Dr. Margaret-Mary Wilson was born in Nigeria but, because her father was in the foreign service, grew up mainly in England, flying back and forth between separate worlds. She is now associate professor of geriatric medicine at the Saint Louis University School of Medicine, and she replied gladly when the Association of Nigerian Physicians in the Americas invited her to their annual conference. But when she mentioned her specialty, they responded, “Geriatrics is not relevant in Nigeria.”
The dismissal threw her.
“My mother is 79; my father died at 82,” she says. “Granted, that’s the socioeconomic upper crust. But there have to be some older people surviving—what happens to them?” Wilson flew into action. “I asked my partner, who is a registered nurse but retired, and a third person if they would donate their time,” she says. “Then I found a Catholic nursing home called the Home for the Elderly. A physician had not been there in 15 years.”
In July 2004, Wilson’s tiny team arrived. “We took general health histories, did preventive screenings, offered a free acute-care clinic. Then, at a priest’s urging, we went to Bodo, essentially a collection of huts, and set up in the church. We saw 150 people that day, some in their nineties.” Finally Wilson set up a table and chair on the roadside in a larger city and announced, “I’m screening for blood pressure.” She was mobbed. And 98 percent of the patients she saw on that trip had high blood pressure.
“Medicine is available to them, and the generics are cheap, but people don’t know what to ask for,” she says. She intends to return to Nigeria this month and do more screenings.
She pauses, thinking back to the first trip. “In the Home for the Elderly there was this resident who couldn’t walk or talk—she just grunted, and she crawled because they couldn’t afford a wheelchair. She had probably had a bilateral stroke; she was paralyzed on both sides. The attendants said to me, right in front of her, ‘We don’t even know what language she speaks; she just crawls around like an animal.’ So I got down on the floor next to her and asked, ‘How are you doing? Are you in pain?’ When I asked about pain, she got very animated, and I saw that she had some movement in her hands. I said, ‘Raise your right hand,’ and she did. She could speak English. She’d been there for five years. I turned to the attendants and said, ‘Do you understand that this lady can speak English?’
“At that point I said to myself, if this is the only thing this trip has accomplished, this is more than enough.”
Dr. Robert Paine has so many emeritus titles, he could prop his feet up on his curriculum vitae and snooze. Now 84, he is emeritus professor of clinical medicine at the Washington University School of Medicine and emeritus chief of medicine at St. Luke’s Hospital, where he headed cardiology.
But instead of snoozing, he calls in favors. Five years ago, at the urging of his energetic wife, Jane Paine—“She’s the real altruist, she’s an ex-social worker”—he rounded up volunteers and started a free clinic.
“Medicine was in a bad way, and we needed to get preventive medicine in place without scaring people off,” he
A mother brings her daughter for cleft palate surgery by St. Louis physicians in the Peruvian American Medical Society.
says. “We cooked up the name A School for Patients, University City let us use its library and University City East took us under their umbrella as
a nonprofit.
“We’re not a health fair,” he adds. “We diagnose and educate and send people to clinics for treatment, because most don’t have a bit of insurance. We track their progress, and, if the results aren’t good, we haul ’em back in.” He smiles. “You look around this great big auditorium, and there’s not a durn soul getting paid and there’s not a durn soul payin’.”
Paine pulls out a beautifully neat handwritten list: column after column of volunteer physicians and clerical staff and administrators who have lent equipment. “I don’t want to look like a goody-two-shoes here. This is a team effort.” He says long lines of people come for free screenings, “all with kind of frightened faces. When we tell them, ‘This is normal,’ it’s like the sun came out. But half have had high cholesterol; one fourth have had high blood pressure; a significant number are anemic. So we know we’re not a well-baby clinic.” After each screening, he makes sure the patient has a chance to consult with a physician. “Some people come back to our clinic several times to have that conversation again and again. Most don’t have a family doctor—they use emergency rooms—and the setting in an ER is not peaceful. With us, they can stay as long as they need to, and the doctor won’t look at the clock.”
About 11 years ago, Dr. Mark Manary began giving his time in Malawi, a country in southeast Africa that’s about the size of Missouri, with 12 million people and a $44-a-year median per capita income. Every year, between 10,000 and 15,000 children are so severely malnourished that they’re at risk of dying. “Their life would be saved at the hospital, and they would go home and still be malnourished,” says Manary, attending physician in emergency medicine at St. Louis Children’s Hospital and associate professor of pediatrics at Washington University School of Medicine. “In 2001, we said, ‘We have to break this paradigm.’ So we started treating children at home with a special peanut butter mixture. Nobody has to cook it, and it doesn’t spoil, because there’s no water for bacteria to grow.”
The results were radical: Ninety-five percent of the children were recovering, compared with the 50 percent who had made up the best-case scenario. Now Manary spends several months in Malawi every year working on Project Peanut Butter (www.projectpeanutbutter.org). “We’ve actually started a small factory to make the food locally, and soon we should have enough for most of the country,” he says.
On his first trip, a woman who was mentally ill, living on the street, showed up with her granddaughter. The little girl was a year-and-a-half old and weighed 11 pounds. “People said, ‘Why are you messing around with this kid? She probably has AIDS,” recalls Manary. “But after two months of feeding, she was much bigger and taller.” He pauses. “Milika comes to see me every year. On my last trip, she was wearing a blue jumper, and she was all excited, with this big wide smile. She was starting school.”
Katie Plax didn’t grow up wanting to be a pediatrician. In the fifth grade, her ambition was to be president. “I was one of those kids who talked about injustice and poverty,” Plax says. “I always had that bent.”
After graduating from Brown University, she worked at a small nonprofit, helping families with members infected with HIV. “The medical director spent a lot of time talking to schools so kids with HIV could go to school,” Plax says. “When I saw that kind of community participation and what it meant for kids, I thought, ‘OK, that’s the kind of doctor I want to be.’”
Her sights settled on the lack of access to health care. “When I graduated from my residency, I worked in one of the county health centers,” she says. “There were all these kids out there who were eligible for health care but weren’t on a plan.” Funded by the Soros Foundation, she
spent the next two years working statewide to get a “presumptive eligibility” policy passed in Missouri, making it easier for kids to get enrolled in Medicaid.
“We won,” Plax says, a bit incredulously. Through the experience, she learned how to untangle the web of government and acquaint herself with all of the community organizations working to help children in need. She decided that this was information other doctors needed to know. “These skills are not part of doctor training,” she says. “Public policy is not necessarily part of medical training.”
It is now. Plax has implemented a program at Children’s Hospital called Pediatricians in Community. During a new two-week rotation, residents spend a half-day or day with some of the 26 organizations partnering with the hospital. “I really wanted to have the pediatricians get involved with the community organizations and really learn about some of the issues that kids in poverty and those with special health-care needs face,” Plax says. “I also wanted them to learn all the assets that are outside these four hospital walls.” Afterward, enthusiastic residents told her that the experience had reconnected them to what originally drove their decision to become
a pediatrician.
Plax splits her time 50-50 between advocacy and seeing patients in Children’s adolescent center. “My patients keep me grounded,” she says. But she also spends hours trekking to Jefferson City, and the fact that more than 68,000 parents in Missouri are soon to be removed from the Medicaid roster has added urgency to her message. “When parents don’t have coverage, kids don’t go to the doctor,” she says. “And if parents aren’t healthy, how are they going to take care of their kids, go to work and provide for their families?”
Almost 14 years ago, Dr. Eliot Casey, chairman of pediatrics at St. John’s Mercy Medical Center, got a call from a friend, a Passionist priest who was building a clinic in Honduras. “I offered to help in what I thought was going to be a very superficial, peripheral way,” Casey says, wry laughter in his voice. He’s been in Honduras every year since, expanding the clinic, helping with nursing outreach, getting equipment, finding current medical books in Spanish, coordinating a seminar, raising money for a medical-waste incinerator (AIDS is a huge problem) and improving the laboratories of what is now the fully staffed, multiservice San Benito Clinic.
Casey remembers his first trip: Before going to the clinic, which is located in a remote area, he visited the local hospital to learn what diseases were typical. The medical director obliged with a tour that Casey’s never forgotten. “There was dirt on the floor, the bed linens were dirty, the ICU was a big closet,” he says, wincing. “I saw a young girl, 9 or 10 years old, with a bone infection in her leg, something that could easily be treated in this country. The bone had been eaten away—you could see where it used to be. She was just lying in her bed—kids there are kind of apathetic; they don’t get a lot of support. People are so overwhelmed, they can’t respond. We call a doctor, we call a lawyer, we call a reporter. They are powerless.”
Casey left the hospital thinking, “If we can provide an antibiotic that will change this in another patient, it’s absolutely worth it.” And he’s moved heaven and earth to keep the San Benito pharmacy stocked ever since.
If it’s spring and you’re asthmatic, you don’t want to live in St. Louis, says Dr. Lee Choo-Kang, pediatric pulmonologist at St. John’s Mercy Medical Center. Our city ranks third in the nation as the worst place for asthma. But if you live in the inner city, you suffer more, all year long. Choo-Kang estimates that the instance of asthma there is 50 percent higher than it is in the suburbs: “It has to do with the living environment, the socioeconomic environment, allergens in their environment and irritants like cigarette exposure.”
Choo-Kang is a man on a mission: to help those underprivileged children with their asthma. A native of Guyana, he has experience with poverty; his country is one of the poorest in the Caribbean. He writes in an e-mail: “In life, I believe that each of us are given a gift that becomes his or her responsibility to use for the betterment of others. I also do not believe in coincidental occurrences. I am here in St. Louis with the knowledge and skills of a physician, specifically trained in childhood respiratory diseases for a specific reason.”
That reason is to establish a mobile asthma clinic for children in the city of St. Louis. (Such clinics already exist in Los Angeles, Detroit, Phoenix and Washington, D.C.) Choo-Kang intends to raise enough money to convert a Winnebago into a fully equipped doctor’s office complete with exam rooms, diagnostic equipment for breathing tests and allergy testing, a physician or nurse practitioner, a respiratory therapist/nurse and a driver/social worker. The plan is to visit several schools a week.
“The inner city has the highest number of kids who are underrecognized and undertreated,” says Choo-Kang. The school nurses will identify the kids who miss the most school, who come in asking for an inhaler, require breathing treatments, wheeze or complain of difficulty breathing. “Our intention is not to just go once but to go back to those schools,” Choo-Kang says. “Our goal is to start a treatment plan.”
In 1991, Dr. Jeffrey L. Marsh, director of pediatric plastic surgery at St. John’s Mercy Medical Center, began visiting Children’s Hospital in Bangkok to teach a local pediatric surgeon to perform surgery on cleft lips and palates. Soon Marsh was on the advisory board of Smile Train (www.smiletrain.org), a nonprofit group focused on cleft lip and palate, with Southeast Asia as his territory. And in 2002 he fell in love with Bhutan, which he describes as “the only surviving Buddhist Himalayan kingdom and the only country I’ve ever been where human beings are actually living in harmony with their environment.”
Marsh took on the medical directorship of the WEcare program, focusing on cleft and other reconstructive work in Bhutan. He spent his first day screening patients, triaging patients with burn injuries (wood heating is prevalent there) and facial injuries resulting from the swipes of startled Himalayan black bears’ claws across people’s faces. “You figure out how many
you can take care of and set a schedule, and people still keep wandering in,” he says. “The day before our last surgery day, two young boys, cousins age 7 and 8, came in. Both had unrepaired bilateral cleft lip and palate, where the center of the face is disconnected from the side of the face so there’s a visible opening. They had walked two days through the jungle with just a knapsack of food. Our schedule was full, but ... this was why we were there.”
Marsh performed surgery on both boys that evening. And when he finished, the boys’ faces had been reconstructed, their palates repaired so they could speak intelligibly.
Trip well spent.
Drs. Anibal Zambrano and Ronald Mera are Peruvian. Every other year, they go home. But they don’t go alone. Through the Peruvian American Medical Society (www.pamsnational.org) they organize missions to their homeland, bringing physicians, dentists, nurses and a boatload of equipment. “Our objective is to help the poor people of Peru and improve medical education in Peru,” says Zambrano, a cardiologist. Mera, an internist specializing in geriatric medicine, calls it “a payback to our country.”
The St. Louis PAMS missions have set up gastroenterology clinics in Cajamarca and Iquitos. Orthopedic surgeons have taught physicians there how to perform laparoscopic surgery. Ophthalmologists perform cataract surgery. Plastic surgeons correct cleft palates. “The most important part of the mission is to teach the other doctors to do the procedures,” Mera says. The group also has built a playground and offered dental and medical care to the local orphanage.
“The doctors receive us with open arms,” Zambrano says. His most vivid memory is from Cajamarca: “The last day we were there, a lady who was 45 years old and had a cleft palate came in. Her face was covered. She asked us if we could treat her. The plastic surgeon said yes. It took about six hours to complete the operation. The following day, the surgeon asked her if she had seen her face, and she said no. He asked why, and she said she didn’t have a mirror. They gave her a mirror, and when she saw her face, she cried. She went down on her knees and kissed the surgeon’s white cloak. Everyone in the room was crying.
“We had changed the life of someone who for more than 45 years wasn’t able to show her face.”
By Christy Marshall And Jeannette Batz Cooperman
