Volunteering in Saint Lucia

We have been members of Health Volunteers Overseas (HVO), a non-profit organization that places medical volunteers (not just medical doctors) in overseas situations where they can give care and/or teach local health care workers. Three years ago we spent the month of February as volunteers at St. Jude Hospital in Vieux Fort, in the southern part of Saint Lucia, West Indies.

In 2003 we returned. Both of us have found the experience educational for the unusual cases we saw, and for the opportunity to meet similar minded volunteers from all over the world.

St. Lucia is in the Windward Islands of the West Indies, south of Martinique and north of St. Vincent. It obtained its independence from England in February 1979. Although English is the official language, most of the people speak a dialect of English and French. Patois or Kwaole (Creole) seems to be a similar language in many of these islands.

The inhabitants of St. Lucia are mostly of African descent with a minority of people descended from immigrants from India. The country's most important industry is tourism, mostly on the northern part of the island near Castries, the capital, but banana production is significant.

The water on the island is generally safe to drink and electricity is usually reliable. Many of the roads are poor. If you rent a vehicle in this country your contract says you must pay for repair of any tires before returning the vehicle. The main road from Vieux Fort to Soufriere (an interesting and beautifully situated town about 16 miles away) is currently under reconstruction and should shorten the 1 1/4 hour trip to 30–40 minutes.

We were surprised to see a brand new soccer stadium in Vieux Fort, and a cricket stadium in Castries, both built by the Peoples Republic of China as a thank you for recognizing them as the legitimate representative of the Chinese people instead of Taiwan.

The Japanese are also building several public buildings for the St. Lucians. There are several young Japanese Peace Corps workers in various health-related areas in St. Lucia. (Our guess is the Japanese get some fishing rights in return.)

St. Jude Hospital is administered by the state government. In the past three years, the physical plant has been improved immensely. The outpatient clinic, X-ray, and lab have been renovated. Basic tests and exams can be performed. Ultrasound is available, as are barium studies. CT scanning is performed in Castries for about $300 U.S. (The study does not commence until after the fee is paid in cash.)

Blood gases are frequently unreliable. EKG's were unreliable (the ER machine was broken and V1 and V2 were not working from the Internal Medicine machine). Outpatients must pay cash before any test is performed (unless they are assessed as indigent).

Many of the permanent physician staff and trainees are from Guyana (of Jonestown fame). Other staff are from India, Myanmar, Nigeria, and the Philippines. Some local specialists were trained in Cuba.

Because of intense inbreeding, diabetes, hypertension, and glaucoma are rampant. Most adult onset diabetics are not overweight. Hyperosmolar diabetic coma is common. This year, I admitted an 80-year-old man with a blood sugar of 1200 and mild anion gap acidosis, who required 12 liters of normal saline.

A 56-year-old woman was admitted with a history of abdominal pain and vomiting for 7 days. She was fully conscious with a grossly distended, nontender abdomen. She had a mild anion gap acidosis but her blood sugar was only 800. Exploratory surgery demonstrated a large bladder wall abscess, etiology undetermined.

A 34-year-old woman presented with a one year history of exertional dyspnea and was billed as CHF of unknown cause. On physical examination, her heart rate was 120 and regular. She had a bruit on each side of her neck with no associated heart murmur. Her palms were warm and moist and there was a diffuse goiter. Her reflexes were brisk with a rapid relaxation of her ankle jerks. Thyroid studies would not be available for the next 6 days, so we treated her for hyperthyroidism with propylthiouracil and beta-blockers, and she was markedly improved the next day .

A 35-year-old man had a very strange affect which made us think he was a psychiatric case. He was one of several with unusual neurological presentations whose CSF was VDRL positive.

A 13-year-old boy presented with hematuria and hypertension. Although there were not many urinary casts, his arm had a healing infected insect bite which grew out Gram-positive streptococci. This year we saw a 20-year-old with sickle cell crisis manifested by bone pain.

Tuberculosis is not unusual on this island. A patient with a tuberculous empyema continued to drain 100+mL of fluid from a chest tube after several weeks. His sputum remained positive on direct smear but his bug was sensitive to all 5 drugs he was taking.

In 2000, during a terrible storm, a 60ish man presented with recurring left lower quadrant pain of several days duration. A palpable pulsating mass was found in his left groin and a bruise in his left flank (Grey-Turner sign) suggesting a retroperitoneal bleed. The ultrasound revealed a 10 cm(!!!) left femoral artery aneurysm. Transport to Castries was impossible as all the roads were closed (a heavy rain storm caused flooding and landslides, blocking all the roads). He was transferred the next day and underwent successful surgery.

The off duty aspects of this adventure are most enticing. The beaches are beautiful, affording the swimmer, wind surfer, sailor, SCUBA diver, snorkeler, or beach bum a fine opportunity to hone skills. The island has many hiking and walking opportunities in the rain forest, or more strenuously, climbing the magnificent Pitons outside Soufriere. There are also many opportunities to go out for dinner and weekend getaways at the numerous beautiful resorts on the island. Visiting the small villages to participate in festivities not only boosts their economy, but also gives an added insight into their culture.

There is always a need for volunteer Internists, ER physicians, family physicians, general surgeons, and orthopedic surgeons registered nurses, medical students, physical therapists, and occupational therapists. ENT specialists attend occasionally. Glaucoma and cataracts are major problems, and the setup for surgical ophthalmology is quite good.

For the cost of a round trip ticket you can work half days and have a relatively non-stressful working vacation while helping the locals and making new friends with a wonderfully diverse group of volunteers.

Non-medical spouses who wish to volunteer have found a variety of things to do, including gardening on the hospital grounds, carpentry, volunteering at the local elementary school, visiting pediatric patients and other useful jobs.

Those who do not wish to volunteer are able to accompany their spouse; they pay a minimal amount for room and board, which is free to volunteers. It is a unique experience for those who want to stretch their skills in a new environment.

We would be happy to discuss the opportunities at St. Jude with anyone interested.

geowmeyer1@earthlink.net