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Fourth-year medical student Andrew Griffin (left) and Dr. Bruno Lewin remove a lipoma, a large fa

By the time the bus pulled up in Falmouth, Jamaica, each morning, the medical students, doctors and other practitioners could see a full day’s work waiting for them.

Every day by 8 a.m., 80 to 100 Jamaican residents were already crowded onto the veranda of the medical clinic where 27 students and professionals from UCLA volunteered for 10 days this April.

Some of the waiting patients suffered from chronic arthritis, others from diabetes or high blood pressure, and still others from infections. But all of them came to the clinic seeking the same thing: health care they could actually afford.

“In Jamaica, they don’t have a system of insurance or health care, so going to a doctor is expensive, but getting your medicines is even more expensive,” said Walter Coppenrath, a first-year medical intern who made the trip both this year and last year.

“We’re able to kind of get everything under one roof for them. They do pay some money, but it’s very reasonable in comparison with what they’d have to pay to see another doctor,” he said.

The clinic was originally founded by a doctor from Missouri, and is manned periodically throughout the year by groups of volunteers. This is the fourth year UCLA has sent a group to help.

Dr. Bruno Lewin, who has coordinated each of the four UCLA trips, said various groups from the United States and Canada send teams. The periods between when teams are sent could range from a week to a month, he said.

As the clinic opened each morning of the UCLA team’s stay, patients would first pass through a “triage room” to explain their main complaints and have vital statistics taken. Next, they would sit in a waiting area until a medical student could provide treatment, sometimes with help from one of the team’s practicing doctors.

If they were prescribed medications, the patients could get them for free from the clinic’s pharmacy, which was also run by students.

“Medical students pretty much do everything there, which is really nice,” Coppenrath said.

Because of the high demand for affordable health care, many patients travel up to five hours to reach the clinic and stand in line almost all day to be seen by a medical student.

“A lot of people end up needing to wait four or five hours to see us,” said Mayssa Sultan, an acupuncturist who went with the UCLA team. “It’s first come, first served, so if you don’t get there by 6:30 or 7 in the morning, you’re not likely to be seen until 5 p.m.”

Of the four annual trips that UCLA teams have made to the Falmouth clinic, this year’s was the first to include two dentists, a dental assistant and a chiropractor.

“I think it’s rare that you see people from Western and non-Western approaches working together, and different providers sharing information,” Lewin said.

“We would have patients who would be seen by a physician and would have chronic arthritis, and ... they would receive a referral to our acupuncturist, which means walking around to our back room and having a treatment. That same person may have acupuncture for their anesthesia for a dental treatment, rather than receiving any medication,” Lewin said.

The collaboration was part of the team’s effort to find alternative solutions to their patients’ health problems. Because the clinic is manned only periodically, volunteer medical teams must work closely with local health care and try to find treatments other than constant medication.

“In a site where you can’t drop off a ton of medicines, you have to see what you can do locally,” Lewin said.

In addition to running the clinic, the UCLA team paid visits to an orphanage, a girls’ shelter and a nursing home, and gave treatments at each location.

“About half the children there were infested with scabies,” Coppenrath said of the orphanage. “(They were) very cute kids, but very sick.”

The team also collaborated with the Bob Marley Jamaica Group of Companies – a coalition of foundations and businesses – to run a one-day health fair at a school in Nine Mile, the rural and poverty-stricken area where reggae legend Marley grew up.

“We mainly just do screenings up there,” Sultan said. “As of now, we’re the only team that goes to that location, so we can’t really dispense any medications, because there’s no one to follow up and make sure that dosages are appropriate or whatever else. And up there, it’s so rural that you end up with very little health care.”

While in Nine Mile, a few medical students made house calls to treat those who were too ill to travel to the clinic or the health fair.

“We had a list of about three people that we were going to go visit, but of course, people around the houses where we were would see that the doctors were there,” said fourth-year medical student Andrew Griffin, who was one of those making the house calls.

Griffin described the case of one woman in her early 40s who had suffered from a stroke and whose blood pressure was too high to measure using a standard blood pressure cuff.

Griffin also related the story of another man who was suffering from sickle cell anemia and had been in the hospital until he ran out of money and had to leave.

“The sickest people that I saw by far on the trip were during the house calls,” Griffin said.

Griffin, like many other students, was struck by the poverty he saw in Jamaica. He described crowded and dilapidated houses, holding as many as 12 people in a single room, with no plumbing and sometimes no kitchen but an open fire.

“The level of poverty was just terrific, to the point where they weren’t supplying their daily needs, but still people seemed to keep a good attitude,” Griffin said. “They were still friendly.”

“I think it would be especially unnerving for anyone that had gone to Jamaica before and had seen the storybook Jamaica that I think most travelers see – kind of the all-inclusive resort where people are expected to stay behind a wall and have all their needs catered to,” Coppenrath said.

“They don’t really have a chance to go out and see the rampant poverty that exists on that island. When we’re there, that’s what we deal with first-hand,” added Coppenrath.

Sultan also emphasized that the 10-day trip to Jamaica was very different from the usual Jamaican vacation.

“It is not a glamorous job,” she said. “You know, we’re wearing scrubs, we’re in a clinic, and at any given time you’ve got at least 30 people in a relatively small space.”

Students who go on the trip not only spend their time working, but have to pay for their own airfare and living expenses. The teams also must bring their own supply of medications to use in the clinic, which can require considerable fund-raising.

But despite these difficulties and the problem of rising costs and inflation in Jamaica, Lewin said he didn’t expect to have trouble finding students to go on future trips.

“I think people have an interest in what are often called volunteer vacations,” he said. “People do work hard for this experience, but ... you get that direct appreciation from the people you’ve given the care to, and that’s a direct reward that I think is sometimes hard in our current medical model.”

Lewin also said he plans to expand the program to other locations over the next few years. He hopes to run a trip to Egypt as soon as January 2006, a trip to Ghana in July 2006, and possibly one to Ethiopia in 2007.

“I think it will continue to grow,” he said. “When people have an interest, they make it happen.”