I am accompanying a group of gastroenterology professionals and support personnel to perform endoscopic procedures for 1 week, at a small hospital in the town of Santiago Atitlan, Guatemala. We will provide diagnostic and therapeutic endoscopy for patients who would otherwise not be able to obtain it, or at minimum would have to travel 3-4 hours, at greater cost.
The population served is the indigenous Mayan community surrounding Lake Atitlan. There is little access to gastroenterology specialty care or endoscopic procedures, despite a high burden of H. pylori and gastric cancer. In addition to limited financial resources to obtain these medical services, the indigenous people often do not speak Spanish (instead Mayan dialects), and/or face discrimination in the tertiary referral centers in Guatemala City.
All professional services are donated, and the not-for-profit hospital charges a means-adjusted sliding scale fee for the use of the operating room and medications.
The main impact is through delivery of clinical care. This is the second trip ever to provide endoscopy in this region. Patients with GI malignancy can obtain a diagnosis that can allow treatment. Patients with functional GI disorders can exclude organic pathology so they can also proceed with medical treatment, and be reassured. Patients with dysphagia can obtain diagnosis and treatment.
After the trip is concluded, we are in contact with the local medical providers regarding doubts about follow-up management, for instance after pathology results return.
As the endoscopy services become more regular (several times per year), we hope to establish a relationship with a local gastroenterologist (likely from another city, or even the capital, on a once a month or 2-month basis), so the equipment that is housed at the Hospitalito Atitlan can be used more frequently even between trips.
The highlands around Guatemala’s Lake Atitlan are populated by mostly indigenous Mayan communities that subsist on agriculture and textile industries. A large percentage do not speak the national language (Spanish), have very limited economic resources, and elect to not pursue specialty care in the capital 4 hours away, or the closest other endoscopic resources 2—3 hours away, even when recommended by local doctors for alarm symptoms such as weight loss and anemia. During Thanksgiving week in 2019, a team of 3 gastroenterologists (2 attendings and myself, a 4th year fellow), 2 nurse anesthetists, and 3 GI procedure nurses, traveled from the US to perform endoscopic procedures for patients from this community who would otherwise likely not have received them. The team was composed of personnel from the Universities of Virginia, North Carolina, and Kentucky. Olympus generously donated the endoscopy equipment to outfit one procedural room, and sent us a representative to help with scope reprocessing, including teaching local hospital staff these practices.
This was our second trip to this site, and this week we performed 27 procedures. The procedures allowed diagnosis and treatment of several significant pathologic conditions, including colonic polyps, gastric ulcers and cancer. They also provided many other patients the peace of mind from a negative study that they may never have been able to achieve without placing significant financial difficulties on their family. The staff of the Hospitalito and the patients we served were very appreciative of our coming. Next on the agenda is continuing to refine local protocols for endoscopy referral and another trip in March. Ideally we would also identify a local gastroenterologist or other endoscopist collaborator to provide any necessary interval procedures between procedure trips.
