by Hugh Chapin
After confirming and re-confirming the critically high blood pressure measurement, I realized that the calm, smiling woman sitting in front of me in her traditional indigenous clothing was not aware of the severity of her situation. She only knew that she had run out of money for her medications and she might as well come see the visiting doctors since they’re here. After all, she didn’t even mention the pesky vision problems, and intense, intermittent headaches and falls until I inquired after accepting the blood pressure measurements. It harkened back to all the literature on hypertensive emergency I had studied in medical school and it was instantaneously clear that I was currently the only one cognizant of the hypertensive time bomb in front of me that could go off at any moment.
This was the beginning to one of my most memorable patient encounters during my first humanitarian medical aid mission. While living several years as an expatriate, I followed the world of humanitarian medical aid organizations with great intrigue, admiration and a feeling of purpose and was resolved to some day explore a niche for myself within that sphere when the time was right. Through a bit of serendipity I discovered the Tandana Foundation in 2011 and became intent on volunteering on one of their Health Care Volunteer Vacation (HCVV) trips and the day I had often imagined finally arrived during the HCVV of March, 2012.
Before leaving my home in New York City for a country I knew little about, I was filled with excitement and forced myself to buffer any images or expectations of what would be, with the inevitability that the reality will be vastly different from any image my mind could conjure. In essence, try not to get excited about the fast-approaching unknown. What a tall order that was!! And how wonderful the unknown turned out to be, as I continue to learn from my experience as I reflect and savor each memory.
My ‘HCVV experience’ with Tandana Foundation was just that….an experience: Personally encountering or undergoing something. A shared experience yet each person takes away their unique perspective. Here are some thoughts from my perspective on my ‘Tandana experience’.
As a young physician, the medical aspect of HCVV: providing medical care to rural, under-served communities, was my driving force to take part. Leading up to the trip I focused on what interesting cases might present, what diseases, parasites and pathologies were unique to that region, and how patient encounters would compare to what I knew from home. During the trip; however, I discovered other aspects and intricacies of the ‘HCVV experience’ apart from the medical. They were just as memorable and not quite as foreseeable. It was often unexpected moments interacting with the group that were most euphoric: a coming together….a sharing of stories…a discovery of common interests…..singing songs…a realization that someone used to work at the same hospital back home.
There was also the learning: Learning from the life experiences of others in the group and especially learning from the people of Ecuador. I suspect that each participant learned something unique from being a guest within the indigenous communities and within Ecuador itself. The cultural beliefs and customs were fascinating and educational for me from beginning to end. I could write a thesis on what I learned and experienced from their rich culture but what impressed on me most personally was the way the people in the isolated communities experienced everyday life and their attitude about it. It was certainly a life without the luxuries taken for granted in modern society which impressed me the greatest. A sort of simple living and content self-sufficiency apart from modern conveniences reminiscent of Thoreau as he took to a Life in the Woods.
Then there was the nature. I frequently think back on the sight of mountain peaks lining up as far as the eye can see as if all standing in an eternal line, the lakes hiding amongst the volcanic peaks, and my favorite by far: looking down at the world below from above the clouds. These pictures show you what it looked like, but neither photos nor words can sufficiently convey the view, the feel of the wind and clouds, and the smell and sound in the air simultaneously stimulating the senses.
Lastly, an over-arching sense from my ‘Tandana experience’ was one of coming together. Indeed, the Tandana Foundation points out the name means “to unite” in the local indigenous language of Kichua. If I had to reluctantly pick only one descriptor of my HCVV experience, it would be “unity”. The sense of unity began with the formation of one medical team out of 14 strangers with very diverse backgrounds on day one. This sense of unity continued throughout the trip as we were guests and ambassadors among many different indigenous communities.
Through no choice of my own, I was born in a country of opportunity and am fortunate to have the opportunities in medicine that I have had. During the HCVV, I enjoyed sharing some fruits of my good fortune with those that, through no choice of their own, were born into a community literally on the edge of the world; far, far away from any level one trauma center, ivy league school, or family medicine clinic.
The case of the woman with hypertensive emergency had an optimum outcome, due in large part to the donations we had received for that mission. A large part of my time with her was dedicated to drawing pictures and using help of interpreters to explain her medical condition and discuss plans for after our departure (She had up until that moment absolutely no understanding of her condition. She had thought of it like a bug bite, that goes away after a few days and a few pills). We gave her a relatively new, hypertensive medication which was donated from Direct Relief International. It enabled us to quickly remove the immediate threat to her health. Experiencing the smile on her face from being free of symptoms, and her joy of understanding her condition is hard to describe. It was a moment that reminded me why I love medicine so much and why we were there. But it was just one little moment amongst so many that together gave me my ‘Tandana experience’