Enriching and Rewarding: Judy Zager, RN, Serves in Panama

Friday, June 28, 2013 3:07 PM comments (0)

This spring, Judy Zager, RN at NorthShore, and Ken Fox, MD, Pediatrician at NorthShore, joined a team of Chicago-area healthcare volunteers in Panama. The team traveled to a remote area of Western Panama to provide much needed healthcare to those with limited access, including individuals from one of the country’s last remaining indigenous tribes, the Ngobe-Bugle. 

Judy Zager tells us about the impact she made and the lasting impact the experience made on her.

Judy ZagerWhy did you choose Panama for your first medical mission trip?
A friend of mine was instrumental in building the dental clinic at this particular site. He’d asked repeatedly for me to join him on a mission. Once I made the commitment, I was asked to recruit a pediatrician and Dr. Fox readily accepted the invitation.

What were your expectations before you left?
My only expectation was that we would be seeing many people who would travel very far distances for care.  When I spoke with another nurse who had been at the site on other missions, she explained what I should expect to see.  It was useful to talk to her beforehand. Her information was a helpful “heads up” for what to anticipate.

What was a “typical” day at the clinic like?
A typical day started at about 9:00 AM. Our arrival was announced on the radio. The patients we saw walked far for care and came early. They often had to wait hours for their number to be called.  With the assistance of Ngobe and Spanish interpreters, each person was triaged prior to being seen by the physician. Vitals were established and their complaints, along with symptoms, were documented. After that, they were evaluated by Dr. Fox and tested when appropriate for pregnancy or strep.  Medication that had been donated to this project was distributed when appropriate.


Was there a case that made an impact on you?
There was a mother and her sister who walked four miles with twins. The twins had an advanced case of impetigo, which is a highly contagious bacterial skin infection common among younger children. This particular case was so advanced that one twin had developed cellulites and the other required IV antibiotic treatment. The minister in charge of our program facilitated getting them admitted to the local hospital.


Why is mission work like this so important for you?
I stepped outside my comfort zone to travel to another country to provide care for others.  I did begin to second guess myself once I had made the commitment to go. Why was I giving up my vacation time and spending my own money to do this work? In the end, it was more rewarding than I ever could ever have imagined. 

What did you take away from your experience? Will you do this again?
The work environment was primitive.  The friend who recruited me helped build the dental clinic and it is a beautiful dental facility that’s very easy to work in.  We (me and Dr. Fox) were in a makeshift area. It was oppressive in the heat with minimal ventilation and just a couple ceiling fans.  There was also no running water.  I came home inspired to return but also inspired to help raise funds to make the medical clinic a better place to work and a better place to receive care. 


A Sense of Purpose: Ken Fox, MD, Serves in Panama

Wednesday, June 26, 2013 4:26 PM comments (0)

This spring, Ken Fox, MD, Pediatrician at NorthShore, and Judy Zager, RN at NorthShore, joined a team of Chicago-area healthcare volunteers in Panama. The team traveled to a remote area of Western Panama to provide much needed healthcare to those with limited access, including individuals from one of the country’s last remaining indigenous tribes, the Ngobe-Bugle. 

In part one of this two part series, Dr. Fox shares some of the most memorable moments and tells us why this wasn’t his first and certainly won’t be his last medical mission trip. 

dr foxWas this your first mission trip?
No. I was in Haiti for a week one month after the earthquake of 2010. And I’ve done work in Cape Town, South Africa as well.

Why are you drawn to this type of medical mission work?
I’ve always been drawn to other cultures and customs. And as a pediatrician, I’m fascinated by the varieties of ways that families and communities come together to do the work of caring for children’s health. My previous work in medical anthropology combined these interests to help inform my clinical work. This Panama trip was an opportunity to rekindle a kind of “vitality of practice” I hold dear.

Prior to leaving on this trip, what were you expecting? How closely did your experience match your expectations?
I wasn’t absolutely sure what to expect. Before we left, I read some on Panamanian history, society and indigenous cultures. And I even read some fiction by a contemporary Panamanian writer. What you learn in books is one thing; being out there on the frontline in the heat and the dust among people struggling to survive with very limited resources is something else entirely.

The abject poverty and absence of resources—poor transportation, housing, nutrition, scarcity of potable water, poor sanitation, low educational/literacy levels, inadequate clothing and shoes—create a perfect storm of risk for the people we served on this mission.

Describe a “typical” day at the clinic? What were some of the most common illnesses you helped treat?
We usually arrived about 9 AM to find a courtyard full of waiting patients. Most of them had walked for hours to get there. We often worked in three languages (Ngobe, Spanish and English). Recruiting all the clinical acumen we had to muster, we tried to figure out quickly and efficiently what was most at stake. Our focus was to address their questions as best we could. There was no lab, x-ray or subspecialist to consult. We had to think on our feet, use our physical exam skills and make decisions.

In this setting, the power of social forces to shape health and illness was so apparent. We had to be mindful of resource constraints and be creative in seeking solutions. But on a deeper level, the moral dimensions and “doctoring” were so much easier to see. It was all very challenging but often very gratifying. 

Was there a single case that had the most impact on you? 
The most memorable case was a pair of two-year-old twins who showed up one morning with their mom and aunt. They heard a radio broadcast about the medical care available at the community center and walked four hours from the mountains to get to us.

They had the worst case of bullous impetigo and ear cellulitis I’ve ever seen. The ear of one was just macerated and covered with sores and pus. Then we brushed back the other twin’s thick black hair to find a similar infection on her forehead. Wcleaned things up and decided to contact a Panamanian colleague with hospital privileges to get them admitted for IV antibiotics. We texted a picture and he arranged for admission to the closest hospital which was about an hour away. It just so happened that someone was delivering supplies to the site by truck at that moment. Since there is no ambulance service available, we arranged for him to drive the family to the hospital. I will never forget the sad sight of this mom climbing into the back of a truck with a twin tucked under each arm heading for the hospital. How difficult it must have been to face such uncertainty and threat. She’d already struggled to get to us, but she was relieved to get help.

How a simple skin infection we see here every day gets transformed into such a severe illness is a reflection of the “structural violence” some people are forced to endure. It just doesn’t seem fair or necessary in a nation in the midst of a vast economic expansion with a 10.5% annual GDP growth rate. The experience just reminds me of the power of social inequalities to harm health—a truth evident here at home as well.

How will work like this help make you a better doctor?
It’s always healthy to have experiences that remind you of the fundamental reasons you go into a “helping profession” like medicine in the first place. The daily grind of primary care can sometimes dull the acute sense of purpose that enlivens our work. Patients are not customers—our work adds up to more. There’s something special about the relationships we form—something sacred—if we’re given the space to do the work.

Where were the other medical professionals from? How many were on this trip?The trip was organized by a prominent Chicago dentist and his wife who built a fantastic dental clinic in the community. They worked in collaboration with an American expat pastor who has longstanding relationships among the Ngobe community in Panama. They’ve done a number of impressive projects together over the years. NorthShore nurse Judy Zager and I joined them on this trip.

Do you think you will do something like this again?
Absolutely! I learned a lot about humanitarian medical relief efforts and community medicine in resource poor settings. And I want to try to build this kind of experience on a regular basis into my ongoing professional work and development.

I was so grateful to my colleagues here at NorthShore. People were interested in what we were doing and so supportive, from covering our patients and on call duties while we were gone to donating books and other materials for the trip. People had our backs. And that means the world to me.

In part two, Judy Zager will tell us about her experience on this medical mission to Panama. 

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