According to physician Brian Medernach, Catholic doctors have a responsibility to live out the gospel through their work in health care.
For Medernach and his wife, Antoinette Lullo, living out the gospel involved traveling to rural Peru, where they lived and worked as physicians at Santa Clotilde, a mission on the Napo River in the very northeast of the country. According to a blog they kept while living there, this involved a 10-hour flight to Lima, followed by a shorter flight to the city of Iquitos, a 45-minute boat ride up the Amazon River, followed by a short taxi ride to another port, where they embarked on the five hour boat ride up the Napo. The mission provides health care for more than 100 villages along a 250-mile stretch of the river.
For both Medernach and Lullo, taking the long trip to Santa Clotilde stemmed from their faith. “It’s really hard to talk about faith with someone if they’re worried about their kid dying or feeding themselves,” Medernach says. “You have to walk with them and stand up for their human rights and dignity. The dignity to work, to live a safe life, to raise a family, and be healthy.”
To this end, what started as a year-long trip after finishing medical school turned into a long-term vocation at the mission. Even today, more than six years after their first trip to Peru, Medernach and Lullo maintain ties with Santa Clotilde, visiting for a couple months each year and offering administrative support from their home in Chicago.
How did you and your wife decide to become mission doctors in Peru?
Toni had known she wanted to go into medicine and to do mission work since she attended Loyola University Chicago as an undergraduate. She went to El Salvador for a social justice course she was taking. The clinic she visited was a small room with one little cabinet on the wall that held only a few pills: some Tylenol, maybe some antibiotics. The doctor there was so proud of her clinic. This experience, along with some other short-term mission trips, was one of the driving forces for my wife.
As for me, I went to a Catholic high school but had never left the United States until after my first year of medical school at Loyola. The school provides short-term immersion service trips, and I went to San Lucas, Guatemala. I was forever transformed by seeing the reality of health care outside the United States. From that point on, I also knew mission health care was something I wanted to do.
That’s actually part of how my wife and I met: We were both in training and doing global mission work in health care. So it was always part of what we were going to do. We started doing short-term trips supervising medical students as we continued our training; Toni, for example, would go to Africa for a month at a time.
After I finished training, we started applying for different programs. And then we met Father Jack McCarthy, a Loyola graduate and physician who started the Santa Clotilde hospital with Father Maurice Schroeder. The short version of the story is that he told us, “Come work with us in Peru.” And we took him up on his invitation.
We originally saved our own money to get down there for a few months. The goal was to stay a year. We thought that a year would be a good amount of time to make an impact, learn the culture, gain the trust of the community, and learn what it truly needs.
But as that year was ending we decided, “Oh no, the need is greater and we plan on staying.” The Mission Doctors Association supported us for three years and now we continue working with Santa Clotilde remotely. We try to visit one month each year, but I also spent a decent amount of this weekend on WhatsApp and emailing with folks there. We are still very much involved even from afar.
What was most rewarding about being a mission doctor?
For me it was the community and relationships with people. We lived in a community called Santa Clotilde, on the Napo River in Peru, and we took care of more than 100 communities along a large stretch of the river. It took about 10 to 12 hours in a fast boat to go from the bottom to the top of the territory we covered.
On our first journey upriver, February 1, 2012, my wife, Toni (Antoinette), and I were on the boat, enjoying the journey with no idea what was waiting for us in Santa Clotilde. When we got to Tacsha, a little community about two hours away from Santa Clotilde, the técnico, or nurse, came down to the dock and loaded a patient into the boat. He asked for the new doctors, and when we raised our hands he handed us an envelope and said, “Father Jack (one of the priests who started the hospital in Santa Clotilde) says that you guys can take this patient up.”
Without warning, there was our first patient. His name was Don Sebastián. Over the next four years, we became close to Sebastián and his family. One of his grandsons became one of the técnicos at our clinic. We know his whole family.
When we met Sebastián during that first boat ride, he was in heart failure. It seemed like he had had a heart attack probably that week or even the night before. We treated him, put him on medication, and he recovered.
Every time he and his wife came for his follow-up visits, he always wanted to see one of us; he wouldn’t see any of the other doctors. On Thanksgiving, he brought us a duck for dinner.
We were even the witnesses at his wedding. One time, when he was really sick, we asked the priest to come and give him a blessing. But the priest came back to us and said, “Let’s gather everybody up, because we’re going to have a wedding tonight.”
It turns out that he and his wife had been together for over 50 years and had a common law marriage, but they were never formally married in the church. So Toni and I witnessed their wedding ceremony along with their grandson, daughter, a few other family members, our staff, and a couple of people from town.
And just as Sebastián was our first patient, he was also our last. About a year after his wedding, in spring 2016, we were heading back to the United States with our son, Charlie. To get back home we had to go through this little town called Mazan. Sebastián was there with his family. He greeted us and gave us hugs, and then a couple months later he passed away.
Being in community with Sebastián and other patients was one of the most memorable things for me, as was being able to provide quality health care without systematic discrimination. Little kids with congenital heart defects were able to get surgery. We were able to treat sick patients who were then able to walk out of the hospital. We treated patients dying from HIV.
How are mission doctors different than something like Doctors Without Borders?
The difference between mission doctors and other organizations that do global health care or relief is that we provide not only medical attention but also spiritual support. Whether at the end of life, sitting and praying with patients, or baptizing a child who’s very ill, our job goes beyond medical care.
Faith brings us into community with our patients. We had a lot of patients pass away in the hospital, and this was very uncomfortable for them: Peruvian culture places much more emphasis on dying at home and around family. I had several sick patients who wanted to go home, and faith was how I accompanied them in grieving and helped them feel more comfortable with being in a hospital.
There were also ways in which our work didn’t just end after the medical care was done. We attended wakes for patients who died away from home, sitting around all night listening to stories about the person, their life, their faith. That was an honor and a privilege. Other times we would find four gallons of gas for someone to drive home or put together a little bit of money so a family could buy candles for a wake. We would even have our maintenance guys build a casket because a family had no way of purchasing or building one on their own.
It was these little things that were an example of how faith came into our daily lives as doctors and how it became integrated into the mission and work of the entire staff at Santa Clotilde.
What role do missions play in global health care?
Missionaries can respond to need where governments often cannot.
Mission health care steps into situations where there is a lack of resources—both financial and in personnel. Health care doesn’t just depend on the government providing social protections, but also on money, medicine, staff, and supplies over the long-term.
A few months after Toni and I got to Santa Clotilde, we treated a girl who had signs of kidney failure. We treated her swelling and knew her kidneys had some kind of problem, but to do a biopsy was too dangerous. There weren’t even that many people in Iquitos, the closest city, who could safely do that for a pediatric patient.
The girl did improve after we treated her, and we told her and her family to come back in four to six weeks to follow up and to see whether this was a chronic issue, in which case we would have to try to get her to Iquitos or Lima. But the family lived at least three hours away by canoe. They saw that she improved, and they didn’t have the resources to get her back to us, let alone to a bigger city.
One night Father Jack woke me up at one in the morning. As soon as I walked into the clinic I recognized the girl and her parents. She was worse than when she initially came in. I gave her medications, but she needed dialysis. She needed to be transferred. But she was too sick to take the six-hour boat ride to Iquitos, and because it rained for three days straight, we couldn’t fly her to a city either. She died.
This girl reminded me of what we were doing and why we were there, along with the lack of resources. If this girl had had access to biopsies and treatments or dialysis, she might have survived. But that’s almost impossible in the Amazon jungle.
What does the ideal mission hospital look like?
The ideal mission hospital responds to the needs of the community. It would collaborate with those wanting to support the mission as well as those working in the mission and who they’re serving. I think it would be an empowering mission, one that would teach skills, work on sustainability, and work on the social determinants of health such as clean water and education. Part of mission work also includes bringing in educational programs and specialists to train the next generation.
The goal is to work yourself out of the job. After a few decades or a few lifetimes, that this becomes a self-sustaining thing that can then be replicated and taught to others.
Santa Clotilde is working on becoming this kind of hospital, but we’re still far away from self-sustainability. It’s hard enough to recruit staff to work in the rural United States, let alone in rural Peru. Likewise, Peruvian doctors aren’t too eager to go there long term.
We want to raise, teach, and educate local people who want to stay, who have their heart in it. And to some extent, we have built that sustainability, especially in terms of nurses, técnicos, and maintenance workers. All of these workers are people from the local community who take a lot of pride in their work and see it as vocational and faith-based.
Do all Catholic physicians have the responsibility to be involved in this type of work?
Yes, although I don’t think you have to go to Africa or Peru. There’s plenty of need here in the United States, whether providing local care to your community or educating the next generation of high school or medical students.
I think we should all be involved in a global mission. But there are a lot of social justice issues and systemic issues that the residents right next door to the hospital where I work in Maywood, Illinois deal with each day in terms of property taxes, clean water, education, and violence. Social justice is not just an issue in other countries.
You don’t have to be a doctor to get involved in mission health care. Lay Mission Helpers is an organization that recruits nurses, pharmacists, teachers, and accountants. We would love to have more people teaching, working on fixing boat motors, doing carpentry, or helping with human resources. A mission is about more than just health care. It relies on a lot of people working as a team.
This article also appears in the January 2019 issue of U.S. Catholic (Vol. 84, No. 1, pages 24–27).
Image: Courtesy of Brian Medernach