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Serle Epstein, MD, and the
Mission Clinic of Our Lady of Guadalupe, Ecuador

by Mary Lou Bernardo, PhD, MSN

Published 2/21/2008; © 2008 Mary Lou Bernardo

Clínica Misional "Nuestra Señora de Guadalupe"

Serle Epstein and his wife, Jana Siman

Perhaps it was serendipity. Perhaps it was how God answered the Padre's prayers. Perhaps it was just meant to be.

The story began about 35 years ago when a young Austrian exchange student came to live with his host family in Connecticut. The boy did well in school and then went on to become a Catholic priest in Austria. He and his American host family remained close, even after he was sent to minister to a poor village high in the Amazonian region of Ecuador.

One day a few years ago a member of the host family became urgently ill and was taken to see the family physician. The physician shared with the family his upcoming plans to travel to the Caribbean with his wife, an advanced practice nurse, as volunteers in medical service. The family shared with the physician their relationship with the priest and the urgent need for medical care in the Ecuadorian village.

The Caribbean trip became an Ecuadorian trip. The Ecuadorian trip became an annual journey which transformed a small, ill-equipped rural facility into a clinic.

The priest is Padre Jorge Nigsch. The parents in that host family are Marie and Frank Glowski. The hospital is Clinica Misional "Nuestra Senora de Guadalupe." The physician is Serle Epstein, MD, FACP, of Madison, Connecticut.

Clínica Misional "Nuestra Señora de Guadalupe"

Clínica Misional "Nuestra Señora de Guadalupe"

Dr. Epstein, who specializes in internal medicine and primary care, has been a medical volunteer for many years. He has worked as a medical preceptor in clinics for migrant workers and in clinics connected with free food kitchens. He has volunteered as a physician for the Special Olympics. He continues his love of both volunteering and his love of teaching by precepting monthly at the Fair Haven Free Clinic in New Haven, CT.

Speaking about why he volunteers, Dr. Epstein said, "I volunteer because I think it is the essence of being a healthcare provider. I think you're doing your best for someone regardless of the finances and the politics. You're role modeling for your children and your colleagues. . . . It becomes part of your identity."

But it is clear that, for Dr. Epstein, the Clinica Misional "Nuestra Senora de Guadalupe" is special: from the way his expression changes when he talks about the people, from the way he describes how the clinic has grown, from the way he remembers it all, and from his commitment. "I committed myself to this clinic knowing that it had no chance to succeed without a physician in the developed world, using contacts to recruit [staff] and to equip [it]", he said. Thanks to Dr. Epstein, the clinic has indeed succeeded.

Clínica Misional "Nuestra Señora de Guadalupe"

Padre Georg Nigsch

Set in the highlands of Ecuador's Amazon, the clinic began as the dream of Padre Nigsch. When he opened it in 2001, the clinic had two rooms furnished as examining rooms, a small pharmacy and the beginnings of an operating suite and dental rooms. Laboratory, radiology and all specialty services were two hours away. . . for those who could afford them.

The clinic serviced adults and children. Although parasitic infestations were common, there are few mosquitoes in the Amazonian highlands, so malaria was rare. During his first visit to the clinic, Dr. Epstein and his wife, Jana Siman, APRN, saw patients and also sorted through boxes of donated materials -� much of it inappropriate or dysfunctional -- and began the task of drawing the modest clinic from the 19th century into the 21st.

Since 2001 there has been an almost steady stream of healthcare workers to the clinic. In fact, there has been a family practice or internal medicine physician on site for all but two months in the last six years. Healthcare practitioners at the clinic include nurses, medical specialists, dentist, and general and specialty surgeons.

In 2004, mobile health clinics were initiated by Dr. Lorna Schumann, Professor of Nursing at Washington State University School of Nursing. Patients have been taught about their chronic illnesses, and management of chronic illness is now part of healthcare in this region. As patients continue to return to the "Clinical Misional," continuity of care is improving.

Dr. Epstein has made a strenuous effort to make this healthcare volunteer experience possible for practitioners of many specialties, particularly those in primary care and internal medicine. He knows firsthand the difficulties of leaving a private primary care practice to volunteer in a remote region. For this reason, the experience at Clinica Misional can be as short as one month. While Dr. Epstein hopes to have long-term volunteers, he is pleased that Clinica Misional can offer a shorter volunteer experience while still providing quality care. The clinic even provides a small family accommodation for volunteers in addition to comfortable single accommodation in a safe rural environment.

Clínica Misional "Nuestra Señora de Guadalupe"

Serle Epstein examining a patient

Dr. Epstein is the recipient of numerous awards including the 2005 Chapter Volunteerism and Community Service Award of the Connecticut Chapter of the American College of Physicians and the 2007 Madison Connecticut Chamber of Commerce Citizen of the Year. In addition, he is Assistant Clinical Professor of Internal Medicine at both the Yale University School of Medicine and the University of Connecticut School of Medicine, and Assistant Clinical Professor of Nursing at the Yale School of Nursing. He was awarded the 2007 Yale University Internal Medicine Departmental Award as Teacher of the Year for Ambulatory Medicine.

But Dr. Epstein is most proud of The Proclamation of Honored Guest Status given to him by the mayor and governing council of the Town of Guadalupe, Ecuador.

Perhaps Dr. Epstein best summed up his philosophy when he said, "The act of volunteerism becomes its own reward. Although you are doing a good thing for people, you take away more than you give. . . . You're doing the essence of medical care. . . . It really brings you back to why you became a physician."

Clínica Misional "Nuestra Señora de Guadalupe"

You may reach Dr. Epstein directly at smepstein@aol.com.

Mary Lou Bernardo, PhD, MSN is a freelance health and medical writer in Branford, Connecticut. She can be reached through her website, www.WritePhD.com, or directly at MaryLou@WritePhD.com.

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