Care in a ‘desperate place’

New CPH surgeon's life changed by overseas charity work

Of all Dr. Jason Lattin's patients, she stands out the most.

 

Her name was Shatara.

And a bus hit her.

In the Middle Eastern Muslim culture, one with an inherent disregard for the value for women and the young, there's a price for the life a young girl, Lattin said.

It's about the price of a cow, which is in the ballpark of $100.

Shatara was struck by the bus, but only critically injured. The driver punched the brakes and did a quick calculation - pay, as required by culture, for the cost of her likely extensive medical bills, or simply pay the cost of the young girl's death.

He chose the latter and put the bus in reverse.

"So he backed up over her to finish her off," Lattin said sitting in his office in Soldotna. "But, he didn't finish her off. She was still alive after he had run over her twice so he then also made an important decision.

"When the crowd around somebody sees a vehicular accident, they will pull the bus driver down from the bus and kill them because that driver just killed one of their village."

The driver sped off, leaving Lattin with Shatara on his operating table. Most of her abdomen was "crushed beyond recognition."

"I honestly didn't think she would live," Lattin said.

The 40-year-old surgeon, who now works for Central Peninsula Hospital, operated on her multiple times for several months, sometimes daily.

"By God's grace she lived and I have pictures of her," he said with a smile.

Such struggles for life and care were part of Lattin's daily routine. As one of two general surgeons for more than 8 million residents of Bangladesh, Lattin was usually busy.

The University of Washington graduate's two-year experience operating in one of the poorest and most densely populated countries in the world would change his life, both professionally and personally.

"When everyone in that whole district is just scrabbling out a life of trying to just get enough to eat and solve whatever immediate medical problem they have, you're not dealing with patients that have some chronic condition that nobody knows what it is and they are doing multiple tests and stuff," Lattin said. "No, you are dealing with patients that have an immediate, obvious problem.

"Typically these are young patients where if you fix it, you have transformed their life and then they now can live another 40 years. For instance, a femur fracture for a working age, 16-year-old male. You know if you can fix that guy's femur and get him back out into the rice field where he feed can his family, you have just transformed that family. You've enabled them to live, essentially."

Lattin, who grew up in Portland, graduated from the University of Washington and was an electrical engineer for Intel for a few years before going back to medical school.

As a pre-med student, he got a chance to work with a missionary doctor serving the headhunting community in Borneo, Indonesia.

"Coming back from that, going through medical school, I knew that I wanted to do something like that," he said.

Six months after finishing a five-year residency at Oregon Health Sciences University in Portland, he and his family were eastbound. He was signed up with World Medical Mission, a branch of Samaritan's Purse, which staffs mission hospitals all over the world in places of need.

He was given a choice of either Bangladesh or Cameroon. He served in the hospital from December of 2008 to December of 2010.

Bangladesh is populated by 142 million people and is roughly half the size of Oregon.

"It would be like all of the people in the U.S. living in Oregon," he said. "There is just people on top of people."
It is, as Lattin put it, a "desperate place."

"The majority of people, if you take away their cell phones, are living the way they did 3,000 years ago," he said. "They are cooking over open fires that are fueled by dung from their cows in bamboo huts. It is mostly subsistence-level rice farming."

Along with the country's population challenges come a variety of health care problems.

Each morning a medic would walk through the crowd gathered around the hospital where Lattin worked and triage those looking for care. Patients who had waited the longest, women and children were given preference.

Only a certain number of people would get tickets, even though Lattin, the other surgeon and Bengali medical staff inside were hard at work.

"Sometime patients would sit outside the gate for a week before they would get seen waiting for a ticket," he said.

"That's the hard reality of a limited supply and an overwhelming demand because you could literally work yourself to death there."

Going to a government hospital would have increased the chance of a life-threatening surgical infection or lack of compassionate care, he said.

Lattin operated almost every day of the week and would do as many as 11 operations in one day.
"They didn't expect their doctor to come and spend a lot of time with them," he said. "They understood the pressures that we were under and they were just grateful to ... have their problem fixed."

Being constantly in demand to perform a variety of surgeries, some of which would be far out of the scope of a general surgeon, sharpened Lattin's skills.

It also sharpened and tugged at his faith.

"Let's face it, you're not doing it for the money or the comforts," he said. "There's not a lot of secondary gains to be gained from that and that's why not a lot of people do it.

"But if you believe that every person is valuable and people are eternal and that's a useful service, which is what God gave me these skills to do, then I felt that was a good use of my time."

The two years opened his eyes to the desperation that much of rest of the world lives in and how ignorant others can be to it. Americans don't quite realize how good they have it, even as it is, he contends.
"All it would take is a week sitting outside your doctor's office waiting for a ticket to be seen to realize that we've got it pretty good," he said.

It also opened his eyes to the incredible amount of waste generated by the often over-cautious and bureaucratic American healthcare system. It is possible to deliver quality healthcare at a fraction of the cost of what many have come to accept.

For example, Lattin said a cesarean section costs about $18,000 in the U.S. That same amount of money would pay for 1,000 residents' medical care in a place like Bangladesh.

"I could do a C-section over there for probably $35 or $40," he said.
"Over there we used cloth drapes that got washed and re-sterilized and when they got torn, they got sewn back up," he said. "We used steel instruments that would get re-sterilized and you know you have to sharpen them occasionally."

Even since he started his Soldotna-based practice in April, he has seen surgical supplies - costing up to $300 - opened, not used and then thrown away because its sterility was compromised.

"You add that up with all the other operating rooms in the United States and that is just an incredible amount of waste, but I can't change that," he said.

Currently, he has a box in his garage filling up quickly with such supplies he plans to mail back to Bangladesh for the surgeon who is still working away to try and meet the Bengali need.

Although Lattin wants to focus on his family for the time being, he still plans on going back to Bangladesh, even if it's for a month at a time. Wanting to visit the surgeon, the Bengali doctor studying to become a surgeon, and the supporting Bengali medical staff of the missionary hospital he left behind fuels that desire.
He admits it has been a somewhat of a task to adjust back to life stateside and he often thinks about the need overseas. But, as he put it, "Americans are people too," and there's plenty of worthy medical needs here on the Peninsula.

"You can never totally be comfortable because you know the need is there all the time," he said. "And you can never really be totally comfortable again with all the riches we have here in the United States."

But slowly he is making peace with the life in-between.

"I know that even if I was there, there would be thousands of patients that would still never receive care," he said.

Brian Smith can be reached at brian.smith@peninsulaclarion.com.

 

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