Doctors Without Borders
In the spring of 2020, fear was in the air. The COVID-19 pandemic had arrived. Cases in San Diego County were growing: On March 3, there was one documented daily case; by April 3, there were hundreds of reported cases daily and, in time, there would be thousands.
Local hospitals were struggling to accommodate the growing numbers of patients with an infectious disease scarcely understood. There were acute shortages of personal protective equipment (PPE): N-95 respirators and surgical masks, gowns, gloves, eye protection. Ventilators — machines that mechanically pump oxygen into patients who cannot adequately breathe on their own — were limited. Physicians faced prospects of needing to choose who might get a ventilator and who might not, the latter effectively a death sentence.
As a pulmonologist (a specialist in the respiratory system, from windpipe to lungs) at UC San Diego Health, all things COVID-19 consumed my world at the time.
Colleagues convened constantly to consider options. Hospital leadership held virtual town halls to update UC San Diego staff on the situation. In one of them, we discussed what was happening less than 15 miles to the south in Tijuana, Mexico. The pandemic seemed worse there: rising numbers of cases and deaths, but even fewer resources. I wondered aloud if anything could be done.
Over the next few days, I received calls and emails from peers asking how they could support my mission to Tijuana. What? I had no experience with medicine outside of the United States. I had never been to Tijuana General Hospital, the largest in the region and the eventual focal point of our efforts. It did not matter. I realized I needed to step up, to try to make something happen.
I reached out to San Diego County health officials to help me get in touch with others who might be able to assist. Andres Smith, an emergency medicine physician, medical director of emergency services at Sharp Chula Vista Medical Center and president of the board of directors for Cruz Roja de Tijuana, which manages the city’s ambulance services, joined the effort and connected us with officials at Tijuana General, who invited colleagues and myself to visit. It became a large-scale team effort. It needed to be to have a chance at success.
We did not go as medical saviors. We had no plans to take over, to treat the hospital’s patients. We went to see for ourselves what was happening and share what we knew, what we were learning every day in our own increasingly crowded intensive care units. We went to learn.
There were critical shortages of people, equipment and technological support, but there was a strong desire among everyone to help as many as possible. Tijuana General had become a COVID-19 hospital, entirely turned over to the care and treatment of infected patients. One had to wear full PPE all day, every day. It was exhausting. Medical personnel were doing their best. They were smart and motivated, but there weren’t enough of them. Many doctors and nurses had already died of the disease. Deemed at high-risk, physicians over the age of 60 were not permitted to treat COVID-19 patients, leaving that duty to younger, less experienced colleagues pulled in from elsewhere. Almost no one possessed specialized training or extensive experience in pulmonary issues and respiratory disease.
For the next month or so, in May and June, volunteer teams of UC San Diego Health medical staff visited the Tijuana hospital daily. We couldn’t treat patients, but we could advise and consult with the doctors and nurses who were providing direct care. We proposed ways to optimize ventilator settings, when specific interventions might be implemented, how to deploy bedside ultrasound to decrease complication rates and myriad other observations learned from our own practices and patients.
It proved an unimpeded give-and-take of knowledge and compassion. We invited staff from Tijuana General to visit UC San Diego Health to see how we were set up and how we did things. I remember discussing the case of a COVID-19 patient with rheumatoid arthritis with one of our Mexican colleagues. He was a trained rheumatologist and thrilled to talk — at least in that moment — about a disease he knew a lot about and who had had minimal opportunity to treat in the preceding months.
Groups gave money in support. The San Diego Rotary Club donated $25,000 to purchase oximeters, a tool critical to monitoring patients’ blood oxygen levels. Other funding bought ventilator humidifiers, a necessity for patients being mechanically ventilated for long periods.
While we couldn’t address every need, other people, groups and institutions also rose to the challenge. We focused on what we could do with the greatest benefit. Most of all, we gave of ourselves — our time, presence, expertise and training — and it helped.