A multidisciplinary team from Duke is providing pediatric surgical care and research in Guatemala, where access to medical services is limited.
Led by Henry Rice, a professor of pediatric surgery at the Duke Global Health Institute, a team of Duke Medicine and DGHI faculty members partnered with the Moore Pediatric Surgical Center in Guatemala City to provide pediatric surgical care and education over the last three years. The team includes surgeons, anesthesiologists, technicians and student trainees.
Rice began building relationships with a small group of pediatric surgeons in Guatemala while visiting frequently to build houses with his family. The project, which started as a smaller base effort, has now grown into a multi-faceted platform that involves education and research initiatives.
Rice said the environment in Guatemala forces the staff to perform their jobs with fewer resources and less money. The platform is about providing state-of-the-art care in an environment that does not have the resources the staff is used to working with. This fosters a learning experience that cannot be duplicated elsewhere and also provides cost-effective models of care to emulate upon leaving Guatemala, he added.
“The care we want to provide is as high-quality as at Duke or anywhere else,” he said. "How we translate quality into working with less resources is the most challenging and rewarding aspect.”
Using advanced techniques, the team works with Guatemalan experts to study how health care limited by financial, structural and cultural barriers affects Guatemalans’ access to care and how these barriers can be overcome. Rice said these same problems and solutions can be applied to areas such as Durham, as well.
Rice returns to Guatemala every six months and the whole team visits roughly once a year. They have taken two major trips to Guatemala so far and provide operations to approximately 50 children per trip.
Rice calls the program a “win-win” for all who are involved. By sharing techniques with staff in Guatemala and working closely in a challenging environment, Duke faculty and trainees provide care to children but also develop a sense of camaraderie, he said.
“It is wonderful to be able to augment our own clinical care by augmenting care in Guatemala, “ he said. “You get used to seeing staff trudging through their jobs. But in this kind of environment, you see them active, engaged and smiling.”
Rice's project is centrally organized by the DGHI, but is funded by Duke Medicine and two non-governmental organizations, Mending Kids International and the Shalom Foundation. A recent grant from the Karl Storz Foundation also funded a Guatemalan laparoscopy center where a high-level laparoscopy was recently performed.
“Our goal through this endeavor is one that is ongoing and long lasting,” he said. “It is not a short-term initiative and our team really takes pride in that.
Benjamin Silverberg, master's student in global health, spent three works over the summer learning anthropologic and qualitative practices with Rice’s team in Guatemala.
He said the most rewarding aspect of the trip was a medical mission he participated in that enabled him to set up mobile clinics in remote locations and evaluate people for surgical needs.
“The mission, and the experience as a whole, took my classroom studies and put them into real-life practice,” Silverberg said. “My experience in Guatemala put everything into context and showed me why people give up their vacations to volunteer there.”
Though the project is still in an early development stage, there is potential for new research programs in the area.
David Boyd, associate professor of the practice at DGHI, also runs student research training sites in Guatemala. His projects among the indigenous Maya people focus on herbal medicine, illnesses and breast-feeding practices.
Boyd said health challenges are far greater in Guatemala than in other places he has done research in previously such as Malaysia, Bolivia and China. Malnutrition is prominent and many kids need surgery, but cultural barriers may make some Maya feel uncomfortable in hospitals and many are unable to afford medical care.
“It is important in a place like Guatemala to realize that barriers to access health care can be cultural as well as financial and geographic,” he said. “The primary advantage of this research is that it allows us to see how people break down these barriers.”
By combining outside research with classroom projects, Boyd demonstrates the project’s potential to transform not only the lives of Guatemalan citizens, but also the ways in which Duke students learn.
“I bring my world into the classroom and the classroom into my world,” Boyd said.
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