|Beautiful mural in local San Cris restaurant.|
There is so much work to be done in global health. In this region, Don Sergio is the only local safety net for wound and burn care. It is not a long term solution to the problem. It is not sustainable and he knows it even though he's been working 6 days a week to give help to those who need it for more than 40 years.
Don Sergio is now 73 and although his energy level is good, he's not going to live forever. There is no system in place to provide for wound and burn care in the future.
In Mexico there has been little emphasis on prevention of diabetes. Don Sergio sees more and more foot ulcers, amputations and other related type 2 diabetic complications. It can be overwhelming and limited resources contribute to poor outcomes (see previous post).
My last day working with Don Sergio we saw an insulin dependent T2DM (type 2 diabetes mellitus) patient with a partial left foot amputation complication. The 71 year old wheelchair-bound man had an above the knee amputation of his right leg done a few years ago secondary to diabetes. His left foot, now is malodorous, there is pus, and the top and bottom of his foot are held together by large deep non-absorbable sutures (take these out and his foot will flop open like a book). Clearly an infection and the top of his foot is becoming dusky purplish (impending necrosis). His mental faculties are sharp but he complains of diminishing eyesight. He discontinued his insulin as he felt it made his eyesight worse. This is a common misconception for the people Sergio serves. They believe insulin makes you go blind. Stopping his insulin only made his foot problem worse.
It is very frustrating to me, having worked with the patients in Chiapas to never see public health/education campaigns directly targeted to prevent diabetes on a national level. The major advertising continues to be for soft drinks which are pervasive and easily obtained in the most remote villages.
In so many words, Don Sergio has expressed the need for a facility to provide medical care for these patients, i.e. access to care, as the work for wound care is piling up. With Dr. Mateo working with him earlier this year, maybe the idea of a proper wound care and burn center has appealed to him. But a clinic would be more practical to begin with. Although, this is not the complete answer, it is part of the solution and other basic systems (e.g. education) can expand from there.
The local medical community is very aware of Don Sergio being a safety net and the director the hospital has asked Don Sergio to give a talk to the local physicians on causes of burns within the Mayan communities. Burns and minor skin injuries is how Don Sergio first fell into the wound care business. Right now the burns are secondary to the diabetic ulcers. When he speaks at the hospital it will be his opportunity to show the extent of the problem and his need for help.
I will not be there during his talk as I've returned to Tucson, but Erick will be there and will help him with a PowerPoint presentation. It seems Don Sergio has attracted a few international professionals that have taken an interest in supporting and helping. Don Sergio's connection and trust from the Mayan communities, international support, and a connection with the local medical community may one day yield that clinic.....to be continued.