Aníbal Zambrano, a medical doctor in St. Louis, and his wife, Katy, have been involved for the last 20 years with an organization that plans medical missions to Peru. The project started when Peruvian doctors training in the U.S. formed a group of about 600 doctors to improve the state of Peruvian hospitals and provide treatment there for people who would otherwise not be able to afford it.
Graciela Corvalan, who also lives in St. Louis, had often heard the Zambranos talk about the Peru project and their trips. One evening in late July 2003, she visited them in their home to talk at length about this work that is so dear to them.
Although the version of the interview published below has been shortened for editorial purposes, it covers the most important aspects of the Peru project and especially conveys the dedication, enthusiasm and expertise lying behind this tremendous effort.
Q. Why do you call these projects "missions"?
A. Why? Although the word "mission" may have religious connotations, we are not a religious organization. We call them "missions" because we go to assist people.
Q. Then what do your medical missions do?
A. We have three main objectives. First, we treat patients such as indigenous people who do not have the means to pay. We do not charge for anything, and we even take the intravenous fluids we might need for surgery. Second, we take medical instruments to improve the quality of care at the local hospitals, which are usually 40 or 50 years behind the level here. For example, we took equipment for laparoscopic surgery to Iquitos, a city at the upper end of the Amazon, which had none. And third, we train the local doctors in the use of all the new equipment and instruments. Of course, some of them already know about the new techniques, but they need to be trained to use the new equipment. While we are there, the doctors may perform 200 surgeries, and when we leave, they can continue doing the work year after year.
Q. Would you say that the health situation in the areas in which you have worked has improved? Are you optimistic about the results?
A. Yes, when we went to Cajamarca four years ago, the hospital was in the same shape as the one we found in Iquitos. Now it is still a poor hospital, but it is much better than before-they have used and maintained the equipment we left, they have even improved it, and they are in touch with other organizations in order to keep improving their service. Once the doctors see that technology can improve the quality of care, that medicine is a science that requires certain tools, they become motivated.
It is very difficult to measure the impact of a particular mission, but here are some stories to show what happens. A neurosurgeon from Washington D.C. joined the Iquitos mission quite late. The day she arrived, a young man had a motorcycle accident and broke his skull. He had serious cerebral bleeding, and there was no neurosurgeon in town. She, of course, set to work immediately and saved his life. In Cajamarca there was a lady who had a cleft palate. She couldn't speak and her face was very disfigured. The doctors fixed her problem and, of course, they changed her life. If she had been the only person treated, it would have been worth the effort. And there are many, many other similar cases.
Q. How do you select the cities?
A. The directors of the missions make the selection. They normally go to their own town or city of origin, but there are other considerations as well. We try to go to towns outside Lima, the capital, because they will benefit more from these missions. It's also very important to have good contacts in the area. The cities where these missions normally go are: Abancay, Ayacucho, Cuzco, Arequipa, Cajamarca and, most recently, Iquitos.
Q. How do you divide the workload? I mean, who does certain things and who does other things?
A. Katy, with local volunteers, is in charge of packing all the instruments and medical supplies. When we went to Iquitos, we sent over three tons of medical equipment and supplies, and everything was packed here in the house-this place became like a supply center. Everything had to leave St. Louis two months before we did because it takes a month or more to get to Iquitos! Everything went by land to Miami, by ship to Brazil, and from the port of Belen in Brazil up the Amazon River to Iquitos.
Q. What is your role, Aníbal?
A. Well, when you are the director you have to organize everything-recruit the doctors and other volunteers, raise money, get the equipment and medical supplies, make sure that all the equipment works, and plan the trip. We also have to contact the local hospitals and doctors. Without their collaboration, we can do nothing. And, of course, we have to take care of all the bureaucratic paperwork required when one takes medical equipment and supplies through customs. This is one of the most difficult tasks of the whole project.
Q. I'm sure! How do you contact the local hospitals and doctors?
A. You have to go there. You can call them, of course, and now, thanks to Katy's work, we can be in contact via e-mail. However, you still have to go to the hospitals, talk to the doctors, and see for yourself what they have, what they want, and what they need. You have to work with them, ask them how you can help them, and tell them what you can get for them.
Q. I assume that all these towns have at least one hospital?
A. For the type of missions that we do, yes, because they are organized with the aim of improving the quality of care at the hospitals and providing them with medical training, equipment and instruments. Therefore we have to select towns or cities with hospitals that have some facilities, such as operating rooms, medical specialties and a medical school.
Q. What kinds of surgery do you do?
A. We do laparoscopic surgery, which means that a patient can have surgery in the morning and return home the same day or the next morning. We also perform diagnostic tests. While we were in Iquitos we did what had never been done before there-we replaced an entire hip. Just think of it! Total hip replacements and laparoscopic surgery are great improvements, and now the local doctors are doing these operations themselves.
We took prostheses with us as well, and various equipment to diagnose cancer of the cervix and to perform electrocardiograms and pulmonary function tests. We even took a dermatome to start a burn unit and a complete gastroenterology laboratory.
Q. How did you acquire all this equipment, and how did you raise the money for it?
A. Some of the equipment is new, and some is secondhand but in very good shape and will last a long time-ten years for endoscopes, and five or six years for laparoscopic equipment. If you wanted to buy new instruments and equipment, you wouldn't be able to afford them. We could not have taken all the equipment we did without donations from people, especially my patients, and from St. Luke's Hospital here. Everyone has been very generous!
Q. Are all the doctors surgeons or do some of them have other specialties?
A. No, no, they belong to all specialties-internists, kidney doctors, cardiologists, pulmonary doctors, rheumatologists, and oncologists. For those in internal medicine it is more difficult to see the impact of their work, because they normally deal with chronic cases that require follow-up. Still, they can teach others by establishing good models for rounds and other important routine-type skills. However, I should say that the missions are mainly surgical.