Three resident doctors got their first dose of global medicine last week, returning home after a 12-day medical mission trip to Bolivia with Altoona-based Love in Action International Ministries.
"Without diagnostic tests, we had to rely on critical skills - the way medicine used to be," said Dr. Tim Romanoski, 31, a third-year resident with UPMC Altoona's family physicians residency program.
Romanoski, his fellow residents and program faculty, Dr. Debra Pike and Dr. Art Morrow, ran clinics every day from 8 or 9 a.m. until noon, breaking for siesta until 3 p.m.
Dr. Tim Romanoski examines a patient with the help of translator Lindsay Luzod, a Cedarville (Ohio) University student. Romanoski was one of three resident doctors who traveled with Love in Action International Ministries in Bolivia.
Then they would often work until 6 p.m. or later, he said, before caring for volunteers working construction on Love in Action's Andrea's Home of Hope & Joy orphanage.
Having attended Ross University, a medical school based in the Caribbean nation of Dominica, Romanoski said spending time in Bolivia brought back many memories of the obstacles he used to encounter there.
"The inconsistency of electricity, problems with showers ... just seeing the poverty and lack of health care," he said.
Having never practiced global medicine outside of the Army reserves, Morrow said there was some culture shock seeing the different health care standards and treatment methods.
The doctors often were unable to treat chronic conditions, he said, because they brought limited supplies with them, and their patients wouldn't be able to afford later follow-up visits once they left.
"A lot of the things we treated were acute problems: infections or a skin rash or a serious enough problem that warranted seeing a specialist," he said.
And doctors often opted not to perform tests for a condition if the results would take weeks to process without changing the treatment.
"Here [in the residency program] they do teach us to rely on our physical exam and clinical knowledge. Tests just help with diagnosis," Romanoski said. "Things we consider routine testing would take weeks to get done, even in the hospital. A thyroid test would take weeks. Here in Altoona, it's done the same day."
This was Pike's fourth trip with Love in Action, but she said she still had new experiences - including performing a cesarean section on a 46-year-old pregnant with her sixth, and unexpected, child. The next-youngest child was 14, she said.
Insurance reasons prevented doctors from performing a tubal ligation previously, so for this pregnancy, they diagnosed the woman with macrosomia, or big baby syndrome, so she could have a c-section, exposing her fallopian tubes so they could be tied.
Scalpels there weren't as sharp, and the stitches used in the procedure were a kind she hadn't seen in years. Still, Pike said, the baby boy was delivered successfully, and both mother and child were happy and healthy.
"It was kind of eye opening, operating in an environment without the same sterility," she said.
Morrow said the trip showed him how lucky Americans are.
Hospitals lacked air conditioning. Bugs flew in front of doctors' faces while they examined patients, and the working spaces were small, he said.
People often rode their motorcycles to the hospital's front doors and brought their dogs with them to appointments.
"There were lines where people waited to be seen for care, and those were only the people who could afford to pay for it," he said.
All said one of the most rewarding parts of the trip was bonding with the children at the orphanage and watching some sing in their first community choral competition - where the kids took second place in their division.
After that, leaving was hard, Romanoski said, because the kids welcome the attention - giving hugs, singing songs and calling the volunteers their aunts and uncles.
"You are part of their family as soon as you step foot on the property," he said. "There's no way you can come back untouched by what you see."