Volume 50 Number 2
H
O O S I E
D O
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Spring 2011
Published by The Indiana Association of Osteopathic Physicians and Surgeons, Inc.
IN THIS ISSUE Member Concerns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 114th Annual Convention . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 Tips from Our Consultant . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 AIOA News . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10 Coming Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19 Practice Opportunities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20
Spring 2011
THE GUATEMALA ADVENTURE By: Terry C. Gehlhausen, D.O.
My trip to Guatemala was intended to be a celebration of my 60th birthday, an exclamation point for becoming a sexagenarian! Originally, I planned to join a DOCARE medical mission going to Malawi, Africa. After applying and being accepted, that mission was scrubbed because it was “no longer medically safe”. DOCARE is an organization for Doctors of Osteopathic Medicine that provide medical care to people in third-world countries. They have been going to Guatemala, in Central America, for 15 years. Various missions throughout the year address the needs of different areas. This mission spent a week in the western Antigua area, and a week in the eastern “Dry Quarter”. I was primarily with a group from the University of North Texas Health Sciences Center at Fort WorthTexas College of Osteopathic Medicine. Nine students and residents, a geriatrician, the Medical Director of the Family Practice Program, a nurse, two pharmacists, and a dental hygienist composed our team. While in Antigua, we worked with a group of about twenty-five from the Kansas City University of Medicine and Bioscience College of Osteopathic Medicine (my alma mater) as well as with Steven W. Etherton, D.O. and Holly M. Heichelbech, D.O., from Oakland City. There was tremendous variety within the group from Kansas City. Most were fourth year medical students, but it also included a pathologist born in Honduras that worked as a translator, a retired neurosurgeon, a professor of pharmacology, and several attending physicians. This mission was partially funded by a thirteen year old Boy Scout working on his Eagle Scout Project. He raised over
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$5,000 for medicine and supplies, and he and his father were with us the first week. The Guatemalan people were very friendly. Spanish is the national language, but some used a Mayan dialect. Most are a cinnamon-brown in color with dense black hair. It felt odd to be taller than almost all of the locals. The majority of women were five feet tall or shorter, and the men just a couple of inches taller. Most seemed well tempered, but the country has a history of violence. A civil war ended in 1996, after 36 years and an estimated 200,000 deaths. Most businesses, including gas stations, banks, and restaurants, have an armed security guard with a hand-held 12 gauge shotgun at the door. Currently Guatemala has a relatively stable democracy. Each day we got up early, ate breakfast, loaded supplies, and headed out to a rural village. We usually drove 60 to 90 minutes, and the mountainous roads were always curvy and in poor repair. Several people became car-sick daily. The first week we used two “chicken buses”. These are regular yellow school buses, but they earned their moniker because they are allowed to have 54 people on a bus with 32 seats, and you feel like you are in a chicken coop. Although we rented them for the week, they are also used for public transportation throughout Guatemala. After arriving at a village, we usually spent 45 minutes getting ready. Tables and chairs were provided, but we had to position them to create a triage entrance, and a pediatric, gynecologic, and general medicine care area. We also had a pharmacy just prior to checkout, and gave everyone toothbrushes, vitamins, analgesics, and medicines for their specific ailments. We also passed out several hundred pairs of glasses.
Musculoskeletal pain was the most common complaint. Headaches and neck pain were common. This is very understandable because people carried firewood,
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fruit, and laundry on their heads. Most people had manual jobs. I learned that women that operated a loom would kneel and mostly use their dominant arm. They would have calluses on their knees and arthritis in the shoulder. Crepitant shoulders with a loss of full motion were noted on many women under the age of 50. Gastric complaints were the second most common problem. Intestinal parasites (worms and Giardia) are very common because most people get their water from rivers and streams. Unfortunately, most sewage ends up in the same rivers and streams. Coughing and respiratory problems were common. Although we saw some people with pneumonia or colds, much of the coughing was due to burning wood in the home for cooking. It is estimated that 85% of the houses use firewood and most of that is indoors. There is a big push to encourage external ventilation or to have the stove outside. There definitely appeared to be less cigarette smokers than in the United States. Smoking is not allowed in any public building including bars.
Skin diseases included scabies, vitamin deficiencies, skin cancer, and fungal or bacterial infections. Iron deficiency anemia was common, partially due to the lack of meat and frequent pregnancies. Diabetes is common, probably because it is indigenous in the Mayans, but also because they eat lots of starches and sugar. Candy, chips, and soft drinks are sold everywhere, and are consumed by anyone with some change in their pockets. A definitive diagnosis was difficult for several reasons. We had no x-rays or lab tests except for urinalysis and glucometer testing. An accurate history was especially difficult for me because my knowledge of Spanish is paqueno (small). Frequently, people had walked a great distance to get to the clinic and wanted to get as many medicines as possible. It was not uncommon that they provided multiple complaints in an effort to get more medicine. Many of the villages we visited had no
doctor, and we only came yearly. We tried to give them medicines for a month. Clearly we only provided a temporary answer. The government does try to help patients, but transportation to a hospital can be a major problem, and many of the hospitals are dependent upon foreign doctors so appointments are not usually possible. We commonly found about 100 people waiting for us when we arrived, and often there were people still in line when we ran out of medicine and closed down the clinic.
We only worked Monday through Thursday, so there was some extra time to explore Guatemala. We spent most of our time in Antigua. This delightful city is a haven for tourists. All of the streets are cobblestone and many of the churches are over 400 years old. Antigua was the Spanish capital of Central America from 1609 to 1821. However, in 1773, an earthquake destroyed most of the city. It was partially rebuilt before a volcano erupted and destroyed much of the new city. The capital was then moved to Guatemala City. Antigua attracts mostly European and American vacationers, and some students come for two weeks to two months to learn Spanish at one of the many schools. Antigua has a variety of restaurants and hotels to attract both back-packers and first class travelers alike. One of my concerns was not getting “tourista�, or vomiting/diarrhea. About one-fourth of our group was stricken to one degree or another, but drinking only purified water seemed to be the key. I was tempted to eat the handmade tortillas on the street. Hundreds of vendors cooked over a wooden fire and used fresh salsa, guacamole, and your choice of cheese or chicken. I did eat lots of fresh local oranges, limes, avocados, and melons. Almost all meals were served with frijoles (black beans), and I learned to make them part of my breakfast with hot sauce. Pollo Campero is a very popular international chain of restaurants that sells chicken. We ate there once, but it was not that different from KFC. I tried several
Spring 2011 restaurants including a Thai piano bar with Ben Atkinson from Oakland City, playing the piano! Monoloco was a tourist bar next to our hotel La Sin Ventura with NCAA basketball games, internet service, and cold Gallo beer. Gallo is the largest Guatemalan brewery and their rooster logo is everywhere. Antigua and much of Guatemala is surrounded by volcanoes. One of them is active and we could see plumes of smoke daily. We took a tour and hiked to Pakaya volcano. It was only a 2 mile hike, but most of the trek was very steep. The locals had horses and kept asking if we wanted to “rent a taxi”. This volcano erupted in May of 2010 and spewed lava for about a mile and ruined the trees and crops in its path. Some of the lava was still hot and we roasted marshmallows. The guide made sure that we stayed on the trail. It was great to get out in the country, but I saw no unusual native animals. The only birds that I saw were vultures, swallows, cattle egret, and the ever present and noisy grackle. The weather in Antigua was perfect. It is about 5,000 feet in the mountains and cool enough to require a jacket in the evenings and early morning. The sun, however, was quite bright during the day and many people got sunburned. Walking the town felt safe and I walked or ran daily, just looking at the unique old Spanish architecture nestled in a valley surrounded by volcanoes. Of course, I spent lots of time shopping for souvenirs. I enjoyed meeting the people and trying to communicate with them. Jade is found locally and is very popular, as are handmade textiles. We also spent a day at the beach. A tour bus drove us two hours to Monterrico Beach on the Pacific Ocean. The water was surprisingly warm, and the black volcanic sand very hot. I body-surfed the large waves to shore. The grilled Mahi Mahi at Johnny’s Place was supposedly caught that morning and was delicious.
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Eastern Guatemala was much different from Antigua. We were in the Zacapa district with an elevation of only 200 feet. It was a desert with 20-foot tall cacti. Farms grew tobacco, corn, and other vegetables. We did drive through lots of mountains to get to the small villages. On two of the days we drove one-and-a-half hours on a dirt road to get to a village. The people were very happy to see us. The mayor provided us with a meal and gave us all handmade hats and woven fans. It was 95 degrees and I was seeing patients in the garage of a municipal building.
We stayed in Rio Hondo which is on the highway to the Caribbean with lots of semi’s hauling fruit and raw materials. Many of the buses and truckers stopped for food. They either picked up a bag of chips and a drink at a small Tienda, or they stopped at one of the Grills along the highway for tortillas and frijoles. There were no fast food options other than a gas station minimart. School kids often stopped for a tortilla breakfast as well. Our hotel in the Dry Quarter did not have hot running water, but no one complained because it had a pool. TIDBITS * I met the coach for the Antigua Professional Soccer Team at breakfast and he invited me to practice. The stadium was beautiful and he really put them to work. * I went to Mass at La Merced, a 300-hundredyear-old Catholic church painted bright yellow. It truly was a celebration. The music was provided by about fifty children playing guitars, marimbas, flutes, and a bass and keyboard. Although it was in Spanish, the people were very devout and the service meaningful. After Mass the celebration continued. At least 10 people had setup grills and were selling food. An ice-cream vendor was jingling his bell, and many people were selling smoothies and juices. I had previously walked past a cathedral and found the same carnival atmosphere after Mass there.
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* There is very little birth control and families are quite large. Almost all the women breastfed, and thought nothing of feeding in public. I was especially struck by a lady in line for communion at Mass. She made the sign of the cross before and after receiving communion, and genuflected towards the alter. All the while she was openly breastfeeding an infant.
* I treated myself to a special lunch at El Tenedor (The Fork) on top of a hill overlooking the city. Spinach ravioli with pumpkin stuffing and a creamy sauce topped with fried shiitake mushrooms. The breeze and sunshine combined with the view of the city below and the volcano belching smoke in the distance to create a beautiful memory.
* The Mayan people wear different colored skirts and blouses depending upon what district they are from.
* One of the medical students was Neha Dingra from Newburgh.
* The flight was simple: 2 hours to Dallas and 3 hours to Guatemala. I never even changed time zones.
* On two occasions we played soccer with the local kids after clinic.
* It was fun being with medical students again. Most of them were about to graduate and had a very good foundation in the study of medicine. * It was somewhat lonely. I really knew no one before I got there and did not speak the native language. I was able to e-mail my wife, Nancy, about every other day. Solitude breeds wisdom. * I bought a lucky necklace, or amulet, made of seeds and precious stones. * Quetzal is the local money. A dollar is worth 7.70 Q’s. Getting currency exchanged at the bank can take an hour. * Some of the smells of Guatemala are sweet like the lavender Jacarunda tree, many are earthy like dust and firewood, but far to many are noxious like burning plastic and trash, diesel fumes, and kerosene. * There is lots of plastic and paper litter along the highway and in the country. Antigua was a bit cleaner. * Even smaller towns have taxies called “tuk tuks”. They are smaller than a golf cart with a tiny gas engine and only one wheel up front. They are imported from India and are designed to carry a driver up front and two passengers in the back. Some of the drivers looked to be 14. * Many of the rich people from Guatemala City come to Antigua on the weekend. Although most vehicles were old and dented, occasionally a new BMW or Lexus with dark windows would drive by.
* Guatemalan coffee is great, and not too bitter. * Some days we ran out of medicines and had to close the clinic. On one of those occasions, we were seeing patients in a large, one room, municipal building. We were having a hard time closing up shop because about 100 children kept hanging around. We frequently passed out toys and they just wanted to get anything free. In order to close the very large doors to the building and disperse the mob, I took a large bag of balloons and began to pass them out. I was being mobbed and almost pushed down by kids saying “luna luna”, but I drew them all outside and the doors were closed. The other doctors laughed and took pictures. * I read The Year of Magical Thinking by Joan Didion while on the trip. It was a very emotional book about having your spouse suddenly die. * Most of the homes were cinder-block, but some had old adobe dirt packed onto sticks for structure with a tin or thatched roof. Virtually all of the houses had dirt floors. * Over half the population lives in poverty. The minimum wage is $7.00 a day. Forty percent of the population is under the age of 15. * Many of the physicians and students provided osteopathic manipulative treatment to patients and even brought a portable treatment table. Patients seemed very grateful. * Although we saw about 3,500 people in eight working days, Guatemala is a country of 15,000,000 and the majority of people are destitute. At times I felt like we were just putting a small Band Aid on a large lacerated artery. Hopefully, we provided some immediate support and hope for their future.
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