ECU teams heal and help in Nicaragua
By Amy Ellis
A long line of Nicaraguan villagers who heard a doctor is coming today spirals around a fence surrounding a dilapidated building. As a school bus full of missionaries and medicine chugs into view, many of them press into the person ahead of them, afraid of losing what might be their only chance to see a medical professional.
Some have walked hours in the rain from their rural mountain dwellings of cardboard and tin. There are mothers nursing diaperless infants, old men leaning shakily on crooked sticks, muddy children with bellies protruding beneath tattered clothes.
Those children, many suffering from malnutrition, appear much younger than they are, while their elders appear much older, their lined faces and swollen joints testifying to the rigors of daily life in this Third World country. Hundreds of big, brown eyes track every movement the "gringos" make as they unload plastic chairs, folding tables and tubs of medicine to transform the cinderblock building into a makeshift clinic for the day.
Dr. Tommy Ellis, an ECU family physician, speaks
with a parent and child in Nicaragua.
Inside, there are no lights, no running water. A clock, its batteries long dead, hangs upside down on one wall, in many ways a metaphor for this culture as well as the practice of medicine in this country, the second-poorest of the western hemisphere.
When Dr. Tommy Ellis, a family physician and 1992 graduate of East Carolina University's medical school, embarked on his first medical mission to Nicaragua in 2003, he brought along two bags of medicine and a giant bundle of uncertainty. Ellis, who serves as medical director for ECU Physicians Firetower Medical Office, said last-minute invitations from local optometrist Ted Watson and then-high-school-student Kelley Haven (now a medical student featured beginning on page 12) coincided with an extra week of vacation that year to convince him to act on inclinations he'd had for some time.
This summer Ellis completed his ninth medical mission in Nicaragua, taking a team of 22 people (including his family of six), 24 50-pound bags of medicine and supplies and an infinite inventory of optimism for an eight-day stay.
"My goal going into it was to see what health care is like in a Third World country, to see if I could make a difference," Ellis said. "My goal when I go now is to impact specific, local communities through more continuity of care and to generate awareness in the people who go with me. I hope the desire to help will trickle down and the effect will be multiplied."
Ellis' base in Nicaragua is an orphanage run by Globe International in the northern mountains of Jinotega, the most medically underserved area of the country. From there, his team traveled about an hour every day to hold medical clinics in various villages. They served 750 patients clinically, treating a parade of infections, asthma, allergies, skin conditions, parasite-related illnesses, anemia, malnutrition and hypertension. They provided parasite treatment to several thousand people. They gave out multivitamins, flip-flops, T- shirts and toothbrushes, as well as dental and medical education.
Ellis is only one of dozens of Brody School of Medicine faculty, staff and students who have devoted weeks of vacation time and untold personal expenses to go on Nicaragua medical mission trips over the past decade or so. Although many medical and nonmedical Greenville residents participate in worldwide missions every year, Nicaragua seems to hold a special draw for the people of this community, ECU and Brody in particular.
A traveler to this country ravaged by war and natural disaster doesn't have to search hard for evidence that Pirates have been dispensing regular doses of hope and healing there. In certain areas, you're almost as likely to see a child sporting a Greenville Little League shirt as one combing through a garbage dump for food.
"Brody, ECU and Greenville in general have an unbelievable culture of compassion," said Sandy Carter-Britnell, director of Globe International-Nicaragua. She said Greenville's medical community has been the largest contributor to her ministry's health efforts — physically, financially and emotionally — since she began helping street children and orphans in the capital Managua 13 years ago. "I built these orphanages with my heart," she said, "but the hearts in Greenville and at ECU have kept them going."
Ellis is often asked why his teams spend months planning, collecting supplies, soliciting donations, packing and drumming up travel expenses, when there are needs in his own backyard. He says it isn't an "either-or" situation.
"We should do both," he said. "I try to help the needy here, too. Some areas of eastern North Carolina are definitely underserved when it comes to basic health care. But even the poorest here have access to clean drinking water and shelter — needs that 50 percent of Nicaraguans go without daily.
"I just read that 70 percent of Americans considered below the poverty level have air conditioning. The word ‘poverty' means something completely different in Nicaragua. Half the population there makes less than two dollars a day, so things like a one-dollar tube of hydrocortisone cream are completely out of reach for them. It's astonishing how much suffering I see there due to things we treat so easily here."
Ellis said the complexity of the U.S. health care delivery system can be frustrating and exhausting for a primary care provider, and his efforts in Nicaragua re-energize him.
"Mission work in a Third World country reminds me that the most basic care can provide long-lasting outcomes," he said. "It re-emphasizes that primary care providers can have a tremendous impact on our own country's health and economy if we're willing to intervene early and take time to educate patients."
Dr. Tim Reeder, an associate professor and vice chair for clinical operations in the ECU Department of Emergency Medicine, said he didn't really know what "poor" was until he accompanied Ellis to Nicaragua this past July. A board member and regular volunteer for the Greenville Community Shelter, Reeder was refreshed by "a week of practicing medicine for the joy of it" and the chance to focus on interaction with patients.
"Of course, there's only so much you can do in a week," he said. "But a lot of what we do in medicine anyway is support the body's process of healing itself. At home, we take for granted that we can pop an ibuprofen when we have a headache. In Nicaragua, just providing a little pain relief makes a huge difference for these people. It's practicing medicine in its purest form."
Dr. Timothy Reeder, an ECU emergency physician,
speaks with a parent and child in the mission clinic.
Although many drugs Reeder dispensed to his Nicaraguan patients will undoubtedly make positive – even lifesaving – changes, he believes the external validation the team provided them might well have been the best medicine they received. "It was obvious that our taking the time to listen, support and encourage was enormously reassuring to them," he said.
Second-year medical student Randall "Rocky" Proctor said the patients' gratitude alone would have made the trip fulfilling for him. He was grateful, in turn, for some hands-on experience, a chance to observe disease states rarely seen at home and the opportunity to work closely with a diverse group of people.
"This mission trip very much enriched my medical education," he said. "I saw how culture and environment affect the type of care delivered. I also saw the importance of all members of a health care team. Each team member had a purpose that was vital to the success of the mission — from the greeters and intake personnel to the translators. I have a new appreciation for the coordination of care and the careful thought process necessary to complete such a task well."
Dr. Brett D. Keiper, an associate professor in the Department of Biochemistry and Molecular Biology, opted to spend his mission week in Nicaragua assisting with a construction project at the orphanage.
"It must be of some encouragement, both to the kids living there and the staff who work there daily, that the infrastructure is slowly and steadily improving," said Keiper. "It is important both for planning and morale to be able to envision a future with even better facilities and services."
On his first trip in 2007, Keiper helped build a desperately needed footbridge on the orphanage property. Over time he has seen figurative bridges built between Nicaragua and Greenville.
"There are clearly kids growing up healthy and strong in the countryside around Jinotega who would not be, had it not been for the many volunteer hours of students, faculty, clinicians from Brody," Keiper said. "But more than that, the real impact seems to be a rising awareness among these Nicaraguan people that we are not really so far away — physically, mentally or spiritually. And we've provided some evidence that we are not unconscious of their plight, not asleep to their world."
Sidebar: Healing hearts
The northern countryside of Nicaragua isn't the only area to be touched by Brody's "culture of compassion." For 12 years, Dr. John D. "Jack" Rose, a professor in the Department of Cardiovascular Sciences, has been doing medical missions in the bustling city of León, southwest of Jinotega.
Over the past decade, Rose, Dr. Harry Adams, an infectious disease specialist; Dr. Theodore C. Koutlas, a heart surgeon; Dr. David Hannon, a pediatric cardiologist; and others have worked to establish a partnership with the medical school in León. This relationship enables them to offer specialized medical care in Nicaragua that would be unavailable otherwise, as well as frequent mission opportunities for medical students and residents.
Rose said they usually make two trips every 12 months, each about two weeks long. "The first is in September," he said, "and it involves evaluating patients with valvular and congenital heart disease, and bringing down a surgical team to perform open-heart surgery. The second trip is in February. It involves general clinics as well as cardiology."
Adams said each team sees about 120 cardiology patients. "In addition, the students round in the hospital," he said. "We attend a weekly HIV clinic operated by the infectious diseases specialist there. We also spend time in community clinics in León or in neighboring towns. This gives everyone a great exposure to public primary care in Nicaragua."
Koutlas is typically accompanied by surgical team members from ECU and Pitt County Memorial Hospital. He performs eight or so heart operations in León annually. "There are about 15 people who all go at their own expense — nurses, operating room techs, perfusionists, anesthetists, anesthesiologists and medical students," he said.
Brody faculty members who work out of León are members of Project Health for León, an effort organized by Dr. John Paar, a Raleigh cardiologist who established the cardiology program in León years ago. The organization aims to train Nicaraguan medical professionals, provide specialized medical care to Nicaragua and offer educational experiences in Nicaragua to American medical students and other medical professionals. The project also funds several cardiac surgeries at PCMH every year for Nicaraguans who require the more extensive resources available here.
"I think we all agree it is an incredibly valuable experience going down there," said Koutlas. "We have a lot of poverty in eastern North Carolina, but there is nothing in the U.S. like you see down there. A week working down there makes us all understand why we went into medicine as a career."
Editor's note: Amy Ellis is a former writer for the ECU medical news office and the wife of Dr. Tommy Ellis.