Medical Outreach Builds Bridges to Latin America
By Douglas J. Gillert
American Forces Press Service
LACKLAND AIR FORCE BASE, Texas, Dec. 19, 1996 In war, health care providers serve alongside combat troops. They treat not only battlefield wounds but just as likely skin rashes, eye wounds and other environmental maladies.
But where do they learn to treat the kinds of ailments service members are likely to suffer, particularly in tropical climates and Third World nations? For instance, two of the most common threats in the tropics -- malaria and dengue fever -- don't exist in the United States. Before facing such conditions in war, medics need practice in peace.
Thanks to the increasing use of the armed forces as a tool of peace and goodwill, the practice field for military doctors has expanded. Since 1992, Air Force and Army medical staff at the Wilford Hall Medical Center here have treated disease and illness and performed surgery at deployed areas overseas -- just as they would during military operations.
Host nations request medical assistance through the Department of State. The U.S. Southern Command administers the visits and has sent dozens of medical specialty teams to Central and South America to deliver care to indigent populations. There, they treat sickness and train for their wartime mission. Their goodwill efforts also strengthen Western Hemisphere alliances.
Air Force Dr. (Col.) Jose Pascual coordinates the missions and has personally gone on eight. His latest -- to Cuzco, Peru -- was in early December.
Chief of pediatric nephrology (childhood kidney disease) at Wilford Hall, Pascual took with him four pediatricians, four internists (including one with a subspecialty in infectious diseases), a dentist, dental technician and pharmacy technician. In Peru, they visited numerous large and small health centers where they divided into two groups to treat children and adults.
"We usually see about 7,000 patients over a two-week period," Pascual said. "Treatment includes extracting teeth, deworming and medicating children with parasites and, for this trip, immunizing children against measles, German measles and mumps. We also give them multiple vitamins, iron, analgesics and antibiotics."
Other teams include dermatologists, ophthalmologists and other specialists, who treat the wide range of diseases and infections endemic to the poorer populations of tropical countries.
Host nations publicize upcoming visits, Pascual said, drawing people of all ages from long distances. "When we went to Iqitos [deep in the Amazon River rain forest of Peru] in April, patients traveled two to three days by boat to get there, then waited in line from midnight until we opened at 7 in the morning. Many of them had never been to a doctor because they cannot pay. We don't charge anything, although the Peruvian government requires them to pay a little, then picks up the rest of the cost."
In the field, the medical assistance teams work alongside their host nation counterparts. An interpreter assists with communication. For both American and host nation doctors, the visits are learning experiences.
"We both see the patients, discuss the diagnoses and treatment," Pascual said. "Before we leave, we write a treatment history on each patient we saw and leave it with the local doctor for follow-up care."
Most local doctors are general practitioners, Pascual noted. "We bring expertise in medical specialties and subspecialties," he said, "and they are always eager to discuss interesting cases with us."
But the Latin Americans also can teach their northern counterparts a thing or two. "For example, they do not depend on laboratories and diagnostic services as we do," Pascual said. "Many times they have to diagnose by physical examination. So we learn a lot about making quick, correct medical decisions in the field."
The visits also expose the American medics to conditions they don't see in the states. For example, in the Amazon rain forest they saw numerous cases of malaria and dengue fever. "We get to know these conditions, and it is much easier to treat soldiers who contract them when they are deployed to similar environments," Pascual said.
Dermatologists particularly like visiting tropical climates. "Some sort of dermatology expertise is necessary to military operations in tropical climates," said Army Dr. (Lt. Col.) Richard Keller, a staff dermatologist at Wilford Hall. "People in the tropics for any period of time will see significant dermatological problems."
His Wilford Hall colleague, Air Force Dr. (Maj.) Chris Sartori, agrees. "Other than having lead or shrapnel in their bodies, the No. 1 reason soldiers couldn't fight in Vietnam was skin problems," Sartori said. "If you're suffering from jungle rot or trench foot, you can't be walking the point, you can't be doing anything productive. So the expertise we gain from these trips is very useful.
"Tissue infections are extremely common when you're living in an incubator, where the median temperature is 98 degrees," he added.
Also common -- although more a product of sanitation than heat -- are eye problems, particularly eye wounds, which military doctors see a lot of in combat zones.
"Our primary goal for these visits is military readiness training," said Air Force Dr. (Lt. Col.) Wendall Bauman, chief of the eye surgical team for South American outreach. "As the drawdown occurs, we have to take advantage of opportunities to participate in operations other than war, because they provide realistic training."
During trips, Bauman and his team perform up to 90 eye surgeries -- 15 a day. Most are to remove cataracts and restore sight -- operations few of the patients could afford otherwise.
"We screen the patients and treat only those who can most benefit from our efforts," Bauman said. "Similarly, when we deploy in combat, we triage lots of patients and must make quick decisions about who we can and cannot help."
Besides enhancing their skills, the medical aid they provide gives team members a great sense of fulfillment, Bauman said.
"For example, during one trip we removed cataracts from a 62-year-old man," he said. "When we later removed the bandage from his eyes, he began crying uncontrollably and we thought he was in pain. But the interpreter was able to learn he was crying with happiness, because he could see his granddaughter's face for the first time."
Stories like this are frequent and reflect the goodwill the medical assistance teams foster. "Our visits not only affect the patients who get treatment and medication, but also the doctors and, in the long run, I think, the governments," Pascual said. "When you do something as simple and basic as ending the tooth ache someone's had for a month and can't sleep, it's very rewarding."
The trips will continue, at least through fiscal 1997, Pascual said. The visitation schedule includes Guatemala in January, Nicaragua in February, Ecuador in April, El Salvador in June and Brazil sometime later. To a person, the medics who participate in the outreach missions -- and most certainly the people they help -- hope the trips will continue much longer.