Doctor, kids return from mission of mercy
A Spring Hill doctor and his children who visited El Salvador realize the difference American help makes.
By BETH N. GRAY
Published July 24, 2005
SPRING HILL - El Salvador, the smallest of Central American countries, teems with tropical vegetation, throws up impressive volcanic mountains as a backdrop, and offers blue lakes and hot springs for diversion.
But the focus was not so bucolic for Dr. R.P. Kanuri and his teenage offspring on five days straddling late June and early July.
The Spring Hill gastroenterologist, son Arjun, 16, and daughter Nitya, 15, joined a medical mission of mercy to Jucuapa, 100 miles southeast of the capital city of San Salvador. The "big village" has no hospital - only an outpatient clinic to serve a population of some 27,000.
The clinic was the main destination for the trio and 40 other volunteers organized by Dr. Roberto Araujo, a New Port Richey oncologist who has been making annual medical mercy trips to his native town for 14 years.
For most residents in the area of Jucuapa, the American mission offering free service is the only opportunity they have for health care, Kanuri said.
"They don't have any money," he explained.
By the close of the five-day stint, the team had attended to about 2,000 patients - up to 400 a day.
"People walked hours (to reach the clinic). Some spent overnight. And we turned people away," Kanuri said.
The volunteers performed 42 surgeries. Kanuri, whose specialty is endoscopy, conducted 10 to 12 scopes a day. The team gave out 60,000 vitamins and 50 boxes of medical supplies. As for prescription medications, they typically were able to provide only a month's supply to each patient needing them.
Tampa Bay area pharmacies donated medications, Kanuri said. Oak Hill Hospital provided surgical packs, and Brooksville Regional Hospital provided endoscopic equipment.
The physicians and nurses treated many respiratory infections, skin diseases and stomach infections, the latter due to parasites.
"There's lots of indigestion," Kanuri said, noting everyone, even children, drink eight to 10 cups of coffee a day.
The team saw many poorly fused broken bones due to the fact that no orthopedic surgeon is available in the region.
"You do see starving kids," Kanuri added. "There's lots of malnutrition."
Blindness and cataracts are rampant, but this year's mission team had no eye specialist.
The team included a surgeon, cardiologist, pulmonologist, internists, podiatrist, anesthetist, respiratory technicians, nurses, nurse assistants and other volunteers. Some took along their children and spouses. They came from the Tampa Bay area, Atlanta and Minnesota, all colleagues, present and past, of Araujo. Araujo's wife, Doreen, organized behind the scenes.
Peace Corps workers served as interpreters between the caregivers and the Spanish-speaking natives.
Briefed on the aims, the health problems and previous mission accomplishments, Kanuri signed up Arjun and Nitya to join the team so they could "get a true perspective on the rest of the world and (serve) where you can make a difference," he said.
Nitya agreed to make the trip because it would look good on a future college admission application. But her father's foresight proved correct, she said.
"I thought it was a really good experience," she said. "You see what real poverty is and how other people live. I felt the surgeries in the hospital would really help. We did two cancers and saw 14 people that day. I saw how that made an impression."
In the surgical suite, Nitya's job was to clean the endoscopy equipment. And she was able to watch the surgeries.
"It actually never interested me," she said, "but it looked interesting. It kind of made me want to be a surgeon."
Arjun, even before the mission, had decided on a career in medicine. He is taking a summer course in the field at Brown University in Providence, R.I.
He said the trip "sort of reaffirmed" his career choice - "or at least something in the sciences."
Nitya and Arjun were able to chalk up their time in El Salvador as community service. The curriculum at Berkeley Preparatory School in Tampa, where they are enrolled, requires 22 hours of community service yearly.
While the Jucuapa clinic served as the team's base of operations - members stayed in homes of local families - the caregivers ventured on a rotating basis to outlying villages to conduct satellite clinics. They hung sheets between trees to create a semblance of examination rooms.
Arjun said it was one such trip that provided his most memorable experience during the mission.
"On an off-trip to a village, I had a lot of patient contact. I worked at the pharmacy, and gave toys to the kids," he said. "I saw how much they appreciated it."
Nitya's work in a village also was her most memorable experience, she said. The accompanying physician taught her how to take a patient's blood pressure and conduct triage, then drew the teen into discussing the cases they had seen.
While Nitya and others staffed the clinic and offered outreach care in the villages, specialty doctors performed surgeries and other procedures at a rudimentary hospital in Guadeloupe, a 20-minute drive from Jucuapa.
Although the hospital is close enough that Jucuapa residents could travel there, Kanuri said they can't afford hospital care, even though it amounts to the cost of a modest meal by American standards.
A chest X-ray is billed at $1.70. An endoscopy that would cost $200 in the United States is provided at $10. A hospital admission is $20.
In cases that generated heartfelt response because of their immediate need, team members dug into their own pockets for the admission fee and chipped in for the cost of care.
Kanuri particularly recalls two procedures the team performed and paid for.
In what seemed a routine endoscopy to determine the source of a digestive complaint, Kanuri discovered a stomach cancer. Surgery was performed the following day.
"That's one of the things we feel good about," he said. "He'd have died within a year (otherwise)."
Noting the prevalence of injuries from machetes, Kanuri said a 25-year-old came in with a severely infected leg wound inflicted 11 years ago. His leg was still open to the bone from ankle to knee. The infection had been treated before, but no surgery had been performed. The doctors drained, supplied antibiotic treatment and repaired the wound.
Kanuri said all of the patients he encountered were "very respectful, smiling, beaming, shirts tucked in."
"Poor as they are, they're very conscious of how they look," he said. "They come well dressed. Their personal hygiene is so good."
And some came in a holiday mood. After newspapers and television reported the medical mission's arrival, lines at the clinic swelled.
"It was like a circus in town," Kanuri said.
Included in the crowd was a 92-year-old woman with no medical complaints, but who cried out: "Scope, scope." She had learned of Kanuri's endoscopy expertise and wanted American attention. In good humor, Kanuri provided it, and confirmed no further medical need. It was a light moment for the doctor.
After his first venture with the mission to El Salvador, Kanuri, a 47-year-old native of India, said he "definitely" will return next year. He is especially interested in following up on the patient in whom he discovered the stomach cancer.
Both of his children said they, too, would be eager to return.
"I'd love to go back every year because the people (on the mission team) who go every year said they recognize those they've seen before," Nitya said.
"I would definitely go on a trip like this again," said Arjun.
Their mother and Kanuri's wife, Radya, had wanted to join the mission. But she felt bound to the family's Tampa-area home with 10-year-old son Ajay.
"Maybe next year," the doctor said.
Patients will be waiting, Kanuri is certain.
"They do come back," he said. "There's a lot of unfulfilled care."
Beth N. Gray may be contacted at graybethn@earthlink.net