Left to right: Brad Wilkinson, M.D.; Kathleen Viereg, M.D.; Craig Czarsty, M.D.; Anne Brewer, M.D.; and Sandra Hughes, M.D., stand outside a church in which they set up a clinic in Pancho Mateo, Dominican Republic.
This structure is an example of a typical rural home in the Dominican Republic.
This man is one of the many Health Horizons International community health volunteers who provide basic care services for their neighbors in the four Dominican Republic villages the organization serves.
Family physician Craig Czarsty, M.D., of Oakville, Conn., embarked on his first medical mission trip to the Dominican Republic in 2005. From then on, he was hooked.
A past president of the Connecticut AFP(ctafp.org) (CAFP), Czarsty continued to go on annual mission trips until the foundation then sponsoring the trips in which he and some of his CAFP colleagues participated pulled out of the Dominican Republic to focus on other mission areas in Central and South America.
- Founded by Connecticut AFP members, Health Horizons International (HHI) is an organization that delivers direct primary care, public health education and research to four rural villages in the Dominican Republic.
- HHI takes a group of physicians and other health professionals on three medical service trips per year.
- In between medical trips, HHI uses a volunteer group of approximately 20 local community health workers, who do basic health assessments and routinely check on residents of the four villages.
"They invited us to come along, but we instead started Health Horizons International(hhidr.org) (HHI) and focused our efforts on four villages in the Dominican Republic," Czarsty said. "We were incorporated in 2009 and were off to the races from there."
Czarsty served as founding chair of HHI, which, at first, made only straightforward medical mission trips. However, with the help of two former Tufts University students who went and lived in the republic for a year to survey what needed to be done, the organization was able to institute positive, systemic change.
"We knew what we wanted to do, and we had to figure out how we were going to do it and where to do it," Czarsty said. "So they came home after a year, and we've been heading in the right direction since then."
HHI, now run by a board that consists of Czarsty and CAFP members Brad Wilkinson, M.D., and Michael Good, M.D., both of Durham, and current CAFP Board member and former chapter president Ayaz Madraswalla, M.D., of Storrs Mansfield, has evolved into a three-armed organization that focuses on delivering direct primary care, public health education and research in four rural villages.
"We run three medical service trips a year (to the Dominican Republic) in January, May and September, usually with five physicians, a medical student or two and several PA (physician assistant) students from Quinnipiac University," said Czarsty. "In between the trips, we have a group of approximately 20 community health workers who volunteer in the four communities in which they live. These volunteers will go around taking blood pressures and blood sugars and checking up on people."
Originally, Czarsty said, the community health workers e-mailed patient results back to the physicians from the last mission trip, but this proved inefficient. So, HHI hired a local Dominican physician to see patients on Monday afternoons. The organization also contracts with three other Dominican physicians for certain specialized tasks.
"The community health workers identify somebody, go through the clinical programs director, and we get these patients an appointment with the doctor we hired," said Czarsty. "That works out very nicely. Two of the other doctors run a class for our community health workers once a month, teaching basic stuff: vital signs, how to take a blood sugar, and a lot of basic first aid, as well as warning signs of simple illness."
With regard to HHI's public health and research arms, Czarsty said he and the organization's other board members quickly learned that positive change is more than just setting up a clinic for a week and "throwing pills at people."
"These folks don't have drinkable water, and people are bathing in and using a very polluted river for cooking and cleaning," Czarsty said. "So, we are working to get water to one village. The Peace Corps has assigned us a volunteer -- a sanitation engineer -- who is going to arrive in April or May and come up with a realistic budget for the project and do all of the engineering work.
"In terms of the third arm, research, we are continually looking into what the health needs of the population are and doing quality improvement research into what we are doing, so we can understand how we can do it better."
In terms of financial support, Czarsty said CAFP EVP Mark Schuman has been very helpful, recently setting up a CAFP/HHI Global Health Scholarship that is available to fourth-year medical students at the University of Connecticut School of Medicine, Farmington, or Yale University School of Medicine, New Haven, who are members of their school's family medicine interest group.
According to Schuman, the CAFP chooses one student each year to go on a medical service trip with HHI, paying as much as $1,000 for expenses. Students either opt for the one-week experience, or, if they can make it work with the medical school, stretch their time in the republic to three or four weeks.
"HHI provided an opportunity for the CAFP to promote to our membership the opportunity to provide primary health care to underserved patients of the Dominican Republic," Schuman said. "The feedback from those members who have participated has been so positive and rewarding.
"We also felt strongly that students interested in family medicine should have the experience of this kind of care. The scholarship allows these students to do something they probably never thought they could do while also receiving a wonderful mentoring experience."
According to Good, reinforcing the organization's pipeline of family physicians is important to its survival.
"Family doctors are uniquely trained to be able to cope with this kind of stripped-down environment -- the other specialties need their gizmos and their referrals and their electricity," he joked.
"In all seriousness, when you go to this environment where you have no technology, it's really just you, the patient and you listening to their story and trying to come up with practical answers given the circumstances," Good said. "Sometimes we have to make decisions and we can't have a CAT scan and we can't have an X-ray and we can't get blood work or send (patients) off to a specialist, because it's just not feasible in these extremely impoverished areas."
A good percentage of the physicians who have gone on the trips have been CAFP members, Czarsty said. "Most of the family docs who have joined us in the Dominican Republic are Connecticut family docs, and Mark is superb about helping us -- sending a blast email out looking for people when we need them. We've never had a trip where we didn't have enough medical personnel -- had to scramble a couple of times, but never a trip without enough people. We've probably had 20 or so CAFP physicians go down there, which, out of a membership of roughly 400, is pretty significant."
Chapter EVP: Mark Schuman
Number of chapter members: 430
Date chapter was chartered: 1948
Location of chapter headquarters: Bloomfield
2013 Scientific Symposium date/location: Oct. 23-24, Aqua Turf Club, Plantsville
Good said the trips are "a blast" and very rejuvenating
"Doctors, in general, are very stressed and burned out these days, and when you go down on one of these medical service trips, it's just you, your patient, their story and your knowledge," Good said. "It really just comes down to the real core of what being a physician is all about.
"The patients know we aren't asking them for any money, and they know we come back every four months," he said. "They really appreciate it, and we get a lot out of it. And when I come back home, it sort of helps me keep perspective on my life as a physician, because sometimes it is hard to find the joy within the stress of American medicine."
Czarsty echoed the sentiment.
"It is back to medicine in the old days, where it's face-to-face with very limited resources in terms of diagnostics," he said. "It actually is a nice way to try and sharpen your clinical skills, because you have to go back to making a diagnosis without CAT scans and echocardiograms.
"Seeing the patients is so satisfying for me, because these are people who have little or no access to medical care, and they are just so incredibly grateful for any little thing you can do for them -- it's amazing. I come back recharged and look forward to the next trip as soon as I get home."
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