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Exporting Expertise

Feinberg faculty and students bring health and medical knowledge to remote area of Bolivia

  • A 55-year-old presented with syncope. On ECG, she was found to have third-degree heart block due to Chagas disease. She was the first clinic patient to receive a pacemaker.
  • A 49-year-old was hospitalized with pneumonia. An X-ray showed left-sided pleural effusion. He was sent for a pulmonary consult to remove the liquid. Results came back with signs of exudative effusion and he tested positive for tuberculosis. The patient is now enrolled in a government program for TB treatment.
  • A 24-year-old with type 1 diabetes maintained very high blood glucose levels and went into diabetic ketoacidosis several times. She periodically ran out of money to buy insulin and had no refrigerator to store it in. She can’t afford to purchase glucose strips.

These are examples of the kinds of cases seen and types of obstacles faced at Centro Medico Humberto Parra, a free medical clinic about two hours outside of Santa Cruz, Bolivia, in the eastern, Amazon Basin region of the country. Mark E. Molitch, MD, professor of medicine in the Division of Endocrinology, Metabolism, and Molecular Medicine at Northwestern University Feinberg School of Medicine, and his wife, Susan Hou, MD, professor of medicine in the Division of Nephrology and Hypertension at Loyola University-Chicago, founded the clinic in 2001.

The formation of the clinic occurred when a chance meeting offered the possibility to fulfill a lifelong dream. Early in their careers, Drs. Hou and Molitch had discussed opening a non-profit medical clinic in an underdeveloped country. In the late 1990s, a friend asked Dr. Hou to provide a consultation for a colleague, Douglas Villarroel, MD, a Bolivian endocrinologist who was suffering from kidney transplant complications.

The Humberto Parra clinic is 100 kilometers from Santa Cruz, with the closest 10 kilometers to the clinic being unpaved, rutted, muddy paths.

A friendship between Villarroel, Hou, and Molitch quickly developed. Conversation often turned to Villarroel’s homeland and the lack of medical care available in its rural regions. Soon, Molitch and Hou were on a plane, flying to visit Villarroel in Bolivia – the poorest country in South America – and learn more about the healthcare situation there.

Preventive health maintenance was – and is – a foreign concept.

“People in the area had limited medical and dental care,” says Dr. Molitch. “There is minimal health insurance and every bit of health care costs money. These people are very poor, and that means they were unable to seek out health care unless there was an emergency or they were seriously ill. And the idea of care for chronic conditions, such as diabetes or hypertension, just wasn’t part of their vocabulary. Preventive health maintenance was – and is – a foreign concept.”

The Clinic Takes Shape

With the obvious need they had just witnessed, the three physicians began to develop plans for a free medical and health services clinic in the region. The first breakthrough came when a wealthy patient of Dr. Villarroel, Milton Parra, donated the land for the facility. He asked that the clinic be named in honor of his father, Humberto. Construction on the building began in July 2000 and was completed one year later.

At first, operations at the clinic were rudimentary. Doctors checked X-rays by candlelight, for example, because there was no electricity. They also lacked running water. Today, the clinic has these necessities, along with computers and the Internet. In October 2002, a laboratory and ophthalmology and dental suites were built. Further expansions resulted in six exam rooms, a pharmacy, and a dormitory.

The value the clinic holds for the villages that it serves became apparent as soon as the building had a useable waiting room. “Some of the villagers helped bring in the clinic’s furniture, and as soon as they put the chairs down, they immediately turned around and sat in them, waiting to be seen as patients,” Dr. Molitch says.

Clinic physicians and health care professionals can see upwards of 100 patients per day

Things haven’t slowed down since that day. Clinic physicians and health care professionals can see upwards of 100 patients per day, treating everything from snake bites to diabetes and parasite infections to appendicitis.

Staffing the Clinic

With such high volume, running the clinic requires many hands. Two full-time nurses, two lab technicians, and a pharmacist hold permanent positions, and Drs. Molitch, Hou, and Villarroel serve as the oversight committee, as well as periodically treat patients. Volunteer physicians, medical students, residents, public health professionals, and locals handle the day-to-day patient care and operations. Medical students and residents can receive credit for their rotations at the clinic.

Current clinic coordinator, Alice Baumgartner, daughter of Assistant Professor of Cardiology Andrea Baumgartner, MD, has served in Bolivia since August 2010. She joined because of an interest in public health and has amassed a great deal of real-world experience in the area.

“As the clinic’s coordinator, I schedule appointments and answer calls, write grants and give health education lectures, drive patients to consults with specialists, take clinical histories, check in patients, find charts, make dinner for the volunteers, teach a creative writing class – in other words, a little bit of everything,” she says.

The experience will also add to the richness of her continuing education, as she plans to attend Oxford for a Master’s in Latin American Studies in the fall.

Steven Schuetz, a second-year medical student, volunteered at the clinic for six weeks during his M1 summer. He had previously spent time in Bolivia and became interested in working at Humberto Parra after attending a presentation given by Dr. Molitch. The volunteer opportunity matched his interest in social medicine, Schuetz says; he plans to study general medicine and work abroad full time when he graduates.

His responsibilities at the clinic included taking patient interviews, providing dietary and lifestyle management counseling, conducting diabetes screenings, and helping fellow volunteers with their Spanish.

The experience helped solidify his interest in international medicine, Schuetz says, and gave him a leg up in the classroom.

“I feel like I learned a lot about medicine in general. You see some of the same diseases over and over, and you get to understand them very well. You’re also exposed to all these tropical diseases that are super rare in the United States that most students only read about in textbooks, but we got to see firsthand,” he says.

Lisa Ramani (Jager) Villarroel, MD ’10, has made several trips to Humberto Parra. She first volunteered during her M1 summer, and then returned for a year after deciding to take a break from medical school following her M3 year. Lisa earned a Master’s of Public Health degree from Universidad Gabriel René Moreno while volunteering. She also met her husband, the son of a clinic patient.

Medical students and residents periodically help staff the clinic during global health rotations for which they receive credit.

In 2009, Dr. Lisa Villarroel and her father, Rama M. Jager, MD, PhD, organized a surgical campaign for patients of Humberto Parra, performing basic general surgeries such as hernias and breast biopsies for 20 patients. They expanded the campaign the following year, running two operating rooms simultaneously and bringing in an OB-GYN physician for more complex surgeries, including repair of uterine procidentia and cystocele.

While patients were, of course, thankful for the campaign, it was the Bolivian surgeons themselves who were the most grateful.

“Both years we were able to donate multiple thousand-dollar staplers for the Bolivian surgeons to use on their Chagas megacolon patients,” she says. “The gynecologist we brought down had such phenomenal technique that the president of the Bolivian Surgeons Association insisted that she return to give classes to the various hospitals’ gynecologists.”

Now a resident in family medicine at Banner Good Samaritan in Phoenix, Dr. Villarroel says her time at the clinic has had an enormous impact on her life.

My experiences at the clinic have shaped my entire future

“Long story short, my experiences at the clinic have shaped my entire future,” she explains. “I am forever grateful to Drs. Molitch and Hou for the connection that now exists between their family and mine. The clinic is providing a service not only to its patients and the surrounding community, but also to the medical volunteers heading down there.”

Funding the Clinic

Volunteers pay a nominal $75 per week to cover their food, housing, and transportation costs, but the fees do not contribute to the costs of running the clinic. Donations provide all of the resources for Humberto Parra, and about 75 percent of its $150,000 annual operating budget comes directly from founding doctors, Molitch and Hou.

“We are currently at the maximum amount we can afford and this clearly limits what can be done,” Dr. Molitch says. “Unfortunately, we find ourselves rationing health care for the particularly expensive procedures or surgeries. If we approve $5,000 for a patient to get a kidney transplant, that means we cannot do 15 hysterectomies for cervical cancer because our finances are limited.”

To help raise funds for the clinic, the pair formed the Daniels Hamant Foundation. They also host an annual fundraiser, which brings in about $5,000 per year. Donations for the clinic are made through the foundation’s website, www.hamantfoundation.org, which also includes information on how to volunteer.

“We both are nearing retirement age but cannot afford to retire if we hope to be able to keep the clinic functioning at its current level,” Dr. Molitch admits. “Additional outside donations would allow more care to be given and perhaps allow us to think about retiring. With retirement, we could spend more time directly delivering health care in Bolivia ourselves.”

If you are interested in supporting the efforts of Drs. Molitch and Hou at Centro Medico Humberto Parra clinic in Bolivia, visit www.hamantfoundation.org.