American College of Physicians: Internal Medicine — Doctors for Adults ®


Want to make a difference? Try volunteering overseas

From the March ACP-ASIM Observer, copyright 2003 by the American College of Physicians-American Society of Internal Medicine.

For a printable version of this column, click here.

By Sara E. Walker, MACP

What motivates American doctors to shut their offices and travel long distances to treat patients in less developed parts of the world?

Some who love to travel seek adventure and a different perspective on life. Many who retire early want to maintain their skills and provide a needed service. And others go because the need is great and they have the ability to relieve tremendous suffering.

For Serle M. Epstein, ACP-ASIM Member, assistant clinical professor of internal medicine at New Haven's Yale University School of Medicine, a personal connection led him to leave his teaching duties and private practice in Connecticut. His goal? To take modern internal medicine to the highlands of Ecuador.

Dr. Epstein's story illustrates the difference donating time and skills can make to patients abroad—and to the physicians who volunteer.

Entering the rainforest

Through a longtime patient, Dr. Epstein learned of the Rev. Jorge Nigsch, a parish priest in Guadalupe, Ecuador who ran a new mission and hospital. The facilities had been built in a high tropical rainforest at the foot of the Andes to serve the indigenous Shuar and Saragura people.

During his first visit there in December 2001, Dr. Epstein got a firsthand look at how desperately the community needed the new facilities. He met the people of the Oriente who live in almost unimaginable poverty, providing for themselves though subsistence farming, shopkeeping and gold mining. One elderly patient lived alone with her chicken, with only the one egg the chicken produced every day to eat.

Before the mission and clinic were established, the poorest people had relied on midwives, a few local physicians and shamans for their medical care. With the new clinic, the people could receive better quality care at a fraction of what it cost in the local villages or at the regional hospital two hours away.

Men, women and children started lining up at 10 o'clock at night to be seen at the clinic the next day. They would patiently wait all night to get the care they needed.

Dr. Epstein treated a variety of ailments. Musculoskeletal problems, parasitic infestations and depression were common, although he also saw patients with gynecological ailments, heart disease and rheumatoid arthritis.

A return visit

Dr. Epstein returned to the clinic in October 2002, prepared to have an even bigger impact. In addition to seeing patients every day, he trained nursing assistants and set up a clinical laboratory—the first in the area that could perform automated complete blood counts, urinalyses and vaginal smears.

Looking back, Dr. Epstein admitted that it took courage to leave his solo practice for several weeks to go work in the rainforest. The pleasure he derived from the trip, however, was almost beyond description. The setting was safe and exceptionally beautiful. Clouds enshrouded the Andes in the mornings, and after a warm rain shower in the afternoon, the evening coolness would settle in and frogs would begin their serenade.

But his greatest rewards came from the people of Guadalupe. "Volunteers are pointed out and held up to the entire community as exemplary models of people living their faith," Dr. Epstein said. "I found the experience a religious one in the purest sense. The entire atmosphere at the mission is that of giving service, of helping those less fortunate build a better life in both spiritual and physical ways. It helped me put my life and my practice in perspective."

Dr. Epstein's commitment to the people of the Oriente didn't end when he came home. Back in Connecticut, he continues to use the Internet to find volunteers, medicine and equipment for his adopted hospital. He described his latest acquisition with pride: an operating microscope that he will soon ship to Guadalupe to upgrade the surgical facility. The microscope will make it much easier to treat patients with ruptured eardrums and cataracts, which are common there.

Getting involved

Perhaps you would like to experience some of the rewards Dr. Epstein describes. The College has a number of resources with information on a wealth of volunteer opportunities abroad. (See "A guide to volunteer opportunities," for more information.)

For information about volunteering at the Guadalupe medical clinic, contact Dr. Epstein at or the Rev. Nigsch at You can also visit the clinic's Web site. (Look for the link to the mission clinic.)

Serle M. Epstein, ACP-ASIM Member, provided information for this article.


A guide to volunteer opportunities


How the College recognizes dedication to volunteerism

Every year at Annual Session, the College gives one internist the Oscar E. Edwards Memorial Award for Volunteer Service.

ACP-ASIM established the award in 1998 to honor the late College Regent known for his dedication to volunteerism. In that spirit, the award is given to an internist who starts a volunteer medical program or provides exceptional medical services on a voluntary basis.

This year, Thomas J. White Jr., FACP, of Memphis, Tenn., will receive the award for his efforts as a full-time volunteer caring for the uninsured in Memphis. He has volunteered his services since 1963, when he served at the Albert Schweitzer Hospital in Deschapelles, Haiti.

For more information or to nominate someone for the award, contact Awards Administrator Jean Elliott at


[PDF] Acrobat PDF format. Download Acrobat Reader software for free from Adobe. Problems with PDFs?

This is a printer-friendly version of this page

Print this page  |  Close the preview




Internist Archives Quick Links

Not an ACP Member?

Join today and discover the benefits waiting for you.

Not an ACP Member? Join today and discover the benefits waiting for you

ACP offers different categories of membership depending on your career stage and professional status. View options, pricing and benefits.

A New Way to Ace the Boards!

A New Way to Ace the Boards!

Ensure you're board-exam ready with ACP's Board Prep Ace - a multifaceted, self-study program that prepares you to pass the ABIM Certification Exam in internal medicine. Learn more.