From Dr. John:
When Joanna and I first came in 1998, we were not particularly surprised to find the level of medical care to be antiquated. Still, we were amazed by the lack of modern medical equipment in the local hospital, which was a teaching hospital. The doctors were excellent. One of the TB doctors, who is well known throughout the world as an expert, regularly lectures as far away as Japan. This same doctor asked me for a good scale to weigh patients and a laptop computer to store data, and both of these needs were fulfilled. The practice of medicine was very clinical, relying on the physical exam due to the lack of diagnostic equipment. This actually appealed to me as a clinician, as we had very little diagnostic equipment when I first came to Highlands in 1971. Now all that is changed with scanners and even an MRI machine. Our lab is filled with computerized equipment that would make the medical providers in Bolivia very jealous.
In 1999, the team decided to bring the laboratory into the modern era. All tests were done by hand if they were provided at all. We supplied the lab, over a several year span, with an automated machine for cell counts and another for chemistries. No wonder we were seeing so many children that were well until they had diarrhea, but were now mentally impaired due to improper treatment of dehydration. The doctors had no tools to tell them how to treat the patients! Infections were a huge problem, but there was no bacteriology lab to tell the doctors what bacteria was causing the infection and what antibiotic might be the best choice for the infection. Frank Leslie and Eugenia Green graciously translated the entire handbook for the instruments into Spanish. The equipment was old, but it could be repaired without being a computer expert.
As far as the hospital was concerned, there were no monitors, no EKG machines, and no defibrillators. This is a teaching hospital and made it clear why the Bolivian doctors were poorly trained. The first time we used our new EKG machine, we went to the surgical ward to find a “normal” patient for training purposes. After 12 EKG’s that were all abnormal, we finally did an EKG on one of the interns who, thankfully, gave us a normal tracing. The doctors now agreed that there was a problem here with hearts. Now every patient who enters the hospital receives an EKG. Deep in my heart, I always knew that one of our group would need all this equipment, but I never knew it would be me! In March of 2004, I had a heart attack while in Bolivia. Fortunately, because of the equipment we had brought, the hospital was able to hire two cardiologists, one of whom was on duty that Sunday afternoon. I received the best of modern care. Another patient had received the “clot buster” therapy the week before, and I was the second trial with that therapy. Seeing the monitors and the defibrillator made me feel comfortable. The hospital now has ample monitors, and we have begun supplying three other local hospitals with life-saving equipment.
The Baptist Hospital System in Tennessee and Mississippi has supplied us with their old defibrillators, fetal monitors, and other valuable equipment. The Highlands-Cashiers Hospital donated their old portable X-ray machine, so a hospital in Portachuela, 25 miles from Montero, could replace their old 1950 model X-ray machine. What is old for us is valuable and new for the third world. New equipment like an ultrasound machine has been purchased, but most of the equipment is second hand. In 2007 Dr. Choi from Franklin, NC, brought laparoscopic surgery to Montero as Angel Hospital upgraded their equipment. Now the hospital in Montero can provide a safe and effective way to see what is causing problems in the abdomen, as they have no sophisticated imaging techniques, and patients will have smaller scars from their gall bladder operations.
In addition to the medical aspect of the mission, Dr. Fred Rodenbeck DDS brought modern dental techniques and equipment to the people of Montero. Before his arrival, it was not uncommon to pull teeth without anesthesia. It was painful for me to watch young children sitting still, mouth open, with a tear running down their cheek, while the dentist pulled their tooth. Dr. Rodenbeck also has taught at the major dental schools in Santa Cruz. Our motto has always been, “If you don’t leave some knowledge behind, you haven’t really done anything.” Over the past several years, Johns Hopkins Medical School has made the Bolivian experience a Spring Break elective, and fifteen of their freshmen students have enjoyed a weeklong learning event at two hospitals and three clinics in Montero. This experience helps them understand that medicine is totally different from the medical center environment.