2 Australian GPs volunteering in Peru
In 2016, Unconventional Conventions generously offered the chance for two doctors to volunteer in Peru & the two of us, Scott Fifeld from the Mornington Peninsula in Victoria & Phil Gribble from Clare in SA, were lucky enough to be chosen for this great opportunity. Working with International Volunteer Head Quarters (IVHQ) [a New Zealand group] and a local Peruvian organisation, Maximo Nivel (MN) we were supported to travel to exotic Cusco in South America.
After the 27 hour travel to get there, we were put up in a home-stay in Cusco with our hosts, Danny & Ali, allowing us to experience full 'immersion' in the modern Peruvian way of life.
We were very well supported by Unconventional Conventions, IVHQ & MN in a country far from our usual experience and in a system of which we had no idea. Support from the volunteer organisations began months before our arrival and included an internet based country-specific briefing and regular email correspondence.
Fortunately we had a weekend to acclimatise to the altitude. At 3400m, our initial symptoms of headache, fatigue, exertional dyspnea and sleep difficulty improved progressively after the first 2-3 days. Our own SOB on exertion also gave us a bit of an insight in to how some of our own respiratory and cardiac patients live life every day. An unexpected life lesson!
Our placement was at the Chinchero clinic, serving a population of around 9000 in the Andes at 3700m. A 45 minute trip from Cusco by public minibus, [costing 3 Peruvian Soles or about $1.20 each way], the clinic provides GP-style consulting, an emergency service, a birthing room & a limited laboratory. The pharmacy on site provided a surprising variety of medications including iv drugs such as Ceftriaxone. A GP is usually present with extra manpower provided intermittently by volunteers such as ourselves and there are generally 2-3 nurses. The services are free to those who are part of the government health scheme [aimed at the poorest citizens but ending up being 70% of the population] whilst those not covered are expected to pay
Thanks to Unconventional Conventions, we also had designated translators to help us. As many in the Andean highlands still use the ancient Inca language of Quechwa, this was essential. Giovanni & Martin, allowed us to negotiate both the clinical demand as well as the bemusing Peruvian paperwork
A drop-in, virtually free clinic, many consults were typical of what we see in Australia : viral URTIs, gastroenteritis, chest infections, even a request for a medical report. Equally similar were patient expectations that they should receive something more than reassurance when presenting with a self-limiting illness; an interesting challenge in view of the translation. Follow up of issues was very haphazard with no appointment system and relying on people to return when advised. The delivery of a healthy baby boy at the clinic during our stay was a particular highlight.
There were some major differences, though, in clinical content. Hypertension is frequent whilst cardiovascular disease is not. Diabetes is relatively rare, as is obesity. Smoking is almost completely absent; in the highlands we met one person [a school teacher] who smoked, none of our patients did at all. Alcohol abuse is, however, widespread, and unfortunately much of the supply is from illegal stills and methyl-alcohol ingestion is common. Parasites are also prevalent, one patient having both gastric biopsy proven Giardia and Hookworm. Many patients also present late, eg a 76yo lady with a year of gastric ulcer symptoms. Perspectives are different, eg a 70yo lady who presented with a viral URTI but as an afterthought, described 3 weeks of probable Ascending Polyneuropathy.
One thing that the Peruvian system does extremely well is early childhood care and immunisations. This has been a priority over the last few years and easily rivals the Australian schedule. Similarly, the effort put in to follow up is impressive : monthly childhood visits to 12 months ; 2 monthly to 3years and then 3 monthly to 5yo.
The profound lack of infrastructure was striking though. There is minimal money available to the extent that the rudimentary ambulance was out of action for months as the replacement battery couldn't be funded [eventually another volunteer bought it for them]; the dental chair cannot be raised as the motor broke several months ago; the wheelchair had no seat and only 3 wheels; we had 2 doorknobs shared across 3 doors; doctors provide all their own equipment to the point of their own gloves. Sterile gloves or instruments are a nice idea but unavailable in practice.
The Peruvian medical system also struggles to retain its doctors. After undergraduate training of 9 years, remuneration is poor [about $1000/month] and facilities are stretched to the limit and beyond. We were told that many qualified doctors leave Peru, resulting in the current national shortage of about 16,000 doctors [in a country of 30 million].
The welcome we had was universally warm, appreciative and trusting, though. We were given almost free rein from the time we got there, being the only doctors at the clinic on several days. We may not have saved any lives but simply being there was of value. For us, being exposed to a different culture with limited resources certainly made us appreciate what we have in Australia, shortcomings notwithstanding.
We left with a deeper appreciation of a different culture, one proud and resilient, as well as a greater appreciation of what we do have. As a parting gift, we left them with a a new 4 wheeled wheelchair, complete with seat, so hopefully our legacy will have some practical effect. Small things can make big differences and being there to understand what aid is actually helpful was an eye-opener; offering anything which would need consumables for ongoing use would be useless for example.
Our heart felt thanks to Unconventional Conventions for providing this opportunity via scholarship. We would encourage any Doctor to take up an opportunity; you may not change the world but it can change you
Dr Scott Fifield
Dr Philip Gribble