From Berlin to Tena: Adapting Western Medicine to Rural Needs

From Berlin to Tena: Adapting Western Medicine to Rural Needs
February 15, 2013 Callie Daniels-Howell

by Katharina Stengl and Goetz-Christian Melloh

Katharina Stengl and Goetz-Christian Melloh are Austro-German doctors who specialize in Urology and Neurology. Both served as medical professional volunteers with Timmy in the Amazon Basin from fall 2012-winter 2013. This blog is a summary of their experiences—both personal and professional. Through their work as long-term volunteers with Timmy, they experienced global health disparities firsthand, and took an active role in expanding access to healthcare to some of the Amazon Basin’s most underserved patients.

Before deciding to join Timmy Global Health as medical professionals, both of us had been working for some years as medical assistants at one of Europe’s biggest university teaching hospitals—Charité – Universitaetsmedizin Berlin. We were used to working with highly specialized diagnostic and therapeutic techniques. Talking to each other, both of us realized that we have shared a growing interest in humanitarian work and an urge to help underserved people ever since we had been in med school. Conscious of the contrast to high-tech university medicine we wanted to go back to basic medical examination and primary care. Unfortunately, it was not easy to find a placement in a humanitarian project for both of us because we wanted to work together as a couple and share the experience. After a lot of research, we were grateful to finally connect with Timmy Global Health—who offered us the opportunity to work and volunteer together. In the spring of 2012 we had applied as long-term volunteers at Timmy´s medical site in the Amazon Basin of Ecuador. Working closely with Timmy’s medical team coordinator in Tena, August Longino, we started our humanitarian mission that autumn.

We were transported directly from Germany´s capital and melting pot, Berlin, to the heart of the Ecuadorian jungle—Tena, situated in the Oriente province. At first, both of us struggled with the jungle´s humidity, the different kinds of huge insects and, of course, with the situation of the patients we encountered in the region. We quickly realized the harsh contrast to Germany´s western-style medicine. Certainly, both of us had expected a lack of hygiene, of diagnostic and therapeutic aid, but in the end, we had to admit that the patients in Oriente were far worse off than we thought they would be.

Working with Antony Hidalgo, the Director of the Jose Maria Velasco Ibarra Public Regional Hospital, we started our humanitarian project by accompanying the local Ecuadorian doctors on their everyday internal medicine ward rounds. After getting more comfortable with our Spanish, we got to know the most frequent diseases of the region—which included a large number of gastro-intestinal infections, pneumonia, malnutrition, and other diseases frequent in developing countries (tuberculosis, dengue-fever, snake bites, and self-induced intoxication with barbasco and organophosphates). Learning about how to diagnose and treat these different diseases was challenging, but the hardest part of our work at the public hospital was encountering a completely foreign patient mentality.

We had to learn to respect their ancient beliefs in the power of the Shamans—which were and are still the natural healers of the communities. And we had to accept their fear of western medicine and their overall preoccupation of not having enough money to pay for the treatments we recommended. This was especially difficult, as many of the inhabitants of the poorer communities in the Oriente could not afford the costs of expensive hospital stays and treatments with their daily incomes of about one US dollar.  In many cases, if patients had to see specialists, they usually had to travel at least five hours to Quito. For the majority of them, this was nowhere near an affordable option. Combined with their cultural backgrounds, anxiety to enter a big city like Ecuador´s capital, and lack of access to the expensive medications recommended for treating urological and neurological problems, providing care to these patients was sometimes just impossible.

In the afternoons both of us established our neurological and urological consultations in the private Stadler Richter Hospital—in the nearby small town of Archidona. There was a high medical demand for consults, especially in neurological treatment for diseases like Parkinson´s and epilepsy. Facing the fate of chronically ill patients, like the many neurological patients we saw through our consults, we felt miserable to learn that coverage for their daily medication does not yet exist within the Ecuadorian health system. We were so grateful to learn that Timmy Global Health organized and financed the treatment of our patients suffering from Parkinson´s disease and epilepsy.

During one of our first weeks in the Amazon Basin, a Timmy Global Health supported hernia repair team came to serve the community (Read more about this trip in a post by Andrew Morrow). Within a week´s time five surgeons operated on more than 60 patients suffering from different kinds of hernias (inguinal, umbilical and scrotal). Christian enjoyed working with the American and Italian surgeons and was thrilled to be able to improve his surgical knowledge. In the meanwhile he was eager doing ward rounds on the common surgical ward of Tena´s public hospital, too, where he got to know its chief surgeon Dr. Llamuca. He could assist in the operating room, especially when it came to urological questions like prostate-excision etc. and tried to help out wherever a hand was needed.

In December and January we joined Timmy’s primary care medical teams that came to the region to provide healthcare to the very remote communities of the Oriente, some of which could only be reached by foot or travelling by boat along the Rio Napo. We really enjoyed these mobile clinic days, visiting every day another community, working together with other Timmy doctors, and teaching and supporting the Timmy student volunteers (which were not all pre-med students, though showed eager interest in public health). They did a great job and showed respect to the patients. I was able to treat approximately 30 to 40 patients a day, sometimes the whole family with a bunch of 7-8 children. The patients presented with a broad spectrum of diseases from common flu symptoms to severe pneumonia, malnutrition of the children due to parasites, skin infections like fungus or impetigo, and also severe cases of epilepsy, Parkinson´s disease, birth abnormalities or genitourinary malformation. Thanks to the service provided by Timmy Global Health, complicated cases like these could be referred to specialized hospitals in Quito.

Looking back at our time in the Amazon Basin, I can say it was a truly unique experience that we had. Working with Timmy Global Health consisted of so many different kinds of work: ward rounds, operating rooms, mobile medical clinics…but above all getting to know the people of Ecuador. We enjoyed getting in touch with the indigenous populations living in their small, remote communities surrounded by wilderness, and supplying them with urgently needed healthcare options. We both can finally say that this kind of humanitarian work was not only a donation to the Ecuadorian people; but it was also a great benefit for us! Thank you!



Leave a reply

Your email address will not be published.