San Andres Medical Outreach

Mission Trip to San Andres October 18-26, 2014

The Picture of Health Foundation Inc. was asked by Chijan Charitable International Foundation to participate in a medical mission trip to San Andres and Providencia, Columbia. The history of the island is quite intriguing. The islands are politically tied to England and are a part of Columbia.  Enslaved people of West African birth were brought into the island by British ship-owners in 1633 from Jamaica to work in lumbering and to grow cotton and tobacco.

The Islands changed hands over the next few centuries from Spaniards, to the pirate Henry Morgan who used it as one of the centers of operation. It became a part of New Granada in 1810 and in 1825 a part of Columbia. The slaves were freed in 1834 and were sole owners of the properties on the Islands until 1953 when General Pinella declared the Islands a free port. This brought in mainland Columbians and the tourism industry. The native Islanders (former slaves) have become a minority in their own land. They have insulated themselves from mainland culture and language. They abandoned agriculture and do not have the skills to assimilate into the “columbianization of their land.  They are employed in low wage jobs and have accepted their faith, selling much of their land for cheap Columbian pesos during the “free port boom. The Island has become overpopulated with close to 100,000 people on an Island only 21 square mile.  These are the people that were targeted for the medical mission outreach.

Our Team consisted of Clement Nwosu MD, founder of Chijan, his wife Janet Nwosu RN, Carley Ebanks MD, his wife Marcia Ebanks RN, Dialysis Tech Chris Jackson, and ICU nurse Marisol Dyer RN. They teamed up with two POHF board members Roberto Springer PA, and Donovan Christie MD, Founder of POHF. All preparation for the trip was secured by the Chijan Foundation.

We departed from Atlanta, GA on October 18th at 6pm and arrived in Panama City, Panama that evening. There is only one flight from Atlanta to Panama and only one flight from Panama to San Andres earlier in the day. This necessitated that we stay overnight in Panama. We then left the following day and arrived in San Andres at noon time. We were greeted by the hosting organization, Island Hope and about 8 members of the team.  Dr. Downs Stewart, Medical Coordinator, San Andres Departmental Hospital and founder of Island Hope established it a few weeks prior to our trip.  The members wore logoed white golf shirt that allowed us to identify them immediately. They were warm and excited about our trip and catered to our every need while on the Island.

Dr. Stewart made preparation for all our meals at local restaurants, garnered the participation of the Columbia air force, the Governor of San andres, secured the clinic sites, community activities, housing, all ground transportation and entertainment. We were treated with a major sense of appreciation by all we met and team members. After lunch at Trattoria restaurant consisting of fish, salad, rice and plantains, we were shuttled over to our guest house. The accommodation was better than most of the POHF medical mission trips. I roomed with Roberto and Chris and we were blessed with running water, shower and toilet with 3 twin beds in the room.  The guest house had a pool and was right next to the beach. We eat breakfast daily prepared by the guest house staff of 3 women. After lunch and check in we were invited to a welcome presentation put together by the San Andres tourist board and Island Hope held at the Columbian air force lecture hall. After several PowerPoint presentations, Dr. Nwosu was invited to introduce our team.

We learned that the overcrowding of the Island has created many problems for the population as the accumulation of waste has been a burden. Much of the food source has been imported such as vegetables and canned foods. This has contributed to a childhood obesity rate of 44%, quite similar to the rates in the US. The primary mode of transportation is by scooters. It seems as though everyone had a scooter, men women and teenagers all rode them up the streets and none of them wore helmets or other body protection. While on the Island we witness and also treated several people who suffered from skull fractures, extremity fractures and other internal organ injuries. The history of San Andres presentation was given by the counsel general for Jamaica, an optometrist, Dr. Robinson who later joined our team on our trip to Providencia. We brought over 350 reading glasses that were dispensed over the 4 days of clinic.

Later that evening we were invited to speak at 2 different churches. Dr. Ebanks and I went to the Baptist church and Dr. Nwosu and PA springer went to another church. I gave a presentation on “healthy lifestyles” utilizing healthy nutrition, exercise and spirituality and then we took questions from the church members. Question was typical and ranged from Gastrointestinal, cardiac, neurological and endocrinology. We were then picked up from the church and had a late dinner at Miss Celia taste restaurant.  That first day on the Island was packed with activities and we were happy to get back to the guest house for rest. We would start clinic bright and early at one of two sites on San Andres.

The first clinic day was quite busy. We were picked up in a van with all the medicines and supplies brought from the US.  Roberto and I shared a room with a divider in one of the Pastors of the church. The clinic was situated at the La Loma cultural center administrative offices for the Catholic Church.  I used a massage table for my exam table covered with drape. Triage of patients were done on the front lawn with key vital signs, chief complaint by Marisol and Chris, the make-shift pharmacy was attended to by Marcia and Janet and Dr. Nwosu and Dr. Ebanks focused on Internal Medicine, Gastrointestinal and Kidney concerns. Roberto and I saw patients of all ages men, women and children.  Dr Nwosu trained one of the rural doctors who just finished medical school how to fit patients for reading glasses.  We documented our visit on a form and wrote prescriptions on the hospital prescription pads. The patient then was referred to the back of the building where the pharmacy was set up for medications, vitamins and free give-a-ways.  At the end of the day we had seen and treated over 213 patients combined. I saw 58 of those.  We ended clinic at 7pm, packed up all the drugs and supplies and headed to the Trattoria restaurant for a delicious sponsored meal consisting of grill chicken breast, rice, and salad.

We treated common conditions and not esoteric ones. We gave knee injections of corticosteroids for painful arthritis, IV antibiotics for fever and performed several skin procedures. The most interesting case of the day was a 12 year old boy who 6 weeks ago was airlifted to Bogota, Columbia for acute brain injury. He was hit off his motorcycle and suffered an open skull fracture. His initial prognosis was grave but his mother had an amazing faith in God and 3 week later he would walk out of the hospital after mechanical ventilator support, craniotomy, and abdominal exploration with Gastro tube insertion. He walked in slowly and communicated with slurred speech but was alert and smiling.  We took his gastro tube out and abdominal sutures and he and his mom was very grateful. We ordered additional physical and speech therapy for him at the local hospital. He would be one of many patients with head injury from motorcycle accidents.

That evening we realized that we were short on several medications including acid blockers, antifungal medications, antiparasitics, ant-allergy medication, etc. so Roberto was task with the job of buying more medication at the local pharmacy.  With the help of Dr. Stewart and his team we were able to get additional medication at a major discount the following morning.

Day 2 clinic was set at the recreational hall of the Catholic Church. Roberto and I had a room upstairs in a consultation room. We treated many adults, children infants with arthritis, diabetes, other endocrine disorders, respiratory illnesses and cardiovascular disease. Many of the patients had seen other doctors but wanted our opinion on what should really be done. It always amazes me to see how oversees people respect the opinion of American doctors.

Dr. Stewart had garnered the support of community organizations including several high scholars for Spanish translations. I worked with an 18 year old boy the in the morning and a 16 year old girl in the afternoon. The students had a quiet demeanor, respectful of the patients and were quiet mannerly. The student assisted us in obtaining the medical histories and in explaining treatment plans. I saw many patients who had metabolic syndrome a condition consisting of the tetrad of high blood pressure, diabetes or sugar intolerance, high lipids particle or cholesterol and overweight or obesity. The US dietary influence had definitely taken its toll. The most interesting case for me was a case of congenital torticollis. At the end of the day we saw over 240 patients and desperately needed some rest. We eat dinner at the Trattoria and headed back to the guest house.

Day 3 was a travel day. Our plans included taking a Columbia air force plane for a 20 minute ride to the island of Providencia. The day started with a 6:00am work-out at a local gym and what a stress relieve spinning class. With a 3pm departure time, we decided to take a tour of San Andres. On one end you have million dollar hotel resorts and on the other end you have the public housing and modest private housing. We visited the local hospital called Amor-de-Patria and was toured by the chief administrator. We toured the ICU, IM and Peds units. There was also a hyperbaric chamber that had not worked for several years.  We then went to visit the Governor in her office and onto Island House museum. We had lunch at a fishery, coffee at Juan Valdez and hurried to get on the military aircraft.

Day 4 was the most productive. We teamed up with several Columbian doctors who accompanied us to the Island of Providencia. Two military doctors: An Optometrist and orthopedic surgeon and 2 local young doctors: An obstetrician and Pediatrician resulted in the doubling of our team. They would work both days side by side with us at the only hospital on the Island of Providencia. It was a 2 story facility that had 20 beds and an Emergency Room. The hospital personnel were very accommodating. I set up my station in a hospital room equipped with crash medicines and power exam table. Another military doctor worked with me as an intern, writing out the prescriptions that I ordered and assisting with translation. I performed all the examinations and procedures. My nurse was Marisol on these 2 days as the hospital personnel had plenty of nurses to provide the intake and vital signs. Marisol started several IV with fluids and antibiotic drips. I removed warts, injected joints with steroids and treated one patient with a blood pressure of 260/150.  The normal blood pressure is 120/80. She was completely asymptomatic but when asked did confess to unsteadiness at times.

On this day we say over 700 patients and worked till 7pm. On this day I saw 67 patients including 2 in the Emergency room; a woman with hysteria after the loss of her mother and a 2 year old injured in a motorcycle accident. The Optometrist worked until 9pm as people had woken up at 4am and arrived by 7am to get appointment to see the doctors. He saw 60 patients and prescribed glasses and other treatment for their eye problem.  On our way back to the guest house, we were diverted to the town square where some town’s people had planned a special event for us. 5 performers with traditional guitars, drums and horns played local reggae and meringue music solely on our behalf. Several yards from the town center were a lighted bride that connects Providencia to the Island of Santa Catalina.  We all followed our sponsor and walked on the bridge to get to the other side. The homes on Santa Catalina were very modest; there were neither schools nor supermarkets. Islanders would take the 15 minute walk over the bridge to Providencia for school and other amenities. They thanked us for the work we were doing for the people of Providencia and San Andres. We got back to the guess house and had dinner prepared by the guest house staff.  After that we went for an evening walk to the local bodega for some fresh bottled water and then back to the house for some rest and relaxation.

Day 5 was equally as interesting and very productive considering the time that we arrived at the hospital. We started at 10am and ended at 1pm. We still managed to see a total number of 188. That brought our total tally to over 1300 patients seen and treated in all of 4 days of clinic. Amazing! God’s grace is truly abounding.

The people of San Andres and Providencia in the Archipelago of Columbia are truly amazing. Their ancestors were able to endure slavery and now they are still trying to preserve their heritage. I believe that the benefit of mainland Columbians invading the Island outweighs the preservation of the West African-Jamaican slave’s way of life.  The people need to adjust to the new way of life, take advantage of the services provided by the Columbia government such as education, healthcare and infrastructure development and persevere.  Insulating themselves on one hand is good to preserve culture but it should not prevent them from getting educated and adapting to our ever changing way of life. That is the only constant thing in life and that is change.

The government needs to set rules for motorbike safety, such as mandating helmets. They need to make them readily available by purchasing them and selling them for an affordable price. Everyone on a motorcycle should have a license to operate one and the age should not be 12 but 16 years old. There should be rules governing how many people can be on a motorcycle at time. Children need to wear protective wear at all times while riding. It breaks my heart to see the risk that is taken when a mother has a 2 year in the front and a 2 year old in the back of her motorbike. It is not as if accidents are infrequent, they occur every day.  We saw many cases of head trauma and limb fractures in our 4 days of clinic.

The other big need is in agriculture and industry. They need to develop vegetable gardens. This is a tropical Island and I find it very hard to believe that the soil is not suitable for green vegetables such as spinach, calaloo, broccoli, green beans and other cruciferous vegetables. The current diet is leading to a morbid state of obesity. Yes, there are fast food restaurants there but I do not believe that the natives frequent them as much because of the lower paying jobs they hold. Instead it is the native diet that is filled with starch such as bread, plantains, breadfruit, cassava, and fried meats.  I saw hundreds of people with the metabolic syndrome and it was just as prevalent as it is here in the United States of America. I gave out copies of the Natural carbohydrate program to most of my patients as I believe they would benefit from the education on nutrition. I told many that I would be back in a year to check to see if they lost weight.  I can only hope that this preventive health specialist will have an impact on the lifestyle of at least 10 percent of the people I treated and counseled.

That afternoon, we hurried to the airport to catch the military aircraft flight back to San Andres. We were told 30 minutes before the scheduled time that the plane was having technical issues and that the flight was canceled. We had to catch a 6pm flight from San Andres back to Panama where we would fly back to Atlanta the following morning. If we missed San Andres flight we would be stranded for another day and having to pay additional fees. Luckily God had a plan. The military was able to get a 6 seat small plane to bring us back from Providencia to San Andres. It made 2 trips. I was on the second trip and arrived only 45 minutes before the scheduled departure of the plane from San Andres to Panama.

This trip was exciting, enjoyable, rewarding and truly remarkable. Everything just seemed to work itself out when you are doing God’s work. I want to thank Chijan and Dr. Clement Nwosu for inviting me on this trip. God grace truly shines on us.