January 30, 2014

Permanente physician takes preventive care to Brazil

Editor’s note: Kaiser Permanente physician and educator Martin Shearn and his wife Lori traveled to Brazil in 1973 where Dr. Shearn served as chief of staff for the SS Hope hospital ship docked in Maceio, a poor coastal community in Northeast Brazil.

Lori Shearn, Guest writer

The SS Hope sailed to Maceio, Brazil, in 1973. Kaiser Permanente physician Martin Shearn and his wife, Lori, spent the year improving health care access for the ordinary people of the community.
The SS Hope sailed to Maceio, Brazil, in 1973. Kaiser Permanente physician Martin Shearn and his wife, Lori, spent the year improving health care access for the ordinary people of the community.

Before Project Hope, outpatient clinics didn’t exist in Maceio. The mother-baby clinic set up by Hope (in 1973) was a miracle. Ordinary people in this community had no health care at all, and no place to go for vaccinations or health information.

In a poor area where no care facility had existed, Hope staff found an old wooden building to serve as a clinic for new mothers whose babies were not thriving.  There, a group of local women were trained to act as educators. They were gathered from the community and carefully screened, mostly for their willingness to learn and to work hard.

The women were shown what happens on their hands when they are not washed properly and germs are allowed to grow. They were shown graphically that flies contaminate food and open sores and that it’s necessary to keep wounds sterile.

The “nurses” became the health educators of their community, explaining to mothers the risks of putting a pacifier back in the baby’s mouth after it has fallen to the dirty floor. They were amazed at how many diseases can be prevented by vaccination and inoculation.

Many of the children were suffering from a type of malnutrition called kwashiorkor that occurs when there’s not enough protein in the diet. One of the symptoms is a protruding belly.

The mothers learned about better nutrition and how creatures like mollusks and snails in the waters surrounding them could provide the protein their children needed.  The mothers were instructed how to prepare the food and the babies magically began to thrive.

Half-built structure converted to outpatient clinic

The crowning achievement of the Hope mission to Maceio was the incredible discovery of a half-finished medical building and its conversion to an outpatient clinic.  The project, meant to replace the inadequate and overcrowded community hospital, had been abandoned when federal funds ran out three years before we arrived.

When Hope staff toured the partially completed health care facility, the buildings were filthy and overgrown with mold and weeds. Amazingly, there were 75 finished rooms, beautifully tiled, and with a large dose of imagination and a grand push of energy, the university was convinced that this kernel of a new medical center could somehow be realized.

As soon as possible, Hope put the skeleton of a building into operation. It was cleaned and painted and equipment was gathered from supplies around town.

Martin Shearn with patient in Brazil. Project Hope photo 1973
Martin Shearn with patient in Brazil. Project Hope photo 1973

After the opening of this outpatient clinic, patients were assigned numbers, and if they couldn’t be seen one day, they could come back the next. A patient’s problem was evaluated by a doctor who decided whether or not the patient should be admitted, treated in the clinic or sent home.

Parents brought their children to see the doctor, even though they had never had such an experience before. They were taught how much they themselves could improve their own well-being even without additional money, using only the tools readily available.

Even though changes came very slowly, the Maceio community responded, and progress could be seen. When their prescriptions for various ailments ran out, the patient loads suddenly increased and they lined up around the block to see the doctor.

One of the diseases the Hope staff treated was Chagas, an infection found in Latin America that is spread by a parasite called a kissing bug. Dr. Shearn was inspired to write a poem about the disease and it was published in the “Annals of Internal Medicine” in the October 1973 edition.

Thoughts on Chagas Disease

In Brazil there are regions with thousands of miles

Of jungles and swamplands and fierce crocodiles

There are boa constrictors of hideous mood

And piranhas who look upon humans as food

But passions exist here quite different from fright

Abetted by kissing bugs active at night

The sleeper is sought and the kiss is bestowed

Then the insect retreats to its nightly abode

The encounter is brief but it quickly erects

A subtle arrangement with complex effects

The seal of that union is destined to start

A lasting relationship deep in the heart

The clinic continued after the ship left. The auxiliaries who became the nurses at this clinic were carefully trained to read numbers, to take temperatures, to read scales for weighing babies. They also gave shots and inserted IVs when necessary. They were carefully supervised until they were able to function confidently alone.

Hope’s success was not lost on our Brazilian hosts. The new clinic opened with great fanfare and heavy local and national publicity.

Hope made a big difference in improving the health of this community.

Editor’s note: Dr. Martin Shearn, who passed away in 2002 after many years as a Permanente physician, added to Lori’s insights in a letter to friends dated Sept. 10, 1973:

“The work has been the most interesting and worthwhile that I’ve done. The program has come along well. The level of education has risen measurably and concepts have been accepted. We are introducing a Kaiser-type ambulatory (care) replete with multiphasic type screening for the indigent.

“The new ambulatory structure started several years ago will be ready for occupancy next month so we will have a little time to work there before we leave.

There will be a relatively large (30 people) land-based program left behind that will include among others a medical director, biostatistician, and epidemiologist. Should be able to define the population with respect to health, get some patient profiles, decent medical records and get busy with vaccinations, nutritional advice and medical care.”