Reflections from a Mother-Daughter Team

Julie shares a smile with a patient.

Julie Anderson is a member of The Tandana Foundation’s Medical Direction Team and has participated in many Healthcare Volunteer Vacations in Ecuador. She convinced Marcella Bernethy, her mother and Tandana’s oldest volunteer, to go with her on one of the trips. Below are their reflections from the trip.

From Marcella:
When my daughter, Julie Anderson, invited and encouraged me to join the medical missionary trip to Ecuador, I thought it an impossibility due to my 83 years. However, as her companion and with her support, I joined the team.

It was a long journey to Quito and then another two hour drive to Quichinche. but well worth the trip as we were welcomed as guests at Las Palmeras Inn for a much needed rest.

Following breakfast each morning, our van and driver took us to our assigned village where we took any supplies we had brought with us and set up clinics. Setting up clinics was a real challenge, anything from an empty potato storage room to planks supported by cement blocks. But it worked and patients came from mountain side walking barefoot on cobblestone roads averaging 50 a day. Animals roaming everywhere and such poverty but accepted as their way of life. It was a very humbling but gratifying experience. As the “greeter” I tried to welcome each patient with a smile or hug helping them to their designated provider. Since clinic hours ended at noon, we sometimes lunched with the community members learning more of their local culture. Also, we lunched in a beautiful hacienda owned by an American living in Ecuador.

Marcella makes friends with a patient.

Our afternoons were spent on activities such as boat rides, hikes, visits to a Shaman and a Master Weaver and just exploring the culture of the area. I especially enjoyed our afternoon at the Otavalo Market Place and our visit to the sacred tree, El Lechero with all of the history being narrated for us by a student. Spanish classes each day and intermingling with the team followed by a delicious dinner at the Inn- what a wonderful ending of a perfect day. I will always be grateful for the opportunity given to me to be a member of that team. My book of memories is a treasure.

Marcella Bernethy

From Julie:

I have been fortunate to travel to a number of countries as a medical provider over the past few decades and each time my mother would contribute in some meaningful way, be it monetarily ,”treats for the children” or shoes for an elder. Each trip she would anxiously await news of our work, the people, the culture, and their needs! At some point I suggested she join me and from that moment she was mentally packing and planning!
I had a little concern about elevation affecting her energy but that was quickly put to rest as she eagerly joined the group in almost all activities including a climb to a picnic site on our last day of the trip. She made friends with an elderly woman in the market and they still stay connected sending their best wishes for each other and each year I’m given “a little gift for your mother” to bring home. My mother still speaks of the people and the culture with admiration and awe for their survival in the midst of poverty beyond our

comprehension. I am very grateful to have had the opportunity to share this with my mother…it’s not out of the question that we would do it again:)
Tandana’s involvement provides the venue for a rich human experience..cross culturally and without borders…and at any age if you’re willing to open your heart and mind.
Julie Anderson

Marcella, Julie, and their group enjoy Cuicocha Lake.

My Tandana Experience

Drs. Hugh and Ash use a portable fetal doppler to check the health of a baby.
Na takes vitals to prepare patients for seeing the doctors.

by Hugh Chapin

After confirming and re-confirming the critically high blood pressure measurement, I realized that the calm, smiling woman sitting in front of me in her traditional indigenous clothing was not aware of the severity of her situation. She only knew that she had run out of money for her medications and she might as well come see the visiting doctors since they’re here. After all, she didn’t even mention the pesky vision problems, and intense, intermittent headaches and falls until I inquired after accepting the blood pressure measurements. It harkened back to all the literature on hypertensive emergency I had studied in medical school and it was instantaneously clear that I was currently the only one cognizant of the hypertensive time bomb in front of me that could go off at any moment.

This was the beginning to one of my most memorable patient encounters during my first humanitarian medical aid mission. While living several years as an expatriate, I followed the world of humanitarian medical aid organizations with great intrigue, admiration and a feeling of purpose and was resolved to some day explore a niche for myself within that sphere when the time was right. Through a bit of serendipity I discovered the Tandana Foundation in 2011 and became intent on volunteering on one of their Health Care Volunteer Vacation (HCVV) trips and the day I had often imagined finally arrived during the HCVV of March, 2012.

Before leaving my home in New York City for a country I knew little about, I was filled with excitement and forced myself to buffer any images or expectations of what would be, with the inevitability that the reality will be vastly different from any image my mind could conjure. In essence, try not to get excited about the fast-approaching unknown. What a tall order that was!! And how wonderful the unknown turned out to be, as I continue to learn from my experience as I reflect and savor each memory.

My ‘HCVV experience’ with Tandana Foundation was just that….an experience: Personally encountering or undergoing something. A shared experience yet each person takes away their unique perspective. Here are some thoughts from my perspective on my ‘Tandana experience’.

As a young physician, the medical aspect of HCVV: providing medical care to rural, under-served communities, was my driving force to take part. Leading up to the trip I focused on what interesting cases might present, what diseases, parasites and pathologies were unique to that region, and how patient encounters would compare to what I knew from home. During the trip; however, I discovered other aspects and intricacies of the ‘HCVV experience’ apart from the medical. They were just as memorable and not quite as foreseeable. It was often unexpected moments interacting with the group that were most euphoric: a coming together….a sharing of stories…a discovery of common interests…..singing songs…a realization that someone used to work at the same hospital back home.

There was also the learning: Learning from the life experiences of others in the group and especially learning from the people of Ecuador. I suspect that each participant learned something unique from being a guest within the indigenous communities and within Ecuador itself. The cultural beliefs and customs were fascinating and educational for me from beginning to end. I could write a thesis on what I learned and experienced from their rich culture but what impressed on me most personally was the way the people in the isolated communities experienced everyday life and their attitude about it. It was certainly a life without the luxuries taken for granted in modern society which impressed me the greatest. A sort of simple living and content self-sufficiency apart from modern conveniences reminiscent of Thoreau as he took to a Life in the Woods.

Then there was the nature. I frequently think back on the sight of mountain peaks lining up as far as the eye can see as if all standing in an eternal line, the lakes hiding amongst the volcanic peaks, and my favorite by far: looking down at the world below from above the clouds. These pictures show you what it looked like, but neither photos nor words can sufficiently convey the view, the feel of the wind and clouds, and the smell and sound in the air simultaneously stimulating the senses.

Lastly, an over-arching sense from my ‘Tandana experience’ was one of coming together. Indeed, the Tandana Foundation points out the name means “to unite” in the local indigenous language of Kichua. If I had to reluctantly pick only one descriptor of my HCVV experience, it would be “unity”. The sense of unity began with the formation of one medical team out of 14 strangers with very diverse backgrounds on day one. This sense of unity continued throughout the trip as we were guests and ambassadors among many different indigenous communities.

Through no choice of my own, I was born in a country of opportunity and am fortunate to have the opportunities in medicine that I have had. During the HCVV, I enjoyed sharing some fruits of my good fortune with those that, through no choice of their own, were born into a community literally on the edge of the world; far, far away from any level one trauma center, ivy league school, or family medicine clinic.

The case of the woman with hypertensive emergency had an optimum outcome, due in large part to the donations we had received for that mission. A large part of my time with her was dedicated to drawing pictures and using help of interpreters to explain her medical condition and discuss plans for after our departure (She had up until that moment absolutely no understanding of her condition. She had thought of it like a bug bite, that goes away after a few days and a few pills). We gave her a relatively new, hypertensive medication which was donated from Direct Relief International. It enabled us to quickly remove the immediate threat to her health. Experiencing the smile on her face from being free of symptoms, and her joy of understanding her condition is hard to describe. It was a moment that reminded me why I love medicine so much and why we were there. But it was just one little moment amongst so many that together gave me my ‘Tandana experience’
Dr. Hugh

Vision screening
Hugh draws blood for an H. Pylori test.

Healthy

By Anna Taft (Some names have been changed to protect patients’ privacy.)

A barefoot woman in traditional Otavaleña dress wandered up to the schoolyard in Larcacunga, grey hair trailing from under her head wrap.  “What are you doing?” she asked.

“We’re offering free medical consultations,” I replied.  “Would you like to see a doctor?”

“Well, okay.  I’m healthy, but I have pain here,” she said, placing her hand on her back.  “Where are you from?”

“Very far away,” I answered in Kichwa.

“All the way from Otavalo?” she asked, eyes wide at the thought of us traveling ten kilometers from the market city.

“Even farther than Otavalo.”

“Even farther?” she asked, incredulous now.  “How is it that you came all this way to my community?”

How is it, indeed?  It’s a winding story that began ten years ago when I first came to Ecuador as a volunteer for a neighboring village.  But even given the incremental, mostly-explicable growth in that story, the question’s underlying surprise merits remembering.  It is a bizarre thing we are doing, though we often forget that in the enthusiasm and instrumental focus to our energies.  We collect volunteers, including doctors, nurses, and willing assistants with no medical experience, from the United States, bring them to the Andean highlands, and each day take them and our boxes of supplies to a different village’s school or community center to provide basic health care.  A bizarre thing, but a beautiful one.

Beginning my usual set of questions for arriving patients, I learned that her name was Maria Juana Perugachi Torres and that she could correctly state her age at 90.  Many elderly patients weren’t sure of their age, or guessed something different than the birth date on their identity card suggested, but Maria Juana was right on.  I couldn’t help grinning at her, and she responded with the most beautiful smile I could imagine.

“Open your mouth,” Katie instructed my new friend, holding out a thermometer and demonstrating with her own mouth, “under your tongue.”   She gently nudged the thermometer into Maria Juana’s mouth.  Maria Juana sat there, mouth gaping wide, waiting for Katie to finish whatever odd thing this was she was doing.  Katie motioned for her to close her mouth, using hand gestures, forcefully closing her own mouth, saying in her brand-new Spanish, “close your mouth.”  But Maria Juana didn’t understand.  Finally, a middle-aged woman who had already been through this process and was waiting her turn to see a doctor came over and taught Maria Juana how it worked.

As Katie helped her roll up a sleeve to make room for a blood pressure cuff, Maria Juana repeated, “I’m healthy!”

Guessing she might fear her sleeve was being raised for an injection, I reassured her that it was only to take her blood pressure, as if that meant anything in her world.  Next, she was asked to climb up onto a scale.  She stepped squarely up from the side, her left foot entirely covering the plastic window where her weight would be read.  Katie and the middle-aged patient managed to convince her to turn 90 degrees and then inch backwards so that her weight could be recorded, then instructed her to dismount.  What an odd set of tests, Maria Juana must have thought; she would have a story to tell when she got home. Speaking of home, her breakfast was there, waiting to be cooked and eaten.

“What time is it?” she asked, as if she were late for an important meeting.  Receiving her answer, she waited patiently for a few minutes and then asked again.  “I haven’t eaten yet,” she offered, as if to appease our quizzical looks.  Unsure of how to respond, we gave her more blank stares, and then I remembered the boiled eggs in my pocket.  I pulled them out, offered one to her, and began to peel the other one for myself.

Why was she so pleasing to me, this 90-year-old I had just met?  Was it the sly, toothless smile, the high voice blending Kichwa and Spanish, or her self-confident air, asserting quite indisputably that she was healthy?  Perhaps it was her approach toward difference.  Walking through the center of her community, she discovered strangers from a distant land there, doing inexplicable things in the name of “medical consultations.”  She wasn’t afraid or angry and neither was she clamoring for a panacea or a handout.  She was curious enough to try it out, and trusting enough to have her vitals taken, but not so enthralled that she forgot about her breakfast.  In a sense, that attitude shouldn’t be surprising; you don’t get to be 90 in her circumstances without developing a certain self-assurance in addition to an impeccable cardiovascular system.  But she had none of the complaints of loneliness or aches and pains, laments about lost joys that are the staple of some of her contemporaries.  If only all of us could approach new experiences and others with that sort of calm curiosity and confident equanimity.

I was hungry too, so I gobbled up my egg and a protein bar, taking advantage of a lull in arrivals.  José Manuel, the current president of Larcacunga, approached me with his bag of pills.  “When do I take these?” he asked.

Reading the simple instruction sheet in the bag with the medication, I replied, “one with breakfast and one with dinner.”  Many patients liked to double and triple check their instructions, so I was not surprised.  I noticed his pills were for stomach problems.

“With which water?” he asked.

“Oregano,” I suggested, knowing that oregano tea was considered the best remedy for an upset stomach, “if you have it, or if not then with toronjil or cedrón or anise, any water is okay.”

“Anita!” called Joaquin, an interpreter we had hired to work with one of our doctors.  “Jim has a patient with women’s problems.”  Joaquin, indigenous himself and fluent in Kichwa as well as Spanish, cared about the patients and was sensitive to women’s modesty and reluctance to discuss female issues with him in the room.  I bounded up the steep bank to the principal’s office, which Jim was using as an examining room.  I translated for Jim as he asked a few questions, and then Molly brought in the patient’s pregnancy test results: positive, not at all what she was hoping for.  Elena was nineteen and already had one child.  Apparently, things weren’t going well with her husband and she was not excited to bear a second child.  She hadn’t even mentioned the possibility of being pregnant, until Jim asked to make sure a prescription he had in mind would be okay.

After Elena left, eyes downcast and red, I reemerged on the sunny soccer field to the sight of the kids, out to recess, running madly up and down, kicking a tiny ball.  Maria Juana was heading home with a bag of ibuprofen (she was healthy!  Just had some pain in her back).  She stopped to shake my hand, saying “yusul pagui.”  God pay you.            As we rode down in the van that afternoon, Jim related the story of one of his patients.  The diagnosis was situational depression; what she needed was someone to talk to.  She had talked to Joaquin for half an hour about her pain; her teenage adopted son had disappeared, perhaps to Colombia, and she wanted to make sure her younger daughter, also adopted, was healthy.  Joaquin had related only the basics of the story to Jim, but both had watched her attentively as she spoke.  Jim had examined the daughter, found her perfectly healthy, and told the mother she was doing a great job of caring for her.  The mother spoke to Joaquin some more, reiterating her worries, and he noted her name and her son’s to see if he could help her by contacting immigration authorities about her son.  She thanked Jim and Joaquin profusely, saying she hadn’t been able to tell anyone about her troubles before, and departed, her burdens at least a little bit lighter.

Sinking back in my seat, I felt a warmth in my eyes.  This was the kind of medicine that touched me.  I had sometimes wondered how it came to be that I, who had always been rather suspicious of medicine, was coordinating groups of volunteers and taking them out to Ecuadorian villages to practice it.  My motives, I must confess, were more about intercultural interaction and education for the volunteers than medicine, when I began the program.  I realized, though, that what bothered me was less about medicine itself and more about the power relations that are typically set up in the clinic and the bureaucratic structures that reinforce them.  Here we were, listening to patients, sharing laughs with them, trying to respond to their needs, and asking only a 50-cents-per-family contribution for the medications we provided.  Our volunteers were doing their best to learn the villagers’ languages, welcome them, play with the young ones, smile with the old ones.  And many of the patients walked away with the means to improve their health.

That night, exhausted from the responsibilities of organizing the group’s work and activities, I closed my eyes.  Maria Juana walking away from the school, trailing her wisp of grey hair, was the first vision that appeared.