You are on page 1of 2

A PIECE OF MY MIND

Big Hearts

WO DECADES AGO, AN AMERICAN FAMILY TRAVELED TO Cusco, Peru, and adopted a 3-week-old Peruvian girl. The process was long and arduous and was successful only because of the intervention of some big-hearted strangers. Finally, after 13 months, the family was able to return to the United States. At about this same time a good friend of mine in his late 40s, an ophthalmologist in Long Island, New York, contracted a rare cancer. He had one child, a daughter, whom I saw frequently when I visited him. My friend lived long enough to see his daughter get into medical school, but he did not live long enough to see her graduate and become an ophthalmologist. Years later, the career arcs of these two children would intersect. When the adopted girl was 11, she traveled with her family back to Peru, land of her provenance. This nowAmerican child was struck by the poverty she saw. She visited orphanages and was so touched by the children, whom she could so easily have been among, that she started an organization and got her parents to raise money and to adopt one particularly remote orphanage near Cusco. This one was off the map, and when she went there she was told no one from the outside had ever visited. Time passed: the young ophthalmologist was injured in a car crash, could no longer work full-time, and had to find other ways to channel her professional energies. The adopted girls efforts attracted some media attention. Thus began an unlikely concatenation of events. First one US medical school, then another found out about the girls work and, with her organizations help, began sending medical missions to Peru, every July. And that is how my wife and I recently came to spend 12 days in the town of Urubamba, 8000 feet up in the Sacred Valley of the Peruvian Andes. I am a 67-year-old family practitioner, still working, and she is a retired schoolteacher and childrens librarian with multiple sclerosis, who can still walk, more or less. We figured there might not be many more adventures to come, and so we signed up for this one. We flew into Cusco, Peru (the ancient capital of the Incan empire), and then were driven to our hotel. The team, which fluctuated over the fourweek project, consisted mostly of medical students who had completed their first year, with some attending physicians, family members, and others with sundry medical skills. There was an ophthalmology team as well. Urubamba had safe streets, Internet access, many loose dogs, rare cats, good food, no obvious beggars or home-

less persons, rare cigarettes. I saw pigeons everywhere in the Sacred Valley, seagulls by the river, a Red Admiral and a Painted Lady butterfly just like on Long Island, no condors. The magisterial Andes stood everywhere you looked. Monday through Friday we traveled by bus, at times chartered, at times public, to rural health posts in small towns and to remote villages at elevations as high as 13 400 feet: Places like Paru Paru and Perccaunknown to Google. That remote. In one village, the townspeople were summoned for medical care by the blowing of a whistle. Many folks spoke only Quechua, the native tongue, and we needed translators to Spanish (Castellano as it was known there) and then to English. We set up shop, often in schools, sometimes in an existing health facility. We gave out shoes, eyeglasses, and vitamins and tried to treat what we could. Headacheslikely from working all day in the sun at high altitudes without watercould not be treated, because the people had no source of clean water. Chronic low back pain from hauling loads and children for half a lifetime could not be managed with Take some time off. Roundworms and Helicobacter pylori could be treated, only to recur via reinfection. I saw children dipping glasses into a street aqueduct to drink water. It was terribly evident that only public health improvements would really matter. I found some satisfaction practicing medicine . . . in the raw, you might say. No credentials committees or malpractice considerations between myself and my patients, just do the best you can with the resources you have. I had been told ear cerumen would be a problem, so I brought with me one of those dental water picks that happen to be good, albeit messy, for this purpose. When a 65-yearold man complained of deafness in an ear we noted to be wax impacted, I plugged in the device (the 220-to-110 volt converter didnt seem to work) and began the irrigation. Just as the cerumen plug reached the mouth of the canal, the little machine went Pow! and ceased working. I extracted the plug with the tweezers from my Swiss Army knife. (The mans hearing problem, in retrospect sensorineural, did not improve.) My wife played with the children while we worked. There was no commonality of language, but pens, paper, crayons, and stickers all spoke for themselves. The children quickly placed the stickers on their foreheads, which is what children everywhere do.
A Piece of My Mind Section Editor: Roxanne K. Young, Associate Senior Editor. JAMA, October 10, 2012Vol 308, No. 14 1441

2012 American Medical Association. All rights reserved.

A PIECE OF MY MIND

All told, I worked seven days in seven different places, so I had no follow-up. My type A personality did not serve me well here. Plans and arrangements changed constantly. Information became disinformation. I had to ratchet down a few letters but found I could still function. There were harrowing bus rides, dreadful latrines, dogs running in and out of examination areas. We had our adventure. If we couldnt make permanent changes to peoples health, we generated gratitude and good will. But in this, the third year of my schools medical mission to the Sacred Valley, something of permanence was accomplished. My friends daughter, the ophthalmologist with some free time, also an alumna, had joined the group last summer. She saw people with cataracts who had no opportunity for surgery. So this year, she assembled a small squadron of eye surgeons and support staff, brought the necessary equipment to Peru, and set up an operating suite in a nearby private school. During their one week, more than 400 eye problems were treated, and 35 cataract extractions/lens implantations were performed. Her dad would have been so proud. I was also privileged to meet the adopted girl, now a 20-year-old woman, who had come as she periodically does, to check on her orphanage. Six of its graduates were attending university, a feat previously unheard of. This quiet, unassuming young woman has been featured as a CNN hero and has spoken at the United Nations.

The owner of the hotel at which we stayed was one of the kind strangers who had helped with the adoption 20 years earlier and had became a close family friend. It was also he who made our medical mission possible. His own concern for the health of his campesinos led him to make most of the internal arrangements that allowed the US schools to get involved. Ironically, the adopted woman and the ophthalmologist did not meet, missing each other by just a day. I know that there are many places in the United States where people lack medical care, places less exciting to see than the Andes. I know a fragile wall exists between the rich and the poor in Peru, and politics impacts medical care. But there was something I did not know. It seemed everywhere I went, in a restaurant, on a train, at the hotel, I met people who had come there on missions of mercy. One was organizing cleft lip repair; another was visiting disabled shutins no one ever visited. There were so many unknown, unpaid heroes, toiling not for adventure but for the satisfaction of what they did. I did not know there were so many people with big hearts.
Robert S. Bobrow, MD
Author Affiliation: Department of Family Medicine, Stony Brook University, Stony Brook, New York (robert.bobrow@stonybrookmedicine.edu). Acknowledgment: The author wishes to thank Ana Dodson and her organization, Peruvian Hearts, and Debra Messina Coritsidis, MD. Conflict of Interest Disclosures: The author has completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

1442

JAMA, October 10, 2012Vol 308, No. 14

2012 American Medical Association. All rights reserved.