AMISTAD 2026 strengthens family care, readiness at rural San Ramón clinic

For most of the year, the San Ramón Family Health Unit serves approximately 4,600 residents with a single family medicine physician, providing primary care for everything from routine illnesses to chronic conditions. When patients require specialty services, they are often referred to larger facilities in the city, which can present challenges related to travel, appointment availability and cost.

During AMISTAD 2026, that daily reality changed.

For two weeks, U.S. and Paraguayan medical professionals worked side by side at San Ramón, expanding access to family medicine, audiology and optometry while strengthening professional relationships and sharing medical expertise. The mission added a second family medicine provider, nurses, medical technicians, audiology specialists and an optometry team to support the clinic’s staff and help meet demand for services that are not routinely available at the facility.

Maj. Meaghan Hart, a physician assistant with the Massachusetts Army National Guard’s Medical Detachment, served as one of the clinic’s family medicine providers during the mission. Working jointly with San Ramón’s resident physician, Dr. David Grance, she helped care for patients across the age spectrum, from infants to elderly adults.

“I am doing family medicine in conjunction with the provider here,” Hart said. “We often see entire families together, siblings, or a mother and child, which gives us a more complete picture of their health. He knows his patients very well, and we work together to see them and understand what’s been going on over time.”

For Hart, who typically cares for adult service members as a flight physician assistant, the mission offered a very different patient population than she sees at home.

“Number one, seeing kids,” she said. “Back home, everyone I see is a soldier, 18 and older. Here I’ve seen patients as young as two months and as old as their 80s, which is newer than my daily life.”

She said the clinic saw a mix of chronic and seasonal conditions during the mission.

“I see a lot of chronic conditions where folks have run out of medication or their blood pressure medicines aren’t working, so hypertensive urgencies,” Hart said. “We’ve also seen a lot of upper respiratory infections in kids with fevers and congestion, allergies, ear infections, headaches and migraines. Those have been the major issues.”

Grance said the additional staffing and specialties had an immediate impact on the clinic’s capacity.

“On a typical day, I see about 20 to 25 patients alone,” Grance said. “With the additional military and Paraguayan medical teams here for Amistad 2026, we’ve been able to see well over 100 patients each day.”

Hart typically saw around 10-15 patients per day while Grance continued his own schedule, allowing the combined team to increase the number of residents who could receive care closer to home.

“I think I’ve been able to increase the patient load,” Hart said. “As a result of me being here, we’ve also been able to spend more time with patients and focus on education, which is harder when there’s only one provider. We might see them for an acute concern, but we also have the time to talk about prevention and education that comes along with it.”

Grance said bringing specialty care directly into the community helped reduce barriers many families face when seeking follow-on services.

“The temporary expansion brought specialty services directly to our patients, without them needing to travel to larger facilities,” he said. “That reduces barriers tied to distance, cost and scheduling.”

Throughout the mission, family medicine providers worked alongside clinic staff to treat patients of all ages, while audiology and optometry teams addressed needs that are not routinely available at San Ramón. Many patients received their first comprehensive eye exams, and providers identified vision concerns that had gone undiagnosed. The optometry team also screened for conditions requiring follow-on care and helped address a backlog of unmet vision needs, while audiologists evaluated hearing concerns and provided recommendations for continued monitoring and treatment.

“For many of our patients, this was their first opportunity to receive specialty care like audiology or optometry here in their own neighborhood,” Grance said. “People are very thankful that they came here to help. The community appreciates seeing the military working with us and supporting our patients. It means a lot to them.”

Hart said the Paraguayan setting and language differences also shaped clinical decision-making.

“Being in Paraguay, you have to have a larger differential,” she said. “Back home I see a lot of musculoskeletal issues and baseline chronic conditions. Here we see those as well, but you also have to consider diagnoses that are more endemic here than they would be in Massachusetts. The language barrier means you have to slow down, be more intentional and make sure patients truly understand their care.”

Working in a resource-limited environment, Hart said the mission reinforced fundamental clinical skills that are essential for deployments.

“As Physician Assistant, when we deploy downrange, we’re often at the role one, pretty close to the front line,” she said. “We won’t always have access to CTs, MRIs or advanced diagnostics. We don’t have those here either, so it really relies on your hands-on physical exam, getting a good history and reinforcing those skills to make the diagnosis.”

She described the experience as a “back to basics” environment that closely mirrors what clinicians may encounter in future contingency operations.

“Back in the States, depending on where you work, you can say, ‘I think this person has X, Y or Z, but let me just get an image or labs to confirm it,’” Hart said. “Here, and likely downrange, you don’t have that. It gets you into a resource-limited mindset, to think outside the box and think holistically about the patient instead of relying on tests.”

The mission also gave Hart and other providers the opportunity to work in a joint and partner-nation environment, sharing knowledge with U.S. Army, U.S. Air Force and Paraguayan medical teams.

“For us, I’m working with an Air Force medic,” Hart said. “I’m familiar with our Army medics and their capabilities, but if we go downrange, I might not be working with an Army medic. Having that joint collaboration within the exam room has been super important. It allows for teaching and training that will be beneficial.”

Grance said working side by side created opportunities to exchange knowledge, discuss cases and strengthen professional relationships that support future cooperation.

“When we share knowledge and experiences, everyone benefits,” he said. “Our providers benefit, the U.S. providers benefit and, most importantly, our patients benefit. Those friendships and professional connections are important because they help us continue working together in the future.”

That spirit of camaraderie reflects the mission’s name: Amistad, Spanish for “friendship,” describing the relationships built between providers, volunteers and patients throughout the engagement. At San Ramón, the military team includes Army and Air Force personnel working alongside Paraguayan health professionals and local translators.

“Our team here is myself as an Army provider, another Army soldier and three Air Force members,” Hart said. “We’ve had team dinners and even gone to dinner with our translators. The clinical staff is always saying hi, laughing and joking with us. It’s a very friendly environment.”

Hart believes that atmosphere carries over to the care patients receive.

“I think that bleeds directly over to the patients,” Hart said. “They see us collaborating and working together in a friendly, open environment, and I think that’s why they’re so happy to be seen. They don’t necessarily care who they see, they’re just excited to be here.”

Hart said the patients’ gratitude has been one of the most memorable parts of her time at San Ramón.

“Even something very benign, like an acute viral upper respiratory infection, the patients are so happy to be seen,” she said. “Here, they are very patient, very kind and very appreciative that we take our time to work with them. That’s been really humbling as a provider.”

For Hart, those interactions are a reminder of why she chose medicine.

“It makes me reflect on why I do medicine,” she said. “Not necessarily to make enormous changes in people’s lives, but to be there, to listen and to offer a little bit of medical advice and support along the way.”

Although Hart previously supported Amistad at a different location, she said each mission brings new lessons and perspectives.

“Although I’ve done this mission before, it’s completely different,” she said. “Different part of the country, different patient panel, different clinic setup. No matter the location, it’s a great learning and training experience for us, and a great way to learn more of the culture and the country. It’s been really impactful for me.”

When asked if she would return for future missions, Hart didn’t hesitate. “Of course,” she said. “Experiences like this are both professionally and personally meaningful.”

For two weeks, a clinic typically staffed by a single physician became a multidisciplinary team serving the community together, expanding access to care, strengthening readiness skills and building the friendships that make future collaboration possible.