By David Doupe, M.D.

David Doupe, M.D., is associate medical director for Family Health Council of Western Pennsylvania.

Published December 1997

• React to this article in the Discussion Forum.

I was asked by the coordinator of the Volunteers in Mission project of the United Methodist Church to serve on a team with a group of volunteers from Leesburg, Florida. This group had developed an ongoing relationship with the church in Zimbabwe, offering periodic assistance not only in medical care, but also in farming techniques, craft development, environmental protection ideas and church leadership development. I was to lead a small contingent of health care workers and staff the rural health care clinic at the remote mission site during the two weeks the team was in Zimbabwe. (Very fortunately for me, one of the senior Family Practice residents from Hamot Medical Center program who had recently rotated on my service volunteered to go along and proved to be a valuable resource.)

Zimbabwe is a modern country in many respects, but poor. In 1980 the native population regained control of the country then known as Southern Rhodesia. The population is now about 11,000,000 and served by 200 physicians—many trained in Zimbabwe, some with part of their training in Europe and North America. The physicians are concentrated in the major cities, leaving the vast rural population with little or no exposure to ongoing medical attention. Approximately 30 percent of the population is HIV positive. Malaria is prevalent. The muscle aches and joint pains of manual labor and walking with heavy loads on their backs or heads—the major means of transportation—seemed to be a common complaint. Upper GI symptoms, chronic conjunctivitis from the smoke and dust, asthma, diabetes, hypertension, tuberculosis are all on the list of patient complaints we saw in those few days. With all these problems, both major and-minor, there normally was a scarcity of simple medications to treat even the most common of-problems. We were fortunate in being able to take with us to use and to leave at the clinic an extensive supply of commonly needed pharmaceuticals.

The word of our arrival was spread across the hills and villages very quickly and we began to see about 100 patients a day. Because of time and supply restraints, as well as limited communication (most of the people spoke Shona with English occasionally as a second language) we treated the chief complaint with out the benefit of laboratory, x-ray or any diagnostic tools, save our history-taking skills and a cursory physical exam. The patients tended to carry a limited medical history with them in a small booklet or collected scrapes of paper. This actually proved to be very helpful, especially when trying to evaluate blood pressure treatment in the adults or nutritional status of the children compared to their last visit to the physician or nurse. Of special note: most of the children we saw were current in their immunizations.

On our return to the United States we attended the 1997 Missionary Medicine Seminar sponsored by World Medical Mission, the medical arm of Samaritan’s Purse in Asheville, North-Carolina. (This is a program headed by Franklin Graham and was held at The Cove—The Billy Graham Training Center.) There we met with over five hundred persons who either were long-term missionaries or had served, or were considering serving, in a short-term status at various sites around the world. The faculty of the conference had vast experience in working in very primitive conditions and were an excellent source of knowledge. It also gave us a chance to learn of the enormous opportunities for third world service.

Dr. Terry Dwelle, Bismark, North Dakota, shared his extensive experience in working with missionaries over the last twenty years. He described what practice was like for 75 percent of the world’s population who live in underdeveloped countries. This segment accounts for 86 percent of the world’s births and 98 percent of all infant and childhood deaths. Only 15 percent of these people have access to clean water. Ten children die every minute of vaccine-preventable diseases. The list goes on, to be looked upon as an opportunity to make a significant difference.

Dr. Tina Slusher, a pediatrician from Los Angles summed up the life of girl born in one of the least developed countries in the 1990s. She can expect to live barely 44 years—two years more than a baby boy born in the same year. Her problems begin before birth, since her mother is likely to be in poor health. If she is born in southern Asia, she has a one in three chance of being underweight, a greater chance of dying in infancy and a high probability of being malnourished throughout childhood. She has a one in ten chance of dying before her first birthday and a one in five chance of dying before her fifth. In some African countries her chance of being vaccinated is less than one in two. She will be brought up in inadequate housing under unsanitary conditions contributing to diarrheal disease, cholera and tuberculosis. She will have a one in three chance of ever getting enough schooling to learn how to read or write. She may be circumcised at puberty with the consequent effects on her life as a woman and mother. She will marry in her teens and may have seven or more children close together unless she dies in childbirth before that. Ancient traditions will prevent her from eating certain nutritious foods during her pregnancies when she most needs building up, and dangerous practices such as sing an unsterile knife to cut the umbilical cord and placing cow dung on the stump may kill some of the babies with tetanus.

She will be in constant danger from infectious disease from contaminated water at the-place where she bathes, washes clothes and collects her drinking water. She will be chronically anemic from poor nutrition, malaria and intestinal parasites. As well as caring for her family, she will work hard in the fields, suffering from repeated attacks of fever, fatigue and infected cuts. If she survives into old age, she will be exposed to the same afflictions of women in the rich countries: cardiovascular disease and cancer. To these she will succumb quickly, having no access to proper medical care and rehabilitation. She will not be able to pay anything herself; her country has less than $9 a year to spend on her health.

This is the plight of the 24 million babies, one-sixth of the world’s total, who were born annually in the least-developed countries in this decade.

Many physicians in Western Pennsylvania have volunteered for both short and long term mission projects. From our own community of Erie, physicians have served in Haiti, Central and South America and India as well as throughout Africa. Each has his or her story of challenge, frustration and fulfillment in seeing another aspect of the profession. While some feel a sense of noblesse oblige, others will serve out of a sense of spiritual commitment. Whatever the motivation, there are untold opportunities to see the world through different eyes and stretch your medical envelope, resulting in a better understanding of ourselves and our world.