Post by Molly Phillips
This fall, I had the opportunity to travel to Guyana for a week with a team of doctors and nurses from George Washington University (GWU). A few months back, my father – a urologist at GWU – was asked to join Doctor’s International, a group of social justice-minded healthcare providers interested in delivering quality healthcare services to underserved communities worldwide. One of the leaders of Doctors International had been connected with the Ministry of Health (MOH) in Guyana, and following a quick scouting trip last winter, plans were set into motion to get an interdisciplinary group of surgeons, anesthesiologists, and nurses to the country in the fall. After learning about the trip, my dad was immediately interested. And after hearing the groups’ goals of building a long-term and ongoing partnership with the MOH and local physicians in Guyana, he agreed to participate and suggested that they consider bringing me along. Because this was the first trip of (hopefully) many more, I proposed that I could help GWU with a needs assessment process to understand what healthcare services are available in country, what primary barriers to accessing healthcare impact the residents, and what resources and services were lacking. Both the trip leaders and officers at the MOH were intrigued by my proposal, and next thing I knew, I was spraying my clothing with heavy duty insect repellent and getting vaccinated for typhoid.
Guyana is a small country – similar in size to the state of Idaho – located on the northern coast of South America. Made up of dense rainforest and coastline, the majority of the population lives along the coast. Guyana’s capital, Georgetown, is located on the coast and is situated below sea level, so flooding is often a concern. The only English speaking country on the continent, Guyana is considered a part of the Caribbean. The CIA estimates that in 2013, the country had a population of approximately 740,000, made up primarily of Indo-Guyanese (43.45% of the population, descendents of Indian indentured laborers) and Afro-Guyanese (30.20% of the population, descendents of African slaves)[i][ii]. A small indigenous Amerindian population resides in the country, as well. As a developing country, poverty is prevalent; approximately one third of the population lives below the poverty line[iii]. Like many developing countries, Guyana is experiencing an epidemiological transition; while communicable diseases such as TB, HIV and vector borne diseases such as malaria and dengue fever continue to plague the country’s residents, non-communicable diseases including heart disease, diabetes, and cancer are becoming increasingly prevalent[iv].
In mid October, armed with bottles of deet, our delegation of 21 people was off! Traveling with me were three anesthesiologists, 3 urologists (including one who was born in Guyana and had not been back since he left the country at age 10), 3 general surgeons, a crew of operating room and recovery nurses, two surgical techs, and a camera crew documenting the trip and working on a film about healthcare in Guyana. The majority of us had never visited the country and had few ideas of what to expect. We were told that there would be patients that were waiting for our providers to see them, and I was told that Chief Medical Officer would be “taking care of me,” but beyond that, we knew little else about the trip. I was anxious about my role, particularly implementing a needs assessment on my own and in a new place, however, I felt confident that throughout this trip, I would be able to rely heavily on the skills I have learned through my experience conducting needs assessments and evaluations with the Center for Population Studies and the Institute for Community-Based Research in Mississippi.
As soon as I met the Chief Medical Officer, my anxiety subsided. He introduced me to a number of employees at the MOH, including the Minister himself, who immediately asked me to write five articles about cancer awareness and prevention for their local newspapers. Throughout the week I was in Guyana, I met with the health communications team at the MOH; I participated in a site visit to a large employment center where the MOH conducts testing, outreach, and primary care services for company employees; I visited two urban coastal hospitals and one rural hospital a couple of hours inland; and learned as much as I could about healthcare delivery and needs in Guyana. I spent two days in the operating room at Georgetown Hospital, the large public hospital, where I met local healthcare providers and watched surgeries. I also attended the recording of two live segments of Guyana Today (the morning show – equivalent to Good Morning America) where members of our team were guests on the show, helped film a television special on the mission of Doctors International and our experience in Guyana, and was interviewed for the local evening news. I left Guyana with stacks of notes for the leaders of Doctors International and a new appreciation for people providing healthcare in highly under-resourced communities.
Although Guyana and Mississippi are very different places, I was able to draw a number of connections between my work in the Delta and my work abroad.
- Costs: In Guyana, healthcare is free for all residents. So how is this a similarity between Guyana and Mississippi? Because all services are free, waiting times for surgeries or even just appointments with doctors can be incredibly long. Something that we might consider a high priority surgery in the US could be put on hold for months in Guyana. In order to get around these waits, residents can pay for care in the private hospital system. However, in order to be able to use this system, residents must have enough money to be able to afford it. Therefore, like in MS, there are immense disparities in access to care, and costs create significant barriers to people obtaining treatment.
- Access to care: Like in MS, much of Guyana is rural. Aside from cities and towns along the coast, the majority of the country is lush forest. While most residents live along the coast, there are villages, mostly of indigenous populations that live inland. There are clinics that provide basic health services, and the MOH does some outreach in the rural areas, however, in general, the services in the rural areas are extremely limited. Like in the Delta, transportation is a major challenge for people who need more care than they can get at a small clinic. Road conditions vary and there are few options for public transport throughout the country.
- Healthcare provider shortage areas: Much of the state of MS is designated as a Health Professional Shortage Area by the Department of Health and Human Services. According to the Office of Mississippi Physician Workforce, the state has 8.3 doctors per 10,000 residents. This is compared to a national average of 12.8 physicians per 10,000 residents[v]. In Guyana, the World Health Organization reports that there are 2.1 physicians per 10,000 residents. Out migration from Guyana is extremely high; many residents see education as a ticket out of the country, or they leave the country to pursue higher education and do not return. Similarly, many Delta residents see an education in a medical field as an opportunity to leave their community.
Thanks to all of my bug spray, I only got a few mosquito bites in Guyana (although one of them did give me a bump the size of a golf ball on my arm), and the typhoid vaccine worked this time (as an undergraduate I studied abroad in Senegal and got sick with typhoid). Aside from a swollen arm, I came home from Guyana with a renewed appreciation for healthcare in this country and immense respect for all that the providers there are able to accomplish with such limited resources. I also left feeling refreshed and reminded of why I chose to pursue public health, social work, and community development. The trip was hugely successful. Our surgical team completed more than 40 operations throughout the week, all alongside local healthcare providers. The MOH was pleased with the health promotion work we did as well; in addition to the newspaper articles I wrote and the media appearances we made, members of our team led continuing education classes for local doctors and nurses. Plans are in the works for another trip in the spring, and while the group of providers from GWU will likely be different, they will use what we learned on this first trip to be able to accomplish even more and strengthen the partnership between Doctors International and the MOH in Guyana.
[i] CIA World Factbook 2013 estimate: https://www.cia.gov/library/publications/the-world-factbook/geos/gy.html
[ii] 2002 Guyana Census
[iii] CIA World Factbook, 2006 estimate: https://www.cia.gov/library/publications/the-world-factbook/geos/gy.html
[iv] Pan American Health Organization (2009). Guyana Country Cooperation Strategy: 2010-2015