Aug 02

Aspen Times Weekly cover story: Bringing new life to a sister city

Originally published in the Aspen Times Weekly, by Hilary Stunda

In the foothills of the Andes, on the south-eastern shore of the crystal-clear Nahuel Huapi Lake close to Argentina’s border with Chile, lies the city of San Carlos de Bariloche. Like Aspen, it’s a popular destination for skiers and tourists.

But the stunning landscape of lakes and mountain peaks, Swiss-style architecture and quaint streets with chocolate boutiques glaze over some darker realities: Argentina’s 30 to 40 percent unemployment rate; corrupt unions that collect and control heath care funds for the wealthy, which are impossible for the rest to afford; and poverty-stricken barrios where children forage through vast garbage dumps.

Despite those differences, in the fall of 2002, Aspen and Bariloche became sister cities, continuing a legacy of the Aspen Sister Cities program that began in 1966 with Garmisch-Partenkirchen, Germany.

The relationship with Bariloche followed the 2001 Argentine economic disaster that caused the Argentine peso to plummet to less than one-quarter of its value, leaving thousands of families without work, forcing them into poverty.

A major financial casualty was Hospital Zonal Ramon Carillo, the only public hospital in Bariloche. Before 2001, it served 30 percent of the population; now it reaches 70 percent. Outdated and with minimal government financial support, the Ramon Carillo Hospital continues to serve the 500,000 indigent people in the Bariloche community and surrounding region.

“When we proposed the relationship with Bariloche, we really had one thing in mind – student exchange,” said Griff Smith, Bariloche sister city coordinator. “I just wanted to get a Spanish sister city so our students could practice the language. Then out of nowhere, Dr. (Mark) Purnell came along. He wanted to see what was going on. Then Challenge Aspen wanted to do something. Ski teams have gone back and forth. I see my job at Sister City as putting people together and helping them pursue whatever they want.”

In 2003, Aspen Valley Hospital sent Dr. Scott Gallager and Dr. Mark Purnell to Bariloche to explore medical exchange opportunities. The following year, the Aspen Valley Medical Foundation started the Bariloche Fund in response to donations from Aspen. In 2005, after the first small delegation of medical professionals from Bariloche visited Aspen, the exchange was officially under way.

In May, the Aspen team of medical professionals included dentist Dr. Robert Christensen; orthopedic surgeon Purnell, of Aspen Orthopedic Associates; orthopedic fellow Dr. Ryan Pizinger; Aspen Bariloche sister city organizer Griff Smith; and Laura Pritchard, executive director of the Aspen Sports Medical Foundation, all key organizers of the program.

Inside the Ramon Hospital, people mill about the hallways. There is no privacy in the large, open wards and no services for people with mental disabilities.

“It’s very archaic and quite terrifying if you come from our system to see how it all works,” Pritchard said. “But they do an amazing job with what they have, especially the nurses. They often get hurt because they don’t have the equipment they need to deal with their patients. If you break your leg down there, you may be in traction for three months, may get a bedsore and die. That’s their reality. The nurses don’t always have the time to deal with it because they are always understaffed.”

“They have a number of orthopedic surgeons,” Purnell said. “They are very well trained and very good. But they have no equipment. That’s one of the main problems. We can’t just bring equipment to people. We have to teach them how to use the equipment. If you go to our hospitals and see how much equipment they have for orthopedics, there are rooms. For them, they have two boxes of supplies.”

At Ramon Hospital, the operating rooms haven’t changed much since 1928.

When the program first began, the medical professionals didn’t fully understand the concept of giving without receiving back. It took some time to work through the cultural mores.

“They were confused,” Pritchard said. “Now they understand it’s an exchange of knowledge and friendship. We’re not looking for anything in return except to help the patient and be the best medical professionals we can be.”

In spite of the thousands of dollars’ worth of equipment over the years (and with thanks to the generosity of Aspen’s Federal Express), strict importation laws continue to stymie plans of delivering two 40-foot container shipments of supplies.

Still, they find a way. In 2010, several physical therapists from Ramon Carrillo asked for some desperately needed wheelchairs.

“I used a wheelchair the whole way down one time,” said Aspen Valley Hospital occupational therapist Krista Fox. “Next time we all might go down in wheelchairs.”

For Purnell, it’s the philanthropy that drives him and why he trains two orthopedists a year in sports medicine in the hopes that they will return to their professions instilled with a higher purpose.

“It’s a tremendous experience for them to go and see orthopedics done in a different country, in a different setting,” he said. “The environment is much different from how we do it here.

“We came down with a group of orthopedists, physical therapists, occupational therapists and nurses. They had never seen people working as a team. All the things we do on a routine basis to make sure things are done properly so that patients get appropriate care were entirely new concepts for them.”

Chistensen, the first and only dentist to participate in the medical exchange, made his first trip in 2007. “I was shocked by how primitive the supplies and facility were. It’s where we were in the states in the 1920s and ’30s. Each little kid had decay on every single primary molar. By the time I was seeing adults in the clinic, many of the adults in their early 20s had no molars or bicuspids. Tragic. But by the end of my first week, I had totally shifted. I was so impressed by how much they could do with so little.”

“Working with them makes you realize why you go into your profession, what it’s truly about,” Fox said. “You have to think outside the box, make it up as you go, use whatever materials you have and do whatever you can for the patients.”

One family Fox met created a rope system for a man whose brain injury left him paralyzed on one side of his body. He was able to use his good arm to pull his body along to get around. Another family created a wheelchair from a plastic chair and parts from a wheelbarrow and plow to maneuver around the gravel paths surrounding their house.

“When Dr. Mindy Nagle (an OB-GYN at All Valley Women’s Care) went down, she had never not used an ultrasound to find out what was going on with the baby,” Pritchard said. “She was given a horn that was hollow. They would put it up to the belly, and she would listen to it. They taught her how. It was just like being back in medical school for her.”

Since the program started, more than 100 volunteers have traveled to Bariloche. Medical professionals in anesthesia, OB-GYN, dentistry, general surgery, family medicine, internal medicine, pediatrics, physical therapy, occupational therapy, speech therapy, cardiology, cardiac rehabilitation, and orthopedics have volunteered their time and have traveled at their own expense to provide supplies, equipment and help to the staff at Ramon Carillo and the barrios surrounding Bariloche.

Today, the program has grown to serve bigger, more far-ranging issues.

“Over a period of time, they gave us a list of things that we could bring them, but now they have brought us a program,” Purnell said. “It’s very exciting. It’s outside the purview of orthopedics. It’s called Nutrir, and it was created by Felipe de Rosas, MD, the former director of the hospital, as well as teachers and lay people.

“The barrios are huge and very poor. There are all kinds of problems. Mothers are teenagers. Here, many times there’s a generation that helps. The grandparents might take over. There, there are many generations in the same family without any education or knowledge of how to raise a child. Because of this, there isn’t a grandmother who can teach a granddaughter how to be a mother because they were never taught. So this group is trying to teach these mothers nutrition, how to stimulate their child intellectually.”

The Aspen Bariloche Medical Exchange is now one of the main conduits to funding and other international programs for Nutrir. The Aspen Rotary Club is on board for this fiscal year. The Snowmass and Carbondale Rotary Clubs are getting involved. Bariloche has several Rotary Clubs, as well. They have plans for a multiyear project.

“We all get hung up on unimportant details, waste materials and resources and forget that people in the world are dying and suffering unnecessarily,” Fox said. “This medical exchange has pushed me to look at the wider world of medical care and solidified my commitment to philanthropy and thinking of what truly makes a difference in people’s lives. Helping those who cannot afford my care and truly appreciate my help is the most rewarding and most important part of my life.”

“It’s amazing to see how this group has come together,” Purnell said. “It’s a constant experience to see what they can accomplish. They are an amazing group of individuals.”

At the end of their sojourn, the medical teams get together and trek, hike or river raft. One year they cycled to Chile.

“It’s really all about our relationship. The warmth and friendship and trust keeps the program successful,” Smith said.

“We haven’t succeeded in everything, but these are the basic things that will have a much bigger impact in the long run than us just going down and fixing a broken leg,” Purnell said. “It’s an evolution.”

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