Treating Parkinson’s Disease in the Amazon Basin

Treating Parkinson’s Disease in the Amazon Basin
April 22, 2013 Callie Daniels-Howell

by Zach Wright

Zach Wright is Timmy student alum from Butler University and is currently working as a long-term volunteer in Tena, Ecuador. For nearly 9 months, he’s volunteered alongside Timmy’s international staff, helping to coordinate short-term medical trips to the Amazon Basin, managing chronic care patients, assisting referral patients in need of advanced care, and piloting Timmy’s new EMR system—TimmyCare. He’ll be pursuing his medical degree at the Marion University School of Osteopathic Medicine in Fall 2013. This blog highlights some of the challenges that arise in chronic care management for patients with difficult diagnoses in developing countries. (Click here to read an earlier blog post from Zach Wright.)

Timmy Global Health (Timmy) has developed a knack for overcoming obstacles on the ground. Whether these barriers to health derive from logistical, financial, or other potential challenges, Timmy’s staff is well equipped to solve issues related to getting our patients the critical treatments they need. One of the biggest challenges that Timmy—and every other international medical aid & relief organization—face is providing continuity of care. While short-term medical trips provide valuable services to many patients (i.e. disbursement of vitamins, anti-parasitic meds, health education, etc.), patients with chronic diseases require a much more intricate and sustainable health system. Many of Timmy’s chronic patients rely on daily medications, and in the absence of Timmy’s primary care clinics, their prescribed treatments are costly and difficult to come by.

I have witnessed these challenges time and again through my work with Timmy. One of the most recent scenarios took place during the January 2013 DePauw University medical trip to the Napo Province, where our Timmy physicians encountered two complex neurological patients—Michael and Alberto—both diagnosed with Parkinson’s disease. Managing chronic treatment plans for patients with hypertension and diabetes is challenging enough in the Amazon Basin, but this disease takes it to another level.

Parkinson’s disease is a chronic, degenerative neurological disease that can present in several forms, and is caused by a loss of dopamine cells in the substancia nigra—a specific region of the midbrain. The loss of the dopamine cells in the midbrain causes a certain movement disorder with rigidity, tremors (shaking), an unstable gait, and a loss of muscle control called akinesia. Although there is no present cure for Parkinson’s disease, dopamine and dopamine agonists are typically used to improve the symptoms. In the western world, new therapeutic strategies such as deep brain stimulation (electro stimulator inserted by surgery in the brain) are common, and costs for treatment average out to be an affordable $30 USD per month.

Dr. Katharina Stengl—an Austrian Neurologist who recently served as a long-term Timmy volunteer—treated Michael and Alberto when they arrived at Timmy’s primary care clinics in the communities of Tamia Urku and San Rafael, respectively. (Click Here to read a blog post from Dr. Stengl). Although neither patient had ever been diagnosed with Parkinson’s disease, nor received dopamine or any other treatments, they both presented with the classical clinical symptoms of idiopathic Parkinson`s syndrome (rigor, tremor and severe akinesia). And both experienced an onset of the disease within the last 4 years. Due to multiple years without treatment, the disease had progressed at an alarming rate for Michael and Alberto. Sadly, Alberto was hospitalized on the same day that he came to clinic, due to severe dysphagia that had caused weight loss and an inability to swallow.

After seeing both patients in Timmy’s clinics, Dr. Stengl referred them to the Stadler Richter Hospital in Archidona, so that she could start their treatments and oversee their progress. Before their follow-up appointments, she had diligently requested specific neurological medications, but unfortunately the meds did not arrive. Dr. Stengal’s time as a long-term volunteer with Timmy Global Health came to a close before she could oversee treatment for these patients. Without another neurologist on staff at Stadler-Richter Hospital to monitor Alberto and Michael’s Parkinson’s treatment, they would have to travel to another Timmy referral destination, Tierra Nueva in Quito.

But the search for a proper care facility for Alberto and Michael encountered another obstacle. As Timmy staff and partners arranged the logistical details for their trip to Quito, we quickly discovered that Tierra Nueva no longer had a neurologist on staff either. After searching high and low for another option, someone finally suggested that we reach out to a former Tierra Nueva neurologist, Dr. Michael Andrade, who now works in public health clinics in other parts of Quito.

Dr. Andrade agreed to schedule a consult for both Alberto and Michael.  Finally, nearly a month and a half after Dr. Stengl initially saw them on the January brigade, they arrived in Quito for their referral. Dr. Andrade assessed both patients, ordered blood labs, and ran tests. The patients had to return to their homes in the Amazon Basin while the tests and labs were processed, and then made a second trip to Quito a few days later to receive the results and begin their medical treatment. Upon their return, Dr. Andrade explained to each patient their medical situation, confirming both diagnoses of Parkinson’s disease, and outlining a treatment plan moving forward. He prescribed medications for each patient, which Timmy Global Health purchased immediately after leaving the clinic.

In order to monitor Alberto and Michael’s treatment and progress, both patients scheduled a second follow-up appointment at Dr. Andrade’s Quito clinic for late April. By the end of February, just a few days after the start of their treatments, both patients were becoming accustomed to their new meds and showed signs of improvement. They will continue to receive treatment and monthly follow-up services from Dr. Andrade, and Timmy Global Health will continue to work with Dr. Andrade for other neurological cases in the future.

Alberto and Michael’s stories show Timmy Global Health’s level of dedication and persistence. Staff members in Ecuador spent nearly 2 months attempting to locate a reliable neurologist and despite many obstacles, they refused to give up—making every effort to ensure that Alberto and Michael had access to the care they needed. But for Timmy Staff members, this story is the rule, not the exception. Timmy is dedicated to its communities and its patients—we’ve made a commitment and a promise to them. We are determined to get results for our patients and we are willing to find solutions, no matter where we have to go or how hard we have to look. And this “never-give-up” mentality is making a difference, one patient at a time.


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