Memories of Panama: we came, we saw, we learned

Posted on Wednesday, May 20, 2009
    Harald Gjerde holds two-year-old Amanda on the first clinic day.  Diagnosis: the common cold. / Photo: by Hidetaka Ishii

Harald Gjerde holds two-year-old Amanda on the first clinic day. Diagnosis: the common cold. / Photo: by Hidetaka Ishii

By Harald Gjerde

Hi, my name is Harald.  What is your name?”

The translator next to me turns to the patient and translates what I just said into Panamanian Spanish, while I try to fight off the morning grogginess without the caffeine fix that I usually enjoy in Montreal.

“How old are you?”
“Do you have any allergies to any medication or foods?”
“Do you have any chronic illnesses?  Any family members with sickness or disease?”
“How can I help you today?”

Since this is my third clinic day, the starting questions for every patient become routine.  I am in Pocrí, a small town of less than 1000 people in southern Panama, with thirteen other McGill science undergrads, all from different years.  With the help of the Science Undergraduate Society’s Medical Direction Program, the 14 of us took this humanitarian trip to Panama during reading week through an organization called Global Medical Training (GMT) to work in makeshift clinics and provide free basic medical attention to local Panamanians.

We arrived in Panama City not knowing any Spanish, nor each other, all that well.  We got to our hotel downtown, where we met Dr. Wil Johnson (founder of GMT), Pat (Dr. Wil’s wife), Gina (regional coordinator and our main tour-guide), and our translators – all of whom we would get to know and love.

The next afternoon, we headed for Pocrí.  However, it’s Carnival season and everyone else in the country was headed for southern Panama.  What should have been a four-hour bus ride ended up taking nine hours due to traffic.

We finally got into Pocrí at 1:30 a.m.  Because the lodgings were all booked due to Carnival, we were put up in an elementary school for the four nights we stayed in town.  Some of us weren’t prepared for the conditions; I was just happy I had a mattress, a blanket, and running water.

6:30 a.m. and the alarms went off.  Zombie-like, we all got ready for our first clinic day.  By breakfast, we looked like “student doctors”: wearing scrubs, stethoscopes around our necks, sphygmomanometers (to measure blood pressure) in our hands.  We were to hold our first clinic at the school we were staying at.  But none of us knew what to expect.

Because it was our first time, we were put in groups of three or four.  I felt like I was a baby who had been thrown into the ocean and told to swim.  All the preparation we had were a package of papers that told us what the symptoms of the common diseases of the area were, and a chart of drugs that we had in our pharmacy.  The patients started coming into the waiting room.  I learned how to measure blood pressure 30 minutes before my first patient.  I was scared that patients’ lives were about to be placed into my hands.

My group gets our first patient.  We ask the then-not-so-routine questions.  Juan complains of back and shoulder pains.  We keep asking questions.  He is a farmer and has been using the machete everyday for 50 years.  He takes out X-rays that he brought of his spine.  I see two slipped disks.  One of the herniations is causing a buildup of cerebrospinal fluid.

After talking it over, my group decides that Juan needs surgery and should take it easy when working on his farm.  We tell him that.  Juan says he wanted to make sure surgery was worth it before going.

We call over a real doctor (Dr. Wil and two local doctors were walking around giving final verdicts) and present the case.  The doctor completely agrees with us, especially upon seeing the X-rays.  We again tell Juan what we think is best and give him tablets of Diclofenac as an anti-inflammatory and analgesic for temporary relief.

For a split second, I feel elated that I was able to do something for Juan.  I could get used to this feeling.  After shaking hands and bidding Juan farewell, we take the next patient in line – the cycle starts all over again, with my confidence growing after each case.  Unfortunately, there are some patients that we can do nothing for, leaving a hole in my heart.  That day, the fourteen of us go through about 120 patients.

We carried out three clinic days in Pocrí.  After the second day, there was no more running water where we were staying.  We ran out of some medications.  Most of us, including me, got sick for at least one day.  Regardless, we pushed on.

Each day, the number of patients increased while the number of students per group decreased.  At one point I was tackling two patients at once by myself.  Despite the routine questions, each patient was different and unique.  It was necessary to get to know them on a personal level before you could do anything for them.  Getting a diagnosis right and knowing that the patient was going to be fine was extremely rewarding.

Travelling back to Panama City, we held two more clinic days in the suburbs.  Out of downtown, it turned suburban pretty quickly.  All of us got used to what we were doing, and were more comfortable with our diagnoses.  We did not want to leave.

We saw a lot.  High blood pressure, tendonitis, pink eye, botched surgeries, fungal growths, pregnancies, common colds, intestinal parasites, ear infections, phobias, mental instability, acute physical trauma, patients who were so poor they couldn’t afford their prescriptions. So they came to us.  We saw it all.  And we learned.

It was time to go already.  Ten days in Panama, five clinic days from 8 a.m. to 5 p.m.  With the help of Dr. Wil, Pat, Gina, the local doctors, and all the translators, the 14 of us collectively diagnosed and helped over 600 patients, ages two to 80.  It wasn’t just science that we learned and gave.  The person-to-person interactions, and to see off a smiling patient – that was the best medicine we gave.

Harald Gjerde just finished his third year in Microbiology/Immunology.  He is an SUS Medical Direction executive and aspiring medical student.  For more information of the Panama trip, visit http://www.gmtonline.org or send an email to harald.gjerde@mail.mcgill.ca.

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Category: Notes from the field

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