Angela Martz worked as a maternal and child health-care worker for the Peace Corps in Guinea Bissau
This is Angela Martz.
By Karen Feldscher
The surgeon is not happy today.
From behind a high-tech plastic eye shield, he frowns at the leg of his eighty-four-year-old patient, on whom he has just performed a vascular bypass with a vein made of Gore-Tex. He’s injected dye into the graft to monitor how well the blood is flowing. There’s not as much improvement as he’d hoped for.
The surgeon muses in front of the X-rays hanging on the lightbox, then fingers the surgical gash in the patient’s leg. “It’s like cement,” he mutters. “I think we’re going to end up taking his leg off eventually.”
The nurses assisting the operation exchange looks over their masks. Off to the side, Northeastern physician-assistant student Angela Martz, who has been observing and lending a hand, shakes her head. “Bad,” she says, to no one in particular.
It’s 1 p.m. Surgery began at 10 a.m. and, at this rate, could last several more hours. Martz bends into the circle of light illuminating the patient’s leg, helping support it as the surgeon and the resident work on the damaged artery. Mostly, the room is quiet except for the soft chink of metal instruments, the beeping cardiac and blood-pressure monitors, and James Taylor’s “Fire and Rain” playing in the background. On the floor near the instrument table sits a bucket filled with blood-soaked cloths.
Later, Martz talks about participating in surgeries. “It’s a little surreal,” she says. “It’s very close to what you see on TV, but the difference is, you could be holding a piece of bowel in your hand. Sometimes, when they’re going after cancer and they know they haven’t gotten it all, that’s really hard. But other times, people come in with something like acute cholecystitis, and you take the gallbladder out, and they’re great. You’ve cured them. It’s really satisfying.”
Discussing her work, Martz is passionate and articulate. She loves being able to help people. She loves learning everything she can about the practice of medicine. She is quick to smile and sprinkles her conversation with laughter, but at the hospital she is intent on the tasks before her. She strides quickly through the corridors to do rounds on her patients or gown up for a morning surgery.
Could be, some of that energy comes from her college years in California, when she was a star athlete playing soccer and Ultimate Frisbee, or from the years she worked as a Nordic ski ranger for the U.S. Forest Service. The truth is, though, these days she’s lucky to get any exercise. She’s too busy caring for patients.
Martz attended numerous operations during her month-long stint at Framingham’s MetroWest Medical Center in January. Along with other physician-assistant students doing clinical rotations at the hospital, she observed many different kinds of surgeries—vascular, neuro-, thoracic, orthopedic, plastic.
And the surgery rotation is just one of seven she is working through as a student in Northeastern’s two-year physician-assistant master’s degree program. The other rotations include outpatient health care, family practice, pediatrics, obstetrics and gynecology, emergency medicine, and psychiatry, all coming after an initial twelve months of classroom training.
Only the beginning
Martz will finish the physician-assistant program in September. She thinks her training has been first-rate. But she also realizes that two years is just the tip of the iceberg. “There’s a sense that you need to learn everything about medicine in two years,” she says. “But, going through the program, I realize that two years is just my introduction. I’m going to be learning medicine all my life.”
That’s okay with Martz, because she is most definitely an avid and energetic learner. In her twenty-eight years, she has tackled a wide variety of roles in the health-care field, looking for the avenue that suits her best.
After earning a bachelor’s degree in psychobiology from the University of California at Santa Cruz in 1994, she became an emergency medical technician. Then, through the rest of the 1990s, she worked as a physical-therapy aide, a teaching assistant in the biology of AIDS at her alma mater, a home health-care worker in Colorado, a medical assistant at Boston’s Harvard Vanguard Medical Associates, and a maternal and child health-care worker for the Peace Corps in West Africa.
Now, as she trains to become a physician assistant, she is also nearing the end of a yearlong Albert Schweitzer fellowship, which enables her to work with Cape Verdean women and children at the Uphams Corner Health Center in Dorchester.
If Martz had any doubts about going into the medical field, they were dispelled by an incident that occurred during her two years in the Peace Corps in Guinea-Bissau, one of the poorest countries in the world. She’d traveled to a village two miles from the health center where she worked, hoping to organize a health-training session.
“It was rice season, so all the villagers were out working in the fields, planting,” Martz recalls. “Then, suddenly, I hear someone calling, ‘Angela, Angela, you have to go to the health center. One of the women is there.’ And I went running over, and there was a woman on the back porch, squatting. She’d had her baby in the rice field, then walked to the health center.
“And I thought to myself, ‘I don’t know what to do.’ There were three older Manjaco women who didn’t speak Creole, the language I know. The health center was locked, so we had to break a window shade to get in. I pulled out a picture book trying to explain how to cut the cord. We were trying to get people to bring water from the well. It was insane. I was shaking like a leaf, thinking, ‘What am I going to do wrong?’ We only had razor blades and string to tie off the cord.
“In the end, the baby was fine,” Martz continues. “The mom was unaffected by the whole thing. After we were done, she was like, ‘Maybe I should go back to the rice field.’ I looked at her like, ‘Are you kidding me? You’re going home!’ And I walked home that day thinking to myself, ‘What am I doing here? These people need a doctor!’”
What she saw in Africa—and sees here in the United States, among underserved populations—convinced Martz she could fill an important role as a physician assistant. “I’ve been thinking about this for a long time,” she says. “There are people who need health-care services.
“You go overseas, it’s so apparent,” she says. “You don’t even have to turn around to see that we’re not reaching these populations. In the United States, in a place like Boston, every time you turn around there’s another hospital, another specialist, another research institution. But there are pockets of places in this country where they need health-care providers. I want to go where they need them.”
“Good-bye, medical school!”
Before Martz settled on becoming a physician assistant, she’d already done a lot of dabbling in entry-level health-care positions.
“I’d taken all the premed courses, and I was thinking about medical school,” she says. “But choosing to become a physician assistant was perfect for me. There’s a shorter training time and incredible exposure to medicine. A lot of what PAs do is what doctors do, and there’s a real need for PAs in the medical profession. They consult on every patient. Their skills are great.”
Martz didn’t even know what a physician assistant was until she joined the Peace Corps. “The first physician assistant I ever met was the Peace Corps medical officer,” she recalls. “And once he told me about it, I was sold. I said, ‘Good-bye, medical school!’”
Even though Martz didn’t choose medical school, she has something in common with med students—very long hours. At MetroWest, she routinely worked twelve-hour days. She was in at 6 a.m. to do rounds on her patients, checking their vital signs, seeing if any issues had cropped up overnight, such as fever or high blood pressure.
Surgeries typically started at 7:30 or 8 a.m. She saw a lot of abdominal surgeries—hernia repairs, bowel resections, gallbladder and appendix removals. As a student, she didn’t actually do that much. “I hold things,” she says. “I’ll cut the sutures. I’ll do suction, a little bit of retracting. But mostly I’m just watching and learning.”
When the surgeries were over, around 3 or 4 in the afternoon, she’d see her patients again, review charts, admit patients to the surgery service. At the end of the day, she checked her patients once more, then signed them over to the residents working the next shift. She’d finish around 6 p.m., and start all over again the next day.
“It’s long,” she admits. “I didn’t realize how tired I was until one Sunday morning I woke up and looked at the clock, and said, ‘Oh, it’s noon!’” She laughs. “I’ve never done that, just slept right through. It felt really good, to get a solid twelve hours of sleep.”
Martz’s previous rotation, in Cambridge Hospital’s maternity unit, was also intense. A couple of times each week, she was on call for thirty-six-hour shifts, working with women about to deliver their babies.
That meant, for example, arriving at the hospital on a Monday at 7 a.m., working a regular shift, then staying overnight and working Tuesday until 5 p.m. If any of the women were in active labor, she’d check on them periodically through the night. “It was a luck thing, whether you had any decent sleep at night or not,” says Martz. She’d be back at the hospital by 7 a.m. Wednesday for her next shift.
“It usually worked out to about ninety hours a week, including weekends,” she says. “It didn’t feel like I was home at all. But it’s the sacrifice you make to be in this field.”
Into the Peace Corps
Martz doesn’t seem particularly fazed by sacrifice. Looking back, she says, spending two years in Africa was the most difficult thing she’s ever done, though it was a life-changing experience she doesn’t regret. She signed up because she liked the idea of an adventure, something she’d never done before. She also wanted to try to make a difference in the world.
Beforehand, though, she didn’t know exactly what she was in for. After all, when she arrived in Cape Verde for three months of Peace Corps training, life was rustic, but more like summer camp than anything else. “We had four hours of classes in the morning, three hours in the afternoon, and then we got free time,” says Martz. “They fed us three meals a day, even washed our clothes. We lived dorm style. Everything we needed was right there.”
Then, flying into Guinea-Bissau, she looked down on miles and miles of tropical jungle dotted with little mud structures and huts. “I thought, ‘You’ve got to be kidding,’” Martz recalls. “‘Heart of darkness, here I come.’ I guess my attitude was, ‘Well, here you go. Just take it day by day, and if you don’t like it, you can go home.’”
She stayed. “I always like to say that joining Peace Corps was the easiest thing I’ve ever done,” says Martz. “You sign a piece of paper, you get plane tickets in the mail. Saying good-bye to my family was hard. But staying in Peace Corps for two years was the hardest. The temptation to come home is just incredible.”
The toughest part wasn’t so much the lack of creature comforts as the language barrier. Martz had wanted to work in a Spanish-speaking country because, having grown up in New Mexico, she was very used to people speaking Spanish. “The Peace Corps talked me into going to a former Portuguese colony, and I thought, ‘Portuguese, Spanish, they can’t be all that different,’” she says. “But they are. And the Creole they speak in Guinea-Bissau isn’t anywhere near Portuguese.”
During Peace Corps training, Martz took ten weeks of intensive Creole. “But nothing beats having to use it every day,” she says. “It took me a year before I was thinking in the language. That’s a long time to feel uncomfortable with all the words going around you. You’re struggling so much with the language, every day you go to bed exhausted.
“Also, while the unifying language is Portuguese Creole, Guinea-Bissau has thirty different ethnic groups. That means thirty different ethnic languages,” she says. “The women in my village spoke their native ethnic language, called Manjaco, which was an incredibly difficult language to learn. Leaving there, I knew maybe five words, although I tried to learn how to do a prenatal exam in Manjaco, asking yes–no questions.”
Even with simple questions, however, communicating was hard. “I’d ask, ‘When was your last menstrual cycle?’” Martz recalls. “And I’d get, ‘Three moons ago.’” She throws up her hands, remembering. “‘What is three moons?’ I’d think. ‘How am I ever going to predict your date of delivery?’ Or they’d say, ‘I had one during the dry season,’ or ‘during the harvest.’ Trying to make sense out of it was so difficult. So we would measure the woman’s abdomen. We usually got it within one or two weeks.”
Time to weigh the babies
In the health center in Calequisse, her home village, Martz organized monthly training sessions in basic patient consultation and health-education techniques for local health workers and midwives. Working together with the local nurses and midwives, Martz would conduct general and prenatal exams, weigh babies, vaccinate children.
On baby-weighing and prenatal-consultation days, the local women would line up outside the clinic. “It was a big social day for them,” says Martz. “They’d all get dressed up and bring their babies and chat.”
As the women stood waiting outside the health center, Martz would present health-education programs on a range of topics, including pre- and postnatal care, nutrition, AIDS prevention, tropical diseases. “We had a lot of picture books, little skits, plays, games, songs,” she says. “It’s almost elementary, but it was fun. It was like, ‘Okay, everybody, let’s talk about why you have to wash your hands.’ Simple things.”
She adds, “I loved talking about family planning. Once in a while, you’d get women who would say, ‘You mean, you don’t have to have babies over and over and over?’ And I’d say, ‘No!’ and they’d say, ‘Okay, sign me up!’”
As satisfying as it was to offer valuable information to Guinean women, Martz also saw her share of tragedy. “The attitude [about childbirth] in Guinea-Bissau is, ‘It’ll happen. We don’t have to interfere; everything will be okay.’ But I’ll tell you, I saw a lot of dead babies born, and it just killed me. When it happened, the women would say, ‘It was one for God.’”
The villagers also preferred to see their traditional healers instead of coming to the health center. “I used to tear my hair out,” recalls Martz, “because they would wait too long. We would get kids who were so dehydrated from diarrhea they couldn’t lift their heads up.”
Mostly, though, Martz’s Peace Corps days were a valuable learning experience. “It’s funny,” she muses. “Everyone leaves Peace Corps saying, ‘I built this building,’ or ‘I redid this hospital,’ or ‘I dug a well.’ But I left feeling, ‘Did I even do anything?’ I feel like I learned so much more than I ever really gave to them.”
In fact, she learned it was best not to tell the villagers what to do, but to ask them what they needed and help them do it. She saw herself as a facilitator, someone who could provide resources. “I certainly didn’t have all the answers,” she says.
Martz also learned about the Guineans, whom she describes as “beautiful, vibrant, resilient, tough. They’re survivors.” And there were the children. Martz, the interesting outsider, developed a fan club of neighborhood kids who hung around her house every day. “We used to play all the time,” she recalls. “I had markers and paper, and they would draw and make things.
“I also had the best soccer ball in the whole village,” she adds. “I probably played soccer about four times a week.” She even organized soccer tournaments in the elementary school and provided the children with T-shirts, shorts, and balls donated by a friend from her hometown, Los Alamos. “That was some of the most fun I had,” says Martz. “There were prizes for everyone who participated.”
After she finished her Peace Corps duty, Martz spent six weeks traveling in East Africa and fulfilled a lifelong dream by climbing Mt. Kilimanjaro, Africa’s highest peak. Of the six-day adventure, Martz says, simply, “It was awesome.”
Some decisions made
Martz returned to the United States more certain of her career path. Her first step was to find a physician-assistant program. She chose Northeastern because it has a great reputation, offers a master’s degree, is economical, and is in Boston, where she’d settled after leaving Africa. “There’s something about learning health care in the Boston area,” says Martz. “This was where I wanted to be trained.”
Martz also wanted to continue to work with underserved populations. That’s how she came across the Schweitzer fellowship that enables her to work at the Uphams Corner Health Center.
She didn’t know who Albert Schweitzer was when she found a pamphlet at Northeastern describing the fellows program. When she learned that in 1913 he had opened a hospital in Lambaréné, Gabon, then a province of French Equatorial Africa, and devoted the rest of his life to caring for the people there, it all fell into place for her. “What an inspiring man,” she says. “And the fact that I had experience in Africa, and with women and children—this was a chance to give back.”
Established in the United States in 1991, the Schweitzer fellowship program supports students in health fields who want to work with needy individuals and communities. Through the program, Martz has attended a symposium on the state of health care in prisons and volunteered at Rosie’s Place, a Boston shelter for homeless women, with other Schweitzer fellows.
But her main role has been working at the Uphams Corner Health Center, which serves many Cape Verdeans living in the area. She began working at the center several hours a week last summer, seeing primarily Cape Verdean women and children, using the Creole she had learned in West Africa. She has also held cooking classes for diabetics and childbirth classes for pregnant teens, conducted in Creole, English, and Spanish.
“The first class I did was teaching how to modify a Cape Verdean diet for a diabetic,” Martz explains. “Their diet is basically oil and salt and beans and meat. I wasn’t trying to tell them, ‘Don’t use gobs of oil; don’t use handfuls of salt.’ I was trying to say, ‘Balance!’”
There were about five elderly Cape Verdean women in the room. They were amazed that Martz spoke Creole, but they laughed when Martz began showing them how to make a vegetable stir-fry. One of the women gave Martz a skeptical smile and asked, “What do you think you’re going to teach me about cooking?”
“It was hilarious, because they’re never going to make a stir-fry again,” laughs Martz. “I said to her, ‘Well, I invited you to the health center today so we could eat together. Next time, you want to teach me about cooking, I’ll come to your house.’ And she laughed and said, ‘Okay, you can come over.’”
Working with young pregnant girls poses other challenges. “There’s a lot of working on eating healthy foods,” says Martz. “I tell them, ‘Eat your fruits and vegetables. Take your prenatal vitamins. Try to avoid Kentucky Fried Chicken—or at least don’t eat it every day!’ But sometimes I think it goes in one ear and out the other.”
Martz recalls, with a troubled look on her face, one young pregnant girl who told her she didn’t want to eat too much because she wouldn’t fit into her prom dress. “I said, ‘Sweetheart, you’re pregnant. You’ve got to feed that baby!’ And I thought, ‘There’s nothing I’m going to be able to say to this young girl that’s going to make her eat more for the baby.’
“I get the sense,” she adds, “that a lot of them really don’t know what they’re in for. I would love to do a project where I could get teens who’ve had children to talk to other teens about what it’s like, the reality of giving up your youth for a child.”
Overall, says Martz, recent African immigrants to the United States are less likely to receive quality health care than others who have lived here for some time. One problem is that if they’re working under the table or they don’t have a job, they may not have health insurance.
“If they don’t have insurance, they have to apply for free care. But if they don’t have a green card, they’re not going to apply, because they don’t want any recognition that they’re here,” Martz explains. And some of the Cape Verdeans’ distrust of Western medicine carries over even after they’ve lived here for some time. “I think they feel there are certain things we can’t take care of very well,” says Martz.
Perpetual motion
On a recent evening at the health center, Martz hurries from a patient exam to a class on nutrition. The pockets on her lab coat bulge with necessities. A thick pack of index cards containing confidential patient information. A penlight for checking into eyes and ears and nostrils. A pager. A couple of dollars. A reflex hammer. A pamphlet that explains how to read EKGs. Steri-strips for lacerations. A pregnancy wheel for predicting due dates. A thin rope so she can practice tying knots for suturing. Drug guides. A candy wrapper.
At the nutrition class, dressed in comfortable clogs and corduroys, Martz stands before a small group, surrounded by display boxes of nutritious foods and a food-pyramid chart. She bends down to a little girl named Jessica.
“If you look at the food pyramid, where do you see the most food?” Martz asks.
Jessica points to the grain area.
“Right!” exults Martz. Then, “Do you eat cereal that’s good for you? Like Raisin Bran? Or do you eat—what are they called—Cocoa Puffs?”
Jessica throws a quick glance at her mom, who nods and smiles. “Raisin Bran,” says Jessica softly.
Martz smiles. It’s an answer she likes.
She has thought a lot about what will happen after she graduates in September. For a while, Martz thought she might like to go overseas again, maybe do a short stint in South America or Mexico to become fluent in Spanish.
She says, “I think it’s irresponsible to be a health-care provider in the United States and not speak Spanish. No matter where you practice, you are going to encounter Spanish speakers. Working through a translator is fine, but if you can communicate directly with the patient, nothing’s going to get lost.”
Still, getting an in-depth taste of what it’s like to be a physician assistant has convinced Martz the first thing she needs is to spend more time drinking in all she can about health care.
“I feel I would do very well with five years of experience in the medical profession under direct supervision,” she says. “I really want to work in a Spanish-speaking population. And I want to stay general—internal medicine, family practice, emergency medicine—something where I’m seeing a lot of different patients from all walks of life, just to build my knowledge base and get more comfortable in my role as a health-care provider. Then, I would love to do a short-term project overseas.”
She laughs, reconsidering what she’d really like to do after two busy years of school and clinical work. “I’m going to put my feet up,” she says, “and make myself a margarita!”
