TMC PULSE

t m c » p u l s e | m a r c h 2 0 1 5 8 Johnson has since passed his love on to many of his colleagues at UTHealth, as well as the medical students and residents who embark on his twice yearly trips to villages in Guatemala, organized by Faith in Practice. The organization targets the most remote areas of Guatemala, which do not have health services. Faith in Practice's structure involves a Guatemalan staff and a local volunteer network to ensure the patients referred to surgery are accompanied during the referral process and the patient remains the central focus throughout care. "There are two types of trips Faith in Practice does—a surgery trip and a medicine trip," said Johnson. "This year, I think there are something like nine one-week medicine trips. We lead one of those. Then there are maybe 31 or 32 surgical trips of one-week duration and we also lead one of those. We're going to do that in May." Many of this year's team members are regulars, traveling with Johnson year after year. Robin Hardwicke, Ph.D., an associate professor of general med- icine and obstetrics and gynecology, has now completed nine consecutive annual trips to Guatemala, motivated by the need she experienced from the start of her very first visit to the country. "I was blown away with surprise. We arrived to a line of people that was farther than my vision can see wait- ing at the gates hoping for care and assessment by us. I never imagined the degree of need," she said, describing that first visit. "There is no way I could see the number of patients here in the United States like what we try to see and accomplish in rural Guatemala. There are just so many people that are in desperate need of basic general health care that we in the U.S. take for granted." The trip consisted of four days see- ing patients, and more than 2,500 peo- ple visited five different clinics: general medicine, gynecology, pediatrics, dermatology and dental. Complaints ranged in severity from those that could be solved with cold remedies, antibiotics or ibuprofen to much more serious issues requiring more extensive treatment or surgical referrals. "We made 230-some referrals for surgery. People who have had hernias, have had uterine prolapse, have other small tumors, things that need remov- ing. They've waited around because there's no access to the surgery," said Johnson. "It's not uncommon to see patients who have had hernias that have affected their work for five or ten years. And we can remove those and they can go back to work." Hardwicke, who oversees the obstet- rics and gynecology clinic, said her team saw as many as 50 to 100 women per day for a variety of gynecologic or obstetric needs, many of whom had never had a pelvic exam before, much less any form of obstetrical care. "Many Guatemalan women don't understand normal menstrual cycles, they don't understand normal premen- strual symptoms, they don't know any- thing about their bodies, however, they may have already been pregnant 10 times," said Hardwicke. "They typically don't have prenatal care, so one might imagine what a joyous treat it is to per- form an ultrasound and show her a live picture of her baby's heart and reassure her the baby is doing OK." One of the most crucial roles the obstetrics and gynecology clinic fulfills is cervical cancer screening. According to the World Health Organization, the cervical cancer mortality rate in Latin America and the Caribbean is three times higher than in North America, and for many of the women visiting Hardwicke's clinic, this may be their only shot at finding it. To that end, Johnson explained the team performs a basic cervical screening, which is much more rapid than a traditional pap smear. "You use acetic acid wash on the cervix of these ladies that are at risk and you do an inspection and then do cryo- therapy on any lesions they have that might be precancerous," said Johnson. This year the OB-GYN team referred nine women who appeared to already have cervical cancer. For the Guatemalan patients, these volunteers can be lifesavers, but the experience is often life-changing for the health care workers as well. Johnson said his trips to Guatemala as a teen- ager are what ultimately inspired him to become a physician. Now they offer him the opportunity to get back to the basics of medical care. "You're working with other people really closely. You can ask questions, the pharmacy is right there, the patients TOP: Pam Gallacher greets patients at Casa de Fe, Faith in Practice's 100-bed patient facility MIDDLE: A young patient smiles in triage BOTTOM: Yun Wang, M.D., examines a patient's eyes

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