The patients treated by MACLA are among the poorest in Bolivia and the Dominican Republic. They have little or no hope for adequate medical or surgical care. The patients come from cold, lantern-heated sod and cement block homes in the Andes or the hot, tropical cane fields in the costal plains of the Caribbean. They come from the country’s capitals of La Paz and Santo Domingo where the barrio homes are clapboard, garbage litters the streets, and sewage flows in open gutters. They come from small villages and remote areas with no electricity or plumbing. Open fires for cooking and heating account for the many burn patients. Each patient has unique history of hardships and suffering. The patients come on foot, on burros, in crowded buses and cabs.
Preoperatively some patients have been screened in a distant clinic and sent for surgery or triage. Most patients however have had very little pre-operative treatment and come directly on their own to MACLA’s clinics having heard of the us by word-of-mouth, reputation, television, radio or by their region’s political or religious leaders. For every patient accepted, three are turned down; they are too sick or malnourished for surgery; their problems are too complicated to be treated or their surgical problem requires other types of medical or surgical specialists.
A third of the patients have cleft lip/palate and cranio-facial deformities; a third have burn scar contractures or deformities; the rest have hand problems, congenital ear deformities and a myriad of tumors and keloids. Over half of the patients are children and about 20 percent are returning patients for stages procedures.
MACLA provides all immediate post-operative care. After our departure, care is continued by host country physicians or local caseworkers. We arrange all long-term post-operative care and provide antibiotics, dressings, suture removal kits, casts and wound care items. After MACLA leaves, by phone and email, we provide consultations and recommendations to host country medical personnel on the care of our clinic patients.
Health Care Systems in Developing Countries
Health care systems in host countries are federally regulated financially broke, overwhelmed, and destitute. Wealthy residents can purchase satisfactory medical care but the impoverished populace has little or no access to quality care. Hospitals and clinics, with a few encouraging exceptions, are poorly equipped and some are horrific. Our current facilities at the Padre Billini Hospital in Santo Domingo and the Hospital Militar in La Paz are vastly better than the facilities of the past.
The physicians and medical personnel in these countries are overworked, underpaid, and generally not respected. Consequently, medicine is not an appealing career for their young people. In spite of these handicaps, the indigenous medical communities are eager to learn new medical and surgical techniques, generous and considerate in their dealings with patients and have come to trust and cooperate with MACLA.