California to Cusco, Peru. Even after a 16-hour red eye flight, I was impressed by the city of Cusco. The city is filled with historical sights, beautiful buildings, and alpacas (and for only a dollar you can even take a picture holding an alpaca right in the center of downtown). My first medical encounter took place even before our medical mission did. I found myself with a nagging headache my first night in Cusco. I self-diagnosed myself with acute mountain sickness as I had just gone from sea level to 11,000ft after stubbornly declining Kaiser’s travel clinic advice to take prophylactic acetazolamide. Although, 200mg of ibuprofen later the next morning and I was ready to begin our group’s work.
We departed for Andahuaylillas, a small town, home to a few thousand residents, located 1 hour south of Cusco. Upon arriving, we set up shop in a newly constructed 5 bed hospital that was not quite ready to be opened yet. The next 10 days consisted of running family practice clinics for the local resident. Every other day we were in our home base in Andahaylillas, while the other days we took a bus to the surrounding villages where access to care was even more sparse. The town of Andahuaylillas has a small clinic with a single general practitioner, but most high acuity care requires a day trip to Cusco. As I would soon find out though, many of the residents who lived in the villages surrounding Andahuaylillas had not been to a doctor in years due to the difficulty and cost of getting to a practitioner.
We treated a wide range of patients and illnesses. Numerous patients were suffering from overuse injuries from their demanding lives. Unfortunately, knee and hand osteoarthritis were almost ubiquitous in all of our geriatric patients. Sun damage also took its toll, with an abundance of pterygium and cataracts, with many starting to impair patients’ vision. A few patient’s stories stood out to me. I recall a farmer who had a rock fall on his leg, but did not seek care because he lived in a remote mountain village. He was stoically walking with a limp and reported that his leg had not recovered well from the incident. He had a cellulitic leg and potentially an underlying fracture. It was satisfying to treat his cellulitis, but frustrating that we could not directly X-ray or cast his leg with our limited equipment. A young mother told me about the difficulties of raising her children since her husband had left her 6 months earlier. She had been struggling with depression and she felt there was no one to talk to. After a long visit and a supply of sertraline, I was optimistic her situation might improve. My most memorable patient however, was a 13-year-old boy with down syndrome. He was minimally verbal but that did not stop him from having an incredibly big personality. He had received almost no medical care throughout his life, but he greeted me warmly. He had a deafening systolic heart murmur that he allowed me to hear by grabbing my stethoscope and placing it in the proper 4 quadrants of his chest with only minimal instruction. He looked at me pensively as I scanned his heart with our portable ultrasound, but pleasantly obliged to my exam after he realized the worst part of the process was the cold ultrasound gel we applied. It was heart breaking to know that in the United States his likely congenital heart malformation could have been treated. But in his rural village outside of Andahuaylillas, he was unable to get that care. His mother could not even afford to bring him to check up exams, let alone pay for an open-heart surgery. Although I could do little for his heart, he certainly affected mine with his joyful spirit and unabashed curiosity.
As we left Peru and our team reflected on the almost 700 patients we saw, I was struck by a familiar feeling I had on previous medical missions. I felt fulfilled that I could bring at least some measure of care and comfort to the patients I saw, but also an even greater feeling of gratitude. The patients I saw not only showed me kindness and taught me about their culture, but they allowed me to gain perspective on my own life and medical practice back at home.