My first view of Paraguay was from the air. The landscape of green fields, low brush, and trees around the capital city, Asunçion, showed characteristic Spanish-style houses with white walls and red-tiled roofs. Red dirt roads crisscrossed the countryside, and paved roads were rare. In the city, streets were cobblestone or brick, with an occasional street paved with blacktop. Many were in poor repair.

I had traveled to the small, poor, South American country last July to explore the possibility of providing volunteer psychiatrists from the U.S. to help meet Paraguay’s urgent mental health care needs. The impetus for my mission had been the 1998 visit to Paraguay by then APA President Rodrigo Muñoz, M.D. He had responded to a request from the country’s health minister for APA to explore ways it could help in augmenting or improving a mental health care system that had only 50 or so psychiatrists to serve a population of 5 million people.

During my five-day visit, during which my psychiatrist hosts treated me like a dignitary, I was able to observe the care provided in several facilities, most of them reminiscent of the state of public hospitals in the U.S. several decades ago. Dedicated staff dealt with out-of-date equipment, a lack of the latest psychiatric medications, and generic drugs whose quality and potency varied with each batch.

While conditions under which Paraguay’s psychiatrists work are often discouraging, it is hard to be complacent in the face of the eagerness and energy of the Paraguayans. I realized that we psychiatrists in the U.S. and Canada can provide valuable assistance to our colleagues in Paraguay that can make a difference for them and their patients. We can send manpower. We can send the accumulated wisdom of years of psychiatric experience to teach, educate, and encourage. We can go there to learn lessons that with our affluence we may have forgotten.

To meet these challenges I would make the following recommendations:

• Develop a "Benjamin Rush Corps" in which psychiatrists from the U.S. and Canada spend one month in each of four locations in Paraguay. These would include private and public hospitals and inpatient and outpatient clinics. These psychiatrists would consult with local psychiatrists and if possible teach medical students and psychiatry residents at the medical school.

• Send psychiatrists to teach at the medical school in Asunçion.

• Have psychiatrists give CME-quality presentations to Paraguayan psychiatrists.

• At a later stage of the program, begin sending psychiatrists into the more rural areas to consult with general practice physicians to educate them in the diagnosis and treatment of psychiatric patients, which may stimulate the development of psychiatric inpatient units in various parts of the country.

• Encourage the AMA to develop a similar program for other specialties.

• Provide books, journals, tapes, updated literature, equipment such as ECT machines, copies of DSM-IV, rating scales, and so on, preferably in Spanish. Residency training curriculum materials would also be valuable.

• Develop a mentor system via e-mail between psychiatrists in the U.S. and those in Paraguay. Mentors fluent in Spanish could be selected for Paraguayans who are less fluent in English.

• Involve Paraguayan residents in U.S. training programs and institute an exchange of residents. Several psychiatry departments would need to be interested and willing to undertake activities in this project. Those in areas with large Spanish-speaking populations may be more suited for this part of the project. It might work best to have Paraguayan residents rotate through programs in the U.S. for several months to a year and consider sending U.S. residents to Paraguay at a later stage.

• Develop an exchange program for residents in other specialties. This would seem to belong under the purview of the AMA or other organizations, but this would be an interesting outgrowth of APA’s program.

• Psychiatrists approaching retirement might consider making a charitable donation of their libraries to the University of Paraguay. The same could be done with equipment that hospitals are about to replace.

The critical question of funding for this project needs to be considered before starting to implement this series of recommendations. Pharmaceutical companies are likely candidates, and certainly some of these recommendations can be taken up individually by anyone inspired to do so.

My journey to Paraguay was a memorable and rewarding experience for which I thank the generosity and vision of APA and those individuals who made my visit possible. This experience has left me with the conviction that this project has realistic possibilities for development and success in Paraguay, and I would be bold enough to suggest this could serve as a pilot project for similar endeavors in other parts of the world. I hope my ideas inspire my colleagues to action.