from the June 2007 issue of Heartbeat, a Seton Family of Hospitals publication

Seton Associates Deliver Medical Services to Nicaragua

Nejapa, Nicaragua, is only 1,456 miles from Austin – closer than New York. But in terms of standard of living and medical resources, it is light years away.

To span that gap, Fannie Suarez, RN, clinical manager of the Endoscopy Center at Seton Medical Center Austin; Tom McHorse, MD, gastroenterologist; and retired Seton endoscopy technician Bobbie Whitwell recently installed endoscopic equipment in Nejapa as part of a mission organized by Medical Oncologist John Doty, MD.

Since 1992, when Dr. Doty began working with a network of allies in Nicaragua and from across the United States (including Seton), he has realized his dream of establishing permanent medical facilities on the outskirts of Managua.

There, Dr. Doty, along the Austin Samaritans and Dr. Nour Sirker, medical director of Fundacion el Samaritano, have built Dispensario El Samaritano, an outpatient surgery center. They are also in the process of developing Hospital El Samaritano. In operation since 1998, the clinic sees about 1,000 patients each month in family practice, dentistry, laboratory and pharmacy. Seton provides expertise, equipment and medications to El Samaritano.

Flickering Lights, No Hot Water

The Seton participants can attest to the rigorous conditions of practicing medicine in Nicaragua. During their April visit, they outfitted Hospital El Samaritano with four gastroscopes, five colonoscopes, a flexible sigmoidoscope, a light source and endoscopy supplies. They also trained the El Samaritano staff to operate and care for the equipment, which is used to diagnose diseases of the esophagus, stomach, duodenum and colon.

The equipment was used at SMCA before Seton upgraded to videoscopes. Though obsolete here, the older static-image scopes are a good fit for El Samaritano, where electricity is unreliable, running water can be iffy and it can take days or weeks to source spare parts when something breaks.

“In setting up the lab and procedure room, and showing the staff how to use and clean the equipment, we had to get creative,” said Suarez. “For example, in lieu of saline, which is impossible to get, we went shopping for bottled sterile water. After a lengthy search, we realized we didn’t have a sterile way to transfer it into water bottles until we hit upon the idea of inverting IV tubing.”

Working on Several Fronts

Diagnosis is at the top of Dr. Doty’s and Dr. Sirker’s punch list this year. The gastroscopes are important because stomach cancer remains among the leading causes of cancer death in Central America, probably linked to lack of refrigeration and poor diet. (One in three Nicaraguan children is malnourished.) Thanks to the generosity of Seton, Dr. Sirker said that Hospital El Samaritano now has the best-equipped endoscopy lab in all of Nicaragua.

Another pressing concern is cervical cancer, the top killer of women aged 30 to 60 in Nicaragua. During the April trip, the Austin Samaritans installed donated colposcopes and cryotherapy units at Dispensario El Samaritano and Hospital Bertha Calderon. Amy Sweet, PA-C, lead a cervical cancer symposium at Hospital Bertha Calderon, which trained 65 technicians, nurses and doctors to detect and treat early-stage cervical lesions. Widespread adoption of the relatively simple procedure could cut the rate of cervical cancer death in half.

The next steps for the facilities are to develop a lab, radiology and a blood bank. Once these are certified, the doctors envision a fully functional 80-bed facility.

Connecting as Important as Constructing

Dr. Doty has worked tirelessly to bring resources together, including hospitals, churches and foundations. He is a selfeffacing man who has been interested in helping others since grade school. His fate was sealed after going on a humanitarian mission to Lima, Peru in 1989, where he helped his brother provide medical care and hearing aids to deaf children via mobile clinics. When civil war in Peru made it too dangerous for U.S. citizens to visit, Dr. Doty turned his attention to Nicaragua. Since 1992, he has worked with Dr. Sirker, the first U.S. Board Certified Surgeon to practice in Nicaragua.

“You see the how the majority of the population lives, and it changes your perspective forever,” Dr. Doty told the Westlake Picayune.

Suarez agreed that charity work gives medical professionals new insights. The 28-year Seton veteran especially appreciated the chance to see her medical colleagues in a new light. “They were so compassionate and caring with the patients and staff,” she said. “When you’re exposed to the way other people live, it makes you appreciate what you have.”

The trip to Nejapa was Suarez’s second mission with Dr. Doty. “The ambulatory center made lots of progress during the 18 months between my trips,” Suarez said, “but I was surprised that general living conditions in the area seem don’t seem to improve.”

She was, however, prepared for the heat, humidity and modest accommodations.

“I left my makeup and blow-dryer at home and wore five sets of older scrubs that I didn’t mind leaving behind for others to use,” she added. “As Dr. Doty says, if you’re lucky enough to have hair, every day is a good hair day.”