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Starr quality


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Summer 2012 issue (pdf)

Alumnus and wife care for underserved in Guatemala year after year

Dr. Clifford Starr is gifted a live chicken as thanks from a family for treating their young boy’s illness during one of his mission trips to Guatemala.

Dr. Clifford Starr is gifted a live chicken as thanks from a family for treating their young boy’s illness during one of his mission trips to Guatemala.

One of the most rewarding experiences in the medical career of Clifford H. Starr, MD ’56, GME ’63, MS ’63, was the time he was paid in chicken. Technically, the chicken was a gift—and still alive—but for the family of the boy he treated, it reflected the magnitude of the situation.

It was springtime during one of Dr. Starr’s many month-long trips to rural Guatemala, and the retired general surgeon was presented with an anemic 5-year-old boy with amoebic dysentery.

“We treated him for the infections, which is fairly routine medicine unless you don’t have the medication. Then it becomes profound,” he said. “The family came back to see us in the fall with the healthy little guy, and they gave me a live chicken in a bag, which is really touching, since a chicken to them is a significant gift.”

Since 1998, Dr. Starr and his wife, Nancy, a former nurse, have traveled 15 times from their Wisconsin Rapids home to San Lucas Tolimán and twice to Guatemala City on medical missions lasting at least a month. San Lucas Tolimán is a village of about 6,000 people in a mountainous, agricultural area not far from the Mexico border. Its residents are primarily Mayan, many of whom are displaced and living in poverty following a 36-year civil war that ended in 1996.

The health care he helped provide is one component of a comprehensive mission serving the village and surrounding areas (about 23,000 total people) that also focuses on schools, clean water and land ownership. Dr. and Mrs. Starr would travel throughout the region conducting day clinics during their trips. At the beginning, organization was lacking, he said, but as time went on, trained local health care providers joined the team, schedules were coordinated, and the Starrs implemented a medical records system.

Dr. Clifford Starr examines a patient in San Lucas Tolimán, Guatemala.

Dr. Clifford Starr examines a patient in San Lucas Tolimán, Guatemala.

Overcoming obstacles

For a couple past retirement age without prior instruction, learning to communicate with monolingual Spanish speakers, plus navigating numerous Mayan dialects, was a great challenge but one Dr. Starr considered good exercise for the brain. Accessing appropriate medications was an ongoing challenge as well, but as the Starrs became veteran missionaries, they developed their own formulary, enabling them to have most essential drugs on hand.

“It was frustrating if you went to a community and you could tell a patient what was wrong but had nothing to fix them,” he said. “We got to a point where we had that pretty well controlled and had a system to get what we needed.”

Toward that end, the 500 pounds of luggage that accompanied the Starrs on each trip was predominantly composed of medical supplies. They self-funded the vast majority of these items but were also heartened by the generosity of others, including a hospital administrator who helped them purchase generics in bulk and strangers who gave small donations after hearing about their work through word of mouth.

“Without having hat in hand and looking for funding, we got some voluntarily, and we thought that was much more meaningful than if we leaned on people,” Dr. Starr said.

A month in the life

Summary of primary complaints of patients seen by Dr. Starr in San Lucas Tolimán, Guatemala, during one-month mission

350
Respiratory: acute URI, chronic bronchitis, asthma

128
Gastrointestinal: GERD, gastritis, diarrhea, amoeba

80
Dermatologic: scabies, impetigo, fungal, warts, “manchas”

48
Headache

37
Throat infection: Strep throat

33
Ear infection: acute or chronic otitis media, external otitis

32
Musculoskeletal: arthritis, cumulative trauma, myalgia

28
Ophthalmic: conjunctivitis, visual, cataract

56
Other: menstrual, urinary, pregnancy, trauma, malnutrition

Friendship in hardship

The Starrs’ work in Guatemala has been both vocation and passion. They formed great friendships; through one such relationship, they were named God parents for a little girl, with whom they remain in contact.

They also became a lifeline for strangers amid disaster, such as the mudslide in 2002 that killed 37 people. The Starrs had only arrived in San Lucas a day earlier with a friend who was finishing an emergency medicine residency when victims began pouring into their clinic in the pitch dark of night. They treated compound fractures, lacerations, dislocations and other trauma in patients drenched with wet volcanic earth.

“It was sort of miraculous that we were there and had just arrived. That was an experience,” Dr. Starr said. “It was rewarding because it was fortuitous we were there but sad because of the people who died.”

Two of the Starrs’ trips served a different group of people, those living within the mammoth city dump in Guatemala City. Here, large canyons have functioned as landfills filled with trash. As the land is reclaimed, it has no official ownership, leading displaced people to squat on the site and live off of what they scavenge from the dump. Their health problems are myriad.

Wisconsin roots

These experiences abroad bear little similarity to Dr. Starr’s career of more than 35 years spent in central Wisconsin. When he began his surgical practice, his group was small, but over the years grew to about 10 physicians. He was the only surgeon, so the workload, though rewarding, became quite demanding.

A part-time Army Reservist and Guardsman, Dr. Starr contemplated ending his career by serving in the active military, but he decided to stay in the community where he had forged so many bonds. His new enterprise was with Consolidated Papers, where he consulted on compensation issues, industrial injuries and occupational medicine. He enjoyed this for 10 years and recalled the advice he received as a medical student from then Dean John S. Hirschboeck, MD ’37, MS ’41, to “find a place you’d like to live, raise your family, do a good job, and you’ll be taken care of.”

His life’s journey has born that out. He and Nancy have six children and nine grandchildren, who have brought much joy to their lives. And Dr. Starr is reminded of a conversation he once had with a group of friends, all doctors, who met regularly to socialize and unwind. The men were in their 50s when one asked the group: “Would any of you like to be younger?”

“And all around the whole table, no one wanted to be younger,” Dr. Starr said. “Each day as you go along is kind of exciting. I don’t want to go back. I want to keep on going and seeing new things.”

 

Dr. Starr repairs a facial laceration. Trauma from falls, machete injuries and other events is common.

Dr. Starr repairs a facial laceration. Trauma from falls, machete injuries and other events is common.

Nancy Starr treats a fungal infection.

Nancy Starr treats a fungal infection.

Families wait outside the community health center. Dr. Starr says "the sign is nice; the building is grim."

Families wait outside the community health center. Dr. Starr says "the sign is nice; the building is grim."

The clinic's waiting room is full. Dr. and Nancy Starr often saw 30-50 patients per day.

The clinic's waiting room is full. Dr. and Nancy Starr often saw 30-50 patients per day.

More notes from the field

Comments and observations from Dr. Starr during a single month-long mission in San Lucas Tolimán, Guatemala

  • Age distribution was as follows: 169 infants age 2 and younger (21.3%); 295 children age 3-12 (37.2%); 55 adolescents age 13-17 (6.9%); 245 adults age 18-60 (30.9%); and 28 elderly age 60 and older (3.5%)

  • With rare exception, patient complaints were multiple, usually three or four.

  • A large number of people with respiratory symptoms also had GI problems.

  • Headache as a complaint was frequently accompanied by anemia.

  • With urine and blood sugar testing, we are seeing many more diabetics.

  • Although patterns of age and complaint are consistent, each time we come there is a small cluster of something new. Some of these have been mumps, chicken pox, urinary tract infections, vaginitis, carpal tunnel syndrome, thrush, pink eye and mass casualty from natural disaster. During most of our visits, we have had lacerations to suture.

  • At times, complaints were not compatible with history or physical findings. Some were simply not realistic. We believe that some people come to see us because it is a social event, they want vitamins or they would like to have something for pain if the need arises down the road.

  • Local health promoters can be a big help. They know the local people and can sort the real problems from the imaginary, get the acute problems seen first and keep control of the crowd.

Comments

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Comments / Ratings

Title:
Wisconsin Rapids native
By:
Brian Paterick, MD
Date:
08-07-12  9:52 PM
Comment:

Dr. Starr:

This article is extremely inspirational. I am a native of Wisconsin Rapids and you set my broken leg on two occasions at Riverview Hospital when I was a young child in 1968-1970. I graduated from MCW in 1994 and am an emergency room physician in Chandler, AZ. I always remember my family speaking of their great respect for you and your commitment to our community. My wife is also a nurse and a graduate of Marquette Nursing School in 1994. We are raising 5 children, ages 4-11. You are a true role model for all.

Title:
Intern@MCH on CS service 62-63
By:
John B. Gillen, MD
Date:
08-04-12  12:30 PM
Comment:

Dear Cliff, I enjoyed the piece "Starr quality". I enjoyed being an intern on your service and was motivated by you and your career up to that time. After 3 yrs. as USN flight surgeon, I took 1 year Int. Med. residency, did FP for 7 years and returned to ophthalmology residency in Cinciinnati. I remembered you, Jim Algiers, and Bruce? as having been in FP. You impressed me with your mature approach to medical practice and convinced me that was a good way to "do it". Thanks, and thanks for your ongoing effort in Guatemala. Need help there.

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