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ACG PERSPECTIVES
GUATEMALA ENDOSCOPY INITIATIVE:
By Bryan G. Sauer, MD, MSc, FACG
IN FEBRUARY 2019, I was part of a group of gastroenterologists, endoscopy nurses, and a nurse anesthetist who traveled to Santiago Atitlán, Sololá, Guatemala to the Hospitalito Atitlán to provide endoscopy care.
The trip was the culmination of work and planning that started several years in advance. My wife is from El Salvador and I speak Spanish and I had been looking for an opportunity to serve others in Central America. I meet Dr. Michael Dougherty when he applied for GI fellowship at UVA and he shared about his experience as an internist at the Hospitalito Atitlán in 2015-2016 as part of Penn’s Global Health Program, so that helped move things along. I visited in April 2016 to evaluate the facilities and to connect with local physicians to understand the endoscopy needs in the region and began fundraising and seeking donations of endoscopic equipment.
ADDRESSING AN UNMET NEED
Endoscopy in the Sololá region of Guatemala is limited. Most patients are referred to Guatemala City for endoscopy services. For most individuals in the region, a day-long travel to Guatemala City for an expensive procedure is not feasible and many forgo endoscopic evaluation. In 2016, an endoscopy needs assessment was conducted in the Sololá, Totonicapán, and Quetzaltenango regions of Guatemala and concluded that there was a significant need for endoscopy services.
In 2017, I partnered with Americares and Olympus to provide endoscopy equipment to be stationed at Hospitalito Atitlán to allow endoscopy services to be provided in the Sololá region. In 2018, I set up the equipment at Hospitalito Atitlán. Then in February 2019, the first clinical care team performed a week of endoscopies with the help of Dr. Dougherty (a fourth year fellow at UVA), Dr. Nicolas J. Nickl, MD, (retired from the University of Kentucky), nurses Farren Dodson, Terri Rodee, and Sarah Schumacher, as well as nurse anesthetist Dixie Mills.
During four days in February, forty-three endoscopic procedures were performed including upper endoscopies and colonoscopies. The team was able to diagnose conditions including H. pylori-associated gastritis, erosive esophagitis, gastric ulcers, gastric cancers, colon polyps. One older gentleman was seen in the outpatient clinic on Tuesday with issues of chronic vomiting and weight loss. He underwent upper endoscopy on Thursday and was diagnosed with a cancer of the stomach causing gastric outlet obstruction. He will be referred for further cancer treatment. The family expressed their gratitude for the excellent and efficient care that was provided at the Hospitalito Atitlán, particularly made possible by the presence of endoscopy services. Patients were universally thankful for the medical care they received and appreciative of the endoscopy care team.
MAKING AN IMPACT
When asked about the impact of the trip, Lyn Dickey, Director of Development at the Hospitalito Atitlán responded, “It is difficult to do justice in expressing the tremendous impact that the equipment and services provided by Dr. Sauer and his team had for the community of Santiago Atitlán. We live in a place where previously there had been virtually no access to endoscopy and colonoscopy services, leaving many gastrointestinal illnesses and problems undiagnosed and unsolvable.”
She added, “Dr. Sauer and his team worked with great organization, kindness and professionalism, and our patients were overwhelmingly grateful for the services they received. On behalf of the people of Santiago Atitlán and its surrounding communities, we thank them immensely for their work and hope to continue working together in providing more of these procedures in the future here in Atitlán.”
PLANS FOR THE FUTURE
With endoscopy equipment now available at the Hospitalito Atitlán, clinical endoscopy team trips are being planned several times per year. Furthermore, foundations have begun to understand the patient population and disease entities encountered through research projects so that care and services can be best tailored to the population. Finally, training of local staff and physicians will continue to be a priority so that the endoscopy services can be used year-round to enable access to care at all times.
—Lyn Dickey
(1) First Endoscopic Procedure, February 25, 2019 (used with permission); (2) Guatemala Medical Team L to R: Bryan G. Sauer, MD, MSc, FACG; Sarah Schumacher, RN; Terri Rodee, RN; Farren Dodson, RN; Michael Dougherty, MD; Dixie Mills, CRNA, and Nicholas J. Nickl, MD; (3) Guatemala Endoscopy Team and Hospitalito Atitlán Staff; (3) Hospitalito Atitlán.
FUNDING: A STRUGGLE
One struggle that I have had is finding ways to fund the medical trips. For our first trip, the nurses/ CRNA agreed to pay their own way for the trip (and take vacation time, etc.) We were able though to raise a fair amount of support with a GoFundMe page to at least pay for the flights, although this is not feasible for more trips. So, my next venture will be to find grants/ donations that will help fund the medical team trips to at least pay for the flights for each trip.
AN INVIGORATING AND REWARDING EXPERIENCE FOR THE GI TEAM
Besides being able to provide much needed endoscopy to a region of Guatemala, the team members found the week invigorating. Farren Dodson, RN, commented, “The trip was rewarding personally and professionally. The Hospitalito Atitlán graciously welcomed us and provided an excellent facility to provide services. It was great to be immersed in Guatemalan culture, provide needed endoscopy care, and collaborate with the Hospitalito nurses and staff.”
The healthcare team left having gained insight into the greater health landscape in Latin America and learning valuable insights into Guatemalan culture. The week in Guatemala can be summed up with their adopted motto, “Work hard, serve others, and have fun.” The group did this in their week and look forward to a return. For more information, please feel free to email Dr. Bryan Sauer:
bryansauer@virginia.edu
Bryan G. Sauer, MD, MSc, FACG Associate Professor of Medicine, Medical Director of Endoscopy; Division of Gastroenterology and Hepatology, University of Virginia Health System
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