In Guyana clinic, U.S. Students Learn Tropical Medicine and Corporal Works

The indigenous families living in this South American jungle village came early to see the American doctors running a free health clinic.

They paddled dugout canoes for miles on the placid waters of the Wakapoa Creek, gave their names and sat on wooden benches to wait for what may be their only doctor's appointment in a year. Nylon hammocks and silky mosquito nets in which the doctors slept hung on the walls around them.

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Some came for a checkup and for a little plastic baggie of vitamins and iron pills the doctors had carried from the United States in heavy plastic bins. Others were looking for a diagnosis to illnesses they had battled for months or years.

"You have to pay for the doctors in Guyana and they don't tell you what's wrong with you," said Herman Emanuel, 58, who began shaking uncontrollably and losing weight seven months ago while he was diving for diamonds and gold in one of Guyana's mineral mines.

None of the three local doctors he visited gave him a diagnosis. But within hours, the doctors inside diagnosed him with hyperthyroidism and arranged for a free surgery.

"That's why I come here," he said.

"Here" is a rudimentary health post set on stilts and operating without running water or electricity. For a few days every year, Mercy Sister Karen Schneider calls it home.

Sister Karen, an assistant professor of pediatric emergency medicine at Johns Hopkins University, has been traveling here every year since 2003 to lead a team of Hopkins pediatric residents in a two-week course in tropical medicine. The course is education for the residents, who choose it as an elective, and part of Sister Karen's commitment to providing free medical care to poor, marginalized populations in Guyana, Haiti, Kenya and Nigeria.

"I have a passion for treating poor kids," she said in an interview with Catholic News Service from the clinic. "I try to provide medical expertise to some of the remote areas that don't have a pediatrician. And for the residents, I hope it teaches them how to practice medicine in resource-poor settings."

In Guyana, the team traveled from the capital, Georgetown, where grasses grew tall in unkempt medians and thick dust accumulated on busted sidewalks. They boarded buses that took them to boats, which cruised down rivers past sherbet-colored homes built on stilts with mounds of sun-bleached coconut husks in their front yards, past thick mangroves where squirrel monkeys leaped from branch to branch. Six hours later, they arrived in Wakapoa, a remote outpost carved out of thick jungle, where they slept in camouflage hammocks under mosquito nets to avoid mosquitos that transmit malaria.

The area's indigenous people, known as Amerindians, are among the poorest and most marginalized populations in South America. The United Nations estimates more than three of every four Amerindians lives in poverty, compared to roughly one in three for the rest of the population.

The clinics are intended to be pediatrics training. On this day, as the sun drenched the white sands of the village and children wearing starched white and green uniforms streamed in on their canoes to attend primary and secondary schools, Ashmini Alexander, a mother of three, arrived concerned about a growth on her infant's upper lip.

Taryn Hill, 30, a second-year resident from Austin, Texas, held the 4-month-old boy, with a growth called a hemangioma, the size of a small peach on his upper lip. The tumors, which eventually disappear on their own, are easily treatable in the U.S., but the medication was not available to Hill. The best she could do was reassure the mother.

"This is normal," she told Alexander. "It will continue to grow and then it will get smaller and smaller."

Hill, frustrated by her inability to treat the child, would have redemption a few hours later. As the clinic's zinc roof popped and crackled, expanding under the equatorial sun, Hill examined a 1-year-old with a cleft lip and palate. She dutifully took the mother's name and contact information and vowed that she would be contacted when a U.S. surgeon travels to the country, likely next year.

As she has done several times in the past, Sister Karen is planning to bring a Johns Hopkins plastic surgeon to the country to repair a handful of cleft lips and palates, including the child Hill examined.

While the clinics are aimed at pediatrics, they draw as many adults as they do children. Sister Karen and the residents visited an orphanage and a leper colony. They screened schoolchildren and carried medication for rheumatoid arthritis to a 30-year-old woman who suffers with so much pain that she spends most of her time in a hammock.

And with every trip, there is an emergency, such as the night Sister Karen opened her laptop to lecture the residents on typhoid fever.

Before she could finish the lecture, Conrad Emanuel burst into the clinic from out of the night covered in second- and third-degree burns. A kerosene tank had exploded, shooting flames down his left arm and across his abdomen.

The residents, soon-to-be pediatricians, erupted into a buzz of activity, unpacking gauze and sliding on pale blue surgical gloves.

They washed Emanuel in saline solution and Jennifer Kamens, 29, began to "scrub" at the burned skin with handfuls of gauze. The brown skin sloughed off in clumps and sheets, leaving behind a layer of flesh as white and smooth as cooked chicken breast. He felt no pain at first, a sign the burn destroyed nerve endings in his forearm. But as Kamens continued to scrub, he writhed in anguish and his muscles twitched.

Sister Karen, meanwhile, sat patiently behind the team on a plastic chair, offering only occasional advice, such as whispering a reminder in the lead doctor's ear about providing pain medication.

"I so wanted to just take over and do it myself," she said later. "But at some point you have to step back and trust them, because this is what they are trained to do."

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