Monday, October 11, 2010
The critical burn patient in Navanchauc (see latest August posting) with 30% body surface area affected has had one complication after another. Sergio is in a quandary as to what to do. First she complained of back pain.... she may have an kidney infection due to an indwelling urinary catheter. Luckily, Sergio has ciprofloxin on hand (OTC in Mexico until 2011) which covers urinary tract infection, hence he treated empirically.
A month later Sergio explains that one of her legs is developing significant swelling that is not going down, compromising her ability to heal. As of most recently both legs are now swollen. The patient has been immobile for more than three months and her pulses on her feet are hard to find but the patient seems to be 'OK'. The list of complications can include a DVT (deep vein thrombosis), compartment syndrome (inner swelling compressing all tissues), hematoma, and poor kidney function, and probably more than I can think of.
In the US, identifying a DVT is made by using a Doppler, if positive, heparin infusion and subsequent warfarin; compartment syndrome is usually relieved by surgical means by opening up the deeper fascia layers relieve pressure/compression; hematoma also may require surgical treatment and poor kidney function can be averted by monitoring and treating appropriately. In Chiapas, this "advanced" medical care is not readily available and the patient had such an unpleasant experience in the hospital that neither she, nor the family, wants her to go back. Sergio’s option is to bring a medical doctor to evaluate the patient. He takes blood and urine with results to be determined. The urine is a good idea to rule out a bladder infection, blood work to determine if there is an underlying infection, anemia, kidney function, electrolytes….but to identify if a clot was present the patient needs a doppler/ultrasound.
Per Sergio, the physician started the patient on furosemide to help push fluid through the kidneys and reduce swelling, as of this writing it has not been successful. It's the only option for now.... just wait and see.
The patients have so much trust in Sergio but it is at times like these he needs a real medically-trained health care provider to guide and help him. These are challenging cases, he does the best he can with what he has.
Sergio encouraged the family to see a physician in Tuxtla but the patient and family refuse to go. They do not want to go back to the hospital for any reason, even if there is pending bad outcome. One has to ask why? Lack of trust? Discrimination? Lack of confidence? What could possibly stop someone from seeking urgent medical care that is limb or life threatening?
Meanwhile in the US, Consuelo and John, directors of Sergio's documentary "El Andalon", attended the Idaho Spiritual film festival and showed their work which was warmly received. No donations have come from the showing but we are always hopeful. Their next stop with the film is Mexico City, where it will be shown four times, then on to Oaxaca. They will then go to Chiapas mid-November to see Sergio personally and leave him "El Andalon" DVDs to sell at his museum.
Bloggers comment: For me, I have recruited a friend/colleague to join me in San Cristóbal in March, 2011. We are planning to take as many medical supplies as possible and to work with him for two weeks. If you would like to help this unique humanitarian with supplies, donations or medical expertise, please contact me via Sergio's email: firstname.lastname@example.org or my personal email: email@example.com