A reason to smile
Memorial alum, Dr. Christopher Patey (BSc (Hon) MD CCFP FCFP) has a lot on his plate. Aside from a busy family life with three young kids, Dr. Patey is the site clinical chief of Emergency in the Carbonear Emergency Department, a part time rural family physician at the Baccalieu Trail Clinic, and a selectives coordinator and clinicial assistant professor with the Disciplines of Emergency Medicine and Family Medicine. But he still found time to give.
In early December, Dr. Patey returned from a week in Nicaragua, where he was armed with nothing but a stethoscope - and it’s changed his views on life and care. He wrote about his experience and also spoke with contributor Michelle Osmond:
A reason to smile
Nicaraguan perspective with Team Broken Earth
By Dr. Christopher Patey
Arriving in Managua, Nicaragua is typical of flying into other underdeveloped nations. A hot overcrowded airport, a poorly dressed boy canvasses the well-to-do foreigners and stacks of overloaded buses securing rooftop suitcases. This trip however is with Broken Earth which has assembled a small medical team to survey the country’s needs and assess the potential for future visits. The driving force for our visit is Dr. Carlos Enriquez who is obviously passionate and organized. He has coordinated with a local foundation at our site of work for the upcoming week.
We are quickly ferried two hours north. We travel on a well-paved highway to Chinandega, the site of our mission. Early clinics overflow with plenty of children with nagging coughs from open fire exposure and adults with non-managed chronic diseases. Thankfully, they all appear well nourished. It is reassuring that we primarily provide free medical advice and reassurance. We realize early in the process that patients are slightly filtered when they reach our larger centre. Without free access to transport it is expensive for others. They do arrive in need however not the truly impoverished.
Working as a physician team, Dr. Tonja Stothart and I, learn early that you cannot apply modern medicine here. A visit to the local pharmacy reveals some of our early inadequacies, as some of our early prescriptions would require three months of income. Patients unfortunately too, have overlying faith in first world technologies as they hand you a glossy ultrasound image attached to a worn, creased undecipherable report. They believe the answer is there however they cannot interpret it. The cost of physician interpretation is too high and abnormal summaries become an obvious concern.
After multiple days in clinic, we arrange an impromptu survey trip to the outlying city. Our goal is to determine true context. We are ferried by one spectacular individual, Laura Callejas, who has true dedication to improving conditions for the Nicaraguan people. She exudes energy and conviction, and will also serve as our Spanish translator. Off the paved modern highway we enter decrepit hurricane washed streets. Pigs and dogs roam freely. Chickens are everywhere. Being the rainy season the green hues mask the filth and poverty from the highway.
Laura has coordinated with a catholic priest who immediately leads us when we exit our vehicle. Arriving at a hollow, cinderblock church we are greeted by children who were reading distantly in the corner. As we cross the gravel floor, I unconsciously take notice of the atypical shiny galvanized metal roof. Our guide explains that is has taken twelve years to create this community hub. As we pass through the side door I am taken back by the mass of individuals quietly awaiting our arrival.
We immediate hold an open-air clinic with only a stethoscope in hand. The older members of the community are surprisingly prioritized while lethargic children are quietly coughing in mother’s arms. We quickly assess numerous patients with longstanding illnesses. We meet a lovely lady complaining of severe upper neck pain. We understand she has a lifetime of tortilla making. I instantly think of my grandmother who daily crafted a batch of Newfoundland three-bun bread. However thanks to Sir Wilfred Grenfell in Newfoundland her medical options were obvious. We take an opportunity to visit her home and offer suggestions of to improve her work environment. Always gracious she cannot let us leave without a fresh tortilla.
Driving back from our short visit we are pointed to other crowds alongside the highway under palm leaf enclosures. Apparently they were informed that there could be the possibility of a physician clinic and they had assembled in case we had extra time. It was emotionally overwhelming to drive past them.
We fortunately do make more time and devote ourselves to a return visit. We dispense medications and assess more patients. We walk the roads and ask families whether they have other immediate needs. We treat kids with rashes on the weathered street. We discuss diabetes and hypertension through broken Spanish. We auscultate sun-tanned skin through a barbed wire fence. We also ask visible family members about other individuals who may require care. It is never declined and always warranted.
Life is not easy and I believe perspective is essential. Nicaraguan people are overwhelmingly trusting, friendly and polite. They accept and always over appreciated our medical reassurance. They fully require what we often undervalue and take for granted as Canadians. When I look at a street picture with three beautiful kids I feel their unbelievable terrible lot in life. I also see my three young children. For a candid photo these children have been asked to smile in Spanish. But it is sadly absent. And above my conditioned camera smile are tears that have been quietly wiped away. There is so much potential in these areas and for that I applaud Team Broken Earth and Dr. Enriquez for the passion. My experience in Nicaragua is one that I am determined to repeat and improve upon.
A conversation with Dr. Christopher Patey
By: Michelle Osmond
M.O: Why did you decide to take this trip?
C.P: Initially I was part of a team with Broken Earth planning a return visit to Haiti. However with political unrest and resulting safety issues in Haiti, a number of other physicians in numerous specialties, including pediatrics, ophthalmology, and orthopedics, were asked to join a scouting mission to Nicaragua.
M.O: Were you prepared for what you saw?
C.P: With previous medical experiences in other countries, I was familiar with the feel of developing world and international medicine. However, with every country being different, the short period of community outreach medicine to the impoverished areas of Nicaragua was extremely rewarding and definitely eye opening. The close intimate experience of treating truly impoverished individuals in their simple but well-tended homes and overwhelmed with their respectful nature and thankfulness.
M.O: Did the MD program here instill a desire to do this type of work? If so, how?
C.P: While in Memorial Medical School, through self-organized selectives and electives, I was fortunate to experience international medicine. Completing surgery in Ireland and Sweden and also emergency medicine in South Africa and India, I quickly gained a broadened view of medicine for life. These early golden opportunities in medical school definitely assisted with my comfort and continued desire to work in underdeveloped countries. It must be also added that one elective was partially supported by Dr. Henry Gault, who managed to positively impact the lives of three eager medical students. Dr. Gault graciously partially funded our electives in India where I completed a month of emergency medicine in Bangalore. It was here that I gained extensive experience in trauma medicine, became aware of true health inequalities and learned to always be extremely thankful for our fortunate lives in Canada.
M.O: What was the hardest thing about an experience like this?
C.P: The hardest thing is only being able to devote a relatively short time there. With significant work and family commitments at home it is next to impossible to be away for longer periods of time. With so much need and having the skills to help those who would otherwise receive little or no healthcare, it is hard to return to Canada and not be affected.
M.O: What was the best thing about it?
C.P: An opportunity to directly help those in true need. It is also refreshing to return to basics of medicine, often only standing with a stethoscope.
M.O: What would you do differently the next time around?
C.P: Now that we are fully aware of the true potential in the area, we realize this can be an ideal location for Broken Earth's model of providing team healthcare. We hope to continue with regular visits to Nicaragua and subsequently increase community outreach and continue with devoted specialty clinics.