Family Medicine on a Mission Part 2: ‘You Get to Stress Yourself a Little Bit…’

By Aaron Burch

Kingstown’s Milton Cato Memorial Hospital

“The thing you have to understand about St. Vincent and the Grenadines, from the start, is that they’re operating on a different level of health care than what we understand in America,” said Lt. Col. Ian Solari, ABFM Diplomate, as he prepared to start his shift at Milton Cato Memorial Hospital.

Milton Cato is the primary hospital on the island of St. Vincent, nestled in the capital city of Kingstown. The facility is old, and ground has been broken for a new hospital elsewhere in the city. But, for a few more years, this is the epicenter of medical care for much of the island.

For a week and a half, Milton Cato served as the primary operational headquarters for US Air Force health care personnel visiting the island. About three dozen active and reserve Air Force members were deployed here as part of the Lesser Antilles Medical Assistance Team’s (LAMAT’s) 2025 mission. For Dr. Solari, these unique experiences make him love being a family physician even more.

“You get to stress yourself a little bit and put yourself in positions that are a little uncomfortable. I like that,” he said. “I think it makes me a better doctor back home. You learn tricks of the trade you wouldn’t think of.”

Dr. Solari’s passion for these experiences, and the methods by which they increase his medical knowledge, defines a recurring theme of LAMAT: “Everyone benefits.”

Consider the different parties involved:

• The Air Force builds strategic relationships with foreign countries and inspires confidence in servicemen and women to enter unfamiliar environments and deliver coordinated patient care.
• Deployed physicians earn valuable experience through one-of-a-kind patient engagements which strengthen their medical care back home.
• The host country benefits from stronger medical efficiency and repaired diagnostic equipment.
• The patients benefit by receiving medical expertise from uniquely talented board-certified American physicians.

All these benefits coalesce within the LAMAT mission structure, pushing all parties slightly outside their comfort zones to inspire growth.

Although Milton Cato has all the medical services you expect to see at a hospital in the United States, physicians and nurses on the island face unique challenges. Dr. Solari and the other deployed medical officers are also adjusting to adversity in real time.

“When I first arrived, I was confused why the counters here were so clear. There was an abnormal amount of space to work,” said Deputy Mission Director Maj. Samantha Diblasi. “It took me about 20 minutes to realize there are no computers.”

Within the hospital, every single patient’s medical history and reasons for their visit are recorded by hand, as are requests for x-rays, labs, etc. The records are filed by date and kept in a room akin to a library, with thousands of sheets of brightly colored paper stacked to the ceiling.

For the physician-patient relationship, each visit is a new beginning. Dr. Ian Solari’s experience in the Emergency Room showed just how pervasive those differences are when caring for patients. As he began his shift, Dr. Solari moved deliberately from patient to paperwork to patient, recording each visit on a neon orange intake card.

The morning began with an evaluation of a patient with urinary retention and another with a likely UTI. Each patient’s medical history and prescriptions were chronicled. If they required an x-ray or referral, alternate-colored forms were stacked nearby.

In the ER’s central office, Dr. Solari was asked if he would have pursued a medical career in St. Vincent if this were his home.

“I think so. Medicine is medicine,” he replied. “Here, you just have different amounts of supplies and technology available to help people. These doctors are doing a really good job, but they are limited on what they can offer patients, and the community is aware of the disparity. They’re good physicians.”

Georgetown’s Modern Medical & Diagnostic Centre

The island’s other major hospital, the Modern Medical & Diagnostic Centre, is an hour northeast of the capital city in a small suburban community. There, Lt. Col. Zoraida Soriano, a board-certified internist, provided primary care to emergency room patients. This was Dr. Soriano’s second LAMAT mission, as she was deployed to Suriname alongside Dr. Solari in 2024.

“Both years have been awesome,” she said. “It makes you feel good to think you can make a difference, even in short visits like this. The people are so thankful for us being here.”

Dr. Soriano’s patient care experience was quieter than Dr. Solari’s, but she used her time to advise island residents on preventive care and the treatment of chronic conditions.

“I’m surprised there is so much chronic illness here,” Dr. Soriano said. “On an island, you’d think there would be a higher likelihood of healthy eating, but there is so much diabetes, hypertension, obesity, and COPD. Non-compliance can be an issue as well. Many patients only take medicine as they feel like it, rather than as its prescribed.”

Just a few rooms away, a vascular surgery team led by Lt. Col. Devin Watson performed dozens of arteriovenous (AV) fistula surgeries for dialysis patients at the facility. Dr. Watson’s work was featured in ABFM’s article on the LAMAT 2024 mission.

The success of these surgeries was especially significant, because the surgical team faced significant adversity upon their arrival to St. Vincent and the Grenadines. The palette of surgical instruments they intended for use never arrived.

“Pretty much everything that would have put us in the best place for success wasn’t here,” Dr. Watson explained. “We took inventory and understood we had to narrow the limits of what we could do.”

The biggest loss came from the lack of vessel loops, small elastic bands which close blood vessels during surgery. “If you don’t have those, you can’t do the surgery,” Dr. Watson explained.

Dr. Watson and his team forged a solution, cutting and stretching medical gloves until they could be tied to provide the necessary artery blockage. This allowed the intended surgeries to proceed as planned and saved the mission.

“We’re very nimble. If you dropped us in the middle of a combat zone with some toothpicks and surgical supplies, we could do vascular surgery at a pretty high level,” Dr. Watson said. “We’re providing a huge service to this country, and they’re providing us a huge opportunity to think outside the box and work through problems in a relatively safe, stable environment.”

Union Island’s Celina Clouden Smart Hospital

Because of Hurricane Beryl, the Air Force took a special interest in supporting the residents of the Grenadines, a cluster of islands south of St. Vincent. Medical teams have been visiting two of those islands (Canouan and Union) throughout LAMAT.

Up a series of dusty hills on Union Island is the Celina Clouden Smart Hospital. Most of the island is visible from that location, and countless buildings remain destroyed by the hurricane nine months prior.

The Air Force’s mobile dental unit was set up on the west side of the hospital, allowing Col. Michael Bates, DDS, and his team to provide exams, cleanings and extractions to island residents.

“I’ve never done anything like this, so I’m very grateful I was able to be a part of this medical mission,” said Dr. Bates. “The most rewarding part is seeing all the kids. I hope we’re able to have a long-term impact on them.”

Dr. Bates estimated that his team had seen 250 patients during the LAMAT deployment. Like the primary care and surgical teams on St. Vincent, this oral health mission promotes thinking outside the box to accomplish patient care. For example, electricity was inconsistent on one side of the building, so the dental unit was relocated to allow for better usage of suction and other tools.

“We’re not being trained for a specific situation but rather to adapt to the situation that presents itself,” Dr. Bates explained. “It makes us all more effective.”

Although they have very different medical backgrounds, the board-certified physicians who led LAMAT’s medical teams are all exceptional caregivers. The surgical and dental teams remained at their deployments for two more days while Dr. Solari and Dr. Soriano concluded their mission providing patient consultations in a Kingstown Health Fair hosted by the Air Force. A closing ceremony would follow to thank the host country and everyone who participated for their hard work.

Aaron Burch serves as Editorial Content Manager for the American Board of Family Medicine. He has been writing professionally in the health care field since 2014.