Story by Diksha Mohapatra.
As a fellow volunteer leaped off the ledge 50 feet high with a rope in her hands, she let go prematurely and slammed her feet on the rocks below. This frighteningly unexpected turn of events occurred when we went on our only true getaway after an exhausting, successful 9 hours at the clinic.
The beauty of the 25-person team of our medical mission trip volunteers working together to conjure up a splint from wood and ripped beach towels was a feat to see! With the fewest hands-on patient experiences there, I realized that graduate school in healthcare was NOT the only method to learn ways to provide excellent patient care. I had only just completed my first year of podiatric medical school, so my knowledge was limited to how to do a general check-up. However, it would have been one of my best opportunities to provide the most critical support for someone in grave need. It reminded me again of how important podiatry is for the world. This small accident alone cost her the rest of the trip. This was just one of the many moments I had during my adventurous and eye-opening medical mission trip experience in 2019.
I. International Medical Relief program
I managed to find a medical mission trip that was affordable and, simultaneously, in a location my family felt safe with. Thankfully, my friend and colleague, Yona, agreed to tag along so that we could have an opportunity to learn from other healthcare professionals. We wanted to apply what we learned in school to those who do not have the luxury of access to podiatrists. Surprisingly, we did accumulate enough knowledge to treat our patients conservatively.
We chose to go to Upala, Costa Rica through the International Medical Relief (IMR) program. They chose a local hotel for us that suited all our basic needs. We always had fresh breakfast served for us, packed lunch, and dinner at a nearby fine dining restaurant. The breakfast fueled us with fresh fruits, eggs, bread, etc. with delicious plantains. The lunches were often quick sandwiches, and the dinners were the most filling. The hotel had open space with trees, flowers, and plants that were a treat to the eyes. Even though the mattresses were flatter than what we were accustomed to, we were pleased with the décor, air conditioning, restrooms, and sound sleep.
We knew exactly what we were expecting, but what surprised us was the location. It was in a relatively secluded small town, and people who wanted to partake in touristy activities would have had to drive over 2 hours away. The locals were nice and friendly, even if we weren’t all fluent in Spanish. There were not too many shops in the area, but there were a few bustling markets, one college, and one school. It was hot, humid, and tropical, so our long, windy drive up to the town consisted of lush, pine green forests and grass with vibrant flowers everywhere.
II. Our Typical Day
Every day, we would awaken to eat breakfast outside at tables during which the IMR leader would discuss who was assigned a specific station or task for the day’s clinic. The local volunteers were a doctor, his wife, and various translators who would also chime in. After, we would load up the bus with the bags of clinic supplies; we would drive to the clinic for the day, which is always a new location which we set up shop. Patients from all over were informed beforehand, and some would travel hours just for the service. Unbeknownst to us before the trip, Yona and I were actually the only podiatry students there. So the first few days, we helped distribute medications, checked vitals, performed basic eye check-ups and administered eyeglasses, and helped the doctor and Physician Assistants (PAs). We were afraid that not having a podiatrist would hinder us, but we eventually realized that we had learned a substantial amount of information and had enough hands-on practice from our school courses that we were able to help.
Yona and I ultimately made a specific podiatry station. Many people had feet conditions but never thought of their afflictions as something they could bring up to any healthcare professionals. We knew very well that we could treat them for simpler conditions or at least give them the proper tools to help themselves after the clinical visit. Hundreds of patients would line up every morning, and we saw quite a few specifically for foot care.
One of our first patients presented to us with plantar fasciitis, which thankfully, was one of the first conditions we learn to diagnose in school. I left her with some exercises to perform on her own and other modifications. Yona performed a wedge resection for a child who was in dire pain. I did not have the regular nail nippers podiatrists use, so I cut my elderly patient’s onychomycotic toenails with drugstore nail cutters. That proved to be a troublesome feat, and those were one of the many moments that I was frustrated for not having brought my own tools. The patient reported that he could not cut his nails for years and lived alone without any help. Quite honestly, that situation was the toughest for me because I could not provide him with anything for the long term. Even though it might seem like a small issue to anyone else, this predicament gives him discomfort to the point that he cannot walk properly. I provided him suggestions but left that encounter feeling the worst.
III. Memorable Times
One of my favorite moments was when the generous PA would teach us what he knew would eventually be expected of us as podiatrists. He taught us how to test a patient’s lower extremity reflexes, so we learned some of the techniques to utilize when someone experiences knee pain. I worked with another PA to help drain an enlarged, protruding cyst on a patient’s knee.
Our most memorable patient lived across the street from where we held a clinic. He was completely non-weight-bearing with a severe venous ulcer, so we visited his house and dressed him accordingly with the PA supervising. He then gave them specific instructions, leaving behind material to help them. That was actually one of the first ulcers we treated, and it showed us the impact that we can have on a patient.
On one of the first days, I was the first one to face the consequences of not heeding the team leader’s advice:
I did not hydrate myself enough.
Again, one of the many advantages of being in a team full of healthcare professionals was that they can see signs that you cannot yet detect. One of the PAs noticed that I looked like I had lost the color on my face. After arriving at the site and setting up, my head started spinning. I grew claustrophobic and sat down, but I could no longer hold a conversation. One of the nurses recognized the signs immediately. She quickly opened up hydrolytes from her pocket, threw them into a water bottle, and firmly told me to stay seated and gulp down the water immediately. She carried me to the bus and set up an IV drip for me. This was another instance that I was thankful for how kindhearted and necessary the healthcare field really is.
Of course, there were moments when we explored the delicious cuisines, tried the local fruits, visited the local bars to bond with our teammates, and danced salsa with our wonderful translators and bus driver.
The trip taught me about the importance of a healthcare team being able to work together and how essential having the correct tools is. Medical professionals can sometimes treat the patients for temporary relief and then never see them again, leaving them without the essential continuing help they need after. However, at the end of the trip, I truly realized that the beauty of podiatry in terms of medical mission trips is that we did not leave the patients with a lack of tools to take care of themselves.
I hope that the next time I do join a medical mission trip, whether I am the only podiatrist or not, I will bring along my own tools. Hopefully, this time around, have the surgical skills to also help those in emergency situations who rely on us.