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PBMC team performs 67 surgeries during trip to El Salvador


Volunteers from Peconic Bay Medical Center struggled to say where they were bound as they reached passport control at the airport in San Salvador. “It starts with a … J? Ju … Ju … Jucuapa?”

The group was headed to the small town in southwest El Salvador for a one-week medical mission trip. Over the course of six days, Jan. 15 through 20, the nine-person team — led by general surgeon Dr. Agostino Cervone — operated on 67 patients.

“It’s very gratifying,” said Dr. Cervone, president of PBMC’s medical staff and director of general robotic surgery. “It allows you to understand what we take for granted [in the U.S.] and how Third World countries that don’t have access to health care [or] surgery will go on for years with a problem that most times in the U.S. will go on for a month or two.”

El Salvador is most frequently in the news for its gang violence problem. The notorious MS-13 gang, which is responsible for a number of grisly murders on Long Island, has its roots in and operates in the Central American country.

In addition to its difficulties with gangs and violence, El Salvador is one of Central America’s poorest countries: 40 percent of its 6.8 million people live below the poverty line. While it does have national health care, overcrowded facilities, long wait times and limited resources mean early intervention and prevention of disease are almost nonexistent. Nationwide statistics put accommodations at national hospitals at one bed per 1,000 patients.

Salvadorans with means will seek treatment at private hospitals, but the poorest and most vulnerable will put off seeking treatment until the situation is dire.

In Jucuapa, about a two-hour drive from the capital of San Salvador, the David V. King Medical Center provides highly subsidized health care in some of the country’s neglected districts.

“It was a new opportunity for Peconic Bay from potential donors in the community and I was approached to be team leader for this trip,” Dr. Cervone said.

The center was built in 2004, an initiative of late American businessman and philanthropist David V. King and Dr. Roberto Arevalo Araujo, a Florida physician originally from El Salvador.

Voluneers from Peconic Bay Medical Center eat lunch at the David V. King Medical Center in Jacuapa, El Salvador. The team participated in a one week medical mission trip where they performed 67 surgeries on needy patients. (Credit: Laura Kelly)
Voluneers from Peconic Bay Medical Center eat lunch at the David V. King Medical Center in Jacuapa, El Salvador. The team participated in a one week medical mission trip where they performed 67 surgeries on needy patients. (Credit: Laura Kelly)

The center has a full-time staff and operates as a clinic, serving between 75 and 100 patients daily. For services including general medicine, gynecology, pediatrics, cardiology and dentistry, patients are charged as little as $2 per visit.

Two years ago, with the purpose of hosting medical mission trips, the center added two operating rooms and a post-anesthesia care unit. Medical missions help the center achieve its bottom line of either free or highly subsidized care. The PBMC team was the second mission to travel to the center.

The King family recently made a donation to the Riverhead hospital and suggested that PBMC staff organize a trip, combining their philanthropic work.

The team included Dr. Jake Gingerich, a third-year surgical resident; Dr. Kaushik Manthani, a general physician; nurse practitioner Cindy Cichanowicz; nurses Sherri Kelly, Mary Uchman, Amanda DeArmitt and Renee Kelly; and hospital administrator Amy Douglas-Smith.

It’s typical for medical missions to bring along much of their own equipment, including surgical instruments, but the center was fully stocked and had local staff to assist in the OR and with patients in recovery.

“It has very much the similar comforts that we have in the states,” Dr. Cervone said of the facilities. “Some of the equipment is certainly outdated from what we have, but we make do with what we have.”

For most volunteers, it was their first mercy trip — and an important “bucket list” item.

“I wanted to try something like this since medical school,” Dr. Manthani said, expressing admiration for the medical teams that stepped up after Sept. 11 and citing his own work with victims of Hurricane Sandy.

Students from the village of Jacuapa at their school. PBMC staff distributed dental goody-bags and toys to the children. (Credit: Laura Kelly)
Students from the village of Jacuapa at their school. PBMC staff distributed dental goody-bags and toys to the children. (Credit: Laura Kelly)

At the center, patients as young as 8 and as old as 84 came in for a variety of procedures, including hernia repairs, excision of fatty cysts and removal of small skin lesions, among others. A few months before the visit, the center advertised the Americans’ arrival, broadcasting messages over loudspeakers in town squares, through megaphones on traveling tuk-tuks — small, motorized taxis — and over the radio.

Maritza Garcia was one of the few patients who required full anesthesia; most were treated with an epidural or local anesthetic. Maritza, age 8, had two hernias that needed repair, at least one of which had been operated on previously, when she was 5.

Maritza’s father, Jose Pablo, a carpenter from the neighboring village of Chinameca, said he was extremely thankful for the center and the American medical team that performed the surgeries. About a year and a half ago, Mr. Garcia and his wife had noticed that the area below Maritza’s stomach was beginning to swell. He was familiar with the center, having taken advantage of its pediatric services for both Maritza and her brother. One day he saw a sign in the clinic saying that an American surgical team would arrive to perform procedures free of charge.

Mr. Garcia said that before he heard of the medical mission, his family had begun the process of putting Maritza in line for surgery at the national hospital. In the recovery room, standing protectively over his daughter, he said he was grateful the surgery had taken place at the center.

“The problem with the national center is that there is too much work for the staff and not enough attention given to the patients,” he said through a translator. “Here, it’s different.”

In addition to working at the center, the volunteer nurses from PBMC took time to visit local schoolchildren to distribute dental goody bags and various toys.

The dental bags — containing almost 200 toothbrushes, tubes of toothpaste and containers of floss — were donated by East Hampton Dental Group and collected by Ms. Douglas-Smith, a medical staff coordinator at PBMC.

“They don’t have the means to get all the stuff we have that is a necessity,” Ms. Douglas-Smith said. “We wanted to make sure we could help provide them with the tools to change the way they look at oral hygiene.”

Nurses from PBMC talk with local staff and learn about the center in Jacuapa, El Salvador. (Credit: Laura Kelly)
Nurses from PBMC talk with local staff and learn about the center in Jacuapa, El Salvador. (Credit: Laura Kelly)

At the school — a squat, concrete building a few minutes from the center — local volunteer and dental student Connie Chávez reviewed proper tooth-brushing procedures with the students.

Ms. Chávez said that dental education and good oral hygiene are a large problem in El Salvador and it’s an area often ignored. People will only fix a problem with their teeth once it becomes too difficult and painful to bear, she said.

“They don’t take care of their teeth and they also don’t know how,” she said.

Deeply moving for the group was an additional visit to a school for children with special needs, where a majority of the 28 students have Down syndrome. The group handed out the dental goody bags, bouncy balls and other toys.

Patricia Mendez is director of Escuela de Educación Especial de Jucuapa, the area’s only school for special needs students. Ms. Mendez said the school receives only a small amount of government money and raises the rest of its $1,500 annual budget by selling trinkets made by the students with help from their teachers. These include earrings, necklaces and bracelets made from cheap plastic beads; keychain-size notebooks made out of old matchbooks; embroidery; and knitted scarves and hats. The students at the school range in age from 4 to 22.

The area’s population is so poor that one woman with twin daughters, both of whom have special needs, can only afford bus fare to send one of them to the school. Ms. Mendez said that when families have no resources to help their children, they are abandoned at home.

For the medical staff, visiting the schools provided a rare opportunity to observe real life in El Salvador.

Back at the center, the 67th surgery was completed around 3:30 p.m. Jan. 20 — earlier than on previous days — and doctors emerged from the operating room looking a little lost.

“I feel like we could just keep going,” Dr. Cervone said.

Top photo caption: Dr. Jake Gingerich (seated, left) and Dr. Agostino Cervone of Peconic Bay Medical Center operate on a patient at the David V. King Medical Center in Jucuapa, El Salvador, while local staff and PBMC nurses look on. (Credit: Laura Kelly)

Ms. Kelly is the former editor of The Jerusalem Post Magazine based in Israel. She has reported from the Middle East, India, Russia and Europe. She graduated from Mattituck High School in 2005.

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