Healthy Futures: Addressing Common Diseases at the Mission Hospital
Written by Faith Pitsikoulis
Today, we’re speaking with Dr. Rafael Tun, the Director of the San Lucas Mission Healthcare Program. He graduated from the University of San Carlos de Guatemala in Guatemala City and has worked for the Mission since 1998. In addition to preventive programs, the hospital serves roughly 25,000 patients a year in both hospital and rural services. We discussed the common diseases treated in San Lucas and how healthcare trends have changed over the past couple decades.
Question: What is your role at the hospital?
Dr. Tun: I am the Medical Director of the Healthcare Program. My job is coordinating the program’s work in preventive health [rural areas] and curative health [hospital care]. I work as a consulting physician three days a week and an emergency physician on weekends in coordination with two fellow physicians. I also perform ultrasounds for two continuous afternoons and do administrative work.
Question: What are the most common diseases or health conditions you treat?
Dr. Tun: In general, respiratory and diarrheal diseases. In recent years, there has been an increase in diabetes, hypertension, and heart disease.
Question: Can you describe the prevention strategies used?
Dr. Tun: We have some sub-programs in the communities that deal with poor nutrition, diabetes, women’s health, and hypertension. All the work is done through 7 local coordinators who distribute work through 32 Health Promoters working part-time and who are members of the communities where the programs are being developed, with well-established protocols to monitor and follow-up. All this is thanks to the intervention of American doctors who have always supported us individually or through universities where they have been trained.
Question: How have common diseases and health conditions changed over the years?
Dr. Tun: Approximately 20 to 25 years ago, our patients died mostly from pulmonary diseases, diarrhea, dehydration, and malnutrition. The community has evolved, and now we see that respiratory and diarrheal diseases (caused from amoebas and other bacteria) have gradually decreased. Chronic degenerative diseases such as heart disease, diabetes, and hypertension have taken a very strong role.
Question: Why do you think there has been a recent increase in diabetes, hypertension, and heart disease?
Dr. Tun: There has been a marked change in diet, as well as in the harvesting of foodstuffs [such as beans and corn], where chemicals have recently been applied to everything for their growth and production. People in the community have stopped eating healthy and homemade food and now consume many processed foods, packaged foods, and fast food that did not exist in the past.
Question: Are there any new diseases or health conditions that have emerged recently?
Dr. Tun: Yes, COVID-19 was one of the last ones that hit the whole world, and now we are in a Dengue crisis.
Question: What challenges do patients in rural areas face when trying to access preventive care?
Dr. Tun: It is complicated, because most people understand that diseases have treatments, but the population knows very little about prevention. It is complicated to make them see that prevention is the best way to avoid many diseases that harm the community, both adults and children.
Question: How does the hospital collaborate with community Health Promoters?
Dr. Tun: We coordinate the work they do. We conduct knowledge sessions and review the results of the information obtained with the different forms of supplementation or distribution of medicines for certain chronic diseases. We also plan talks and review the topics that can be taught to the community.
Question: Do you have mobile care for patients who cannot travel to the hospital?
Dr. Tun: Most patients have their own resources, but when we have very specific cases in our prevention programs, we provide transportation. We can also transfer patients to another care center in the region or to Guatemala City if necessary.
Question: Do you have any common supply or medication shortages?
Dr. Tun: Yes, usually first-line drugs, which are basic antibiotics. The cost is usually high in relation to the average salary that most people have in the community. The Medical Brigades [programs that provide healthcare services to under-resourced communities throughout Guatemala] that visit us donate all their medication. What they do not manage to finish in the clinics, we send to a common warehouse for donations to continue helping all the people who cannot acquire their medication at some point.
Question: How do you manage patient care with these shortages?
Dr. Tun: We use all the donations and talk to all the medical groups that visit us to bring medicines that are of common use. We also have a small fund to buy medicines and donate them to those who have no possibility [of buying them on their own]. We can help 100% or 50%, depending on the case and the possibility of the patient.
Question: How do community Health Promoters provide feedback from the community to the hospital’s management?
Dr. Tun: We have regular meetings with the coordinator, and we talk to see if we can help or establish communication with other organizations that could help if we don’t have the possibility.
Question: Is there anything else you would like to share?
Dr. Tun: This year, we have started evaluating children with nutritional problems in the urban area. This prevention program has only been applied in rural areas, but we realized that the number of nutrition problems is increasing in urban areas. Thanks to the generosity of many people who know the community, we have already started. All the community wants is a dignified life and humane treatment as the children of God that we are.
If you would like to learn more about the Healthcare Program, click here.