San Cristóbal de las Casas

Tourism in Mexico is down, including San Cris. Usually, North Americans vacation at the Mexican beaches and don't realize the beauty of the pias adentro, country inside.  More than 60% of Mexico is 5000 feet above sea level and there are numerous old colonial cities throughout.

San Cris epitomizes all the charm of Mexican colonial cities. It is over 7000 feet above sea level, has historical landmarks, and el centro is a tourist mecca with shops and restaurants and tour agencies. The downfall is it's not so easy to get to.  Coming from the US you have to fly into Mexico City, then to Tuxtla Gutierrez, then take a taxi or bus 1.5 hours up into the Highlands.  From Tucson, I'd be thrilled if I could get here in 12 hours, however it is usually an average 15-hour day of travel.

Despite the 3 plane rides and taxiing here, its worth the visit.  The climate is cool in the evening and early morning, the sun is brilliant and strong during the day and right now we are getting afternoon showers. The flora and fauna are a mix of pine forest, similar to the Pacific Northwest, with desert cacti and agave plants. The local Mayan wear their traditional and fashionable textiles daily and you can learn to recognize which outlying village they are from by the clothes they wear.

Zinacantecas.

El Centro has colonial structures including elaborate churches from the 16th century.  Even older Mayan ruins; Toniná is 2 and a half hours away and if you want a full day excursion you can go to Palenque, one of the most impressive ruins in Maya Mundo. To learn about the local Mayan textiles and culture, Don Sergio's tour is a must, however, he will only give it if he has a larger group and there is also a nice Textile Museum adjacent to Santo Domingo church. (If you do go to Don Sergio's tour, please donate generously - reading this blog will inspire you.)

Toniná.

Atop of Toniná.

Lastly, Bela's Bed and Breakfast is the most charming place to stay in San Cris. For me, this is my San Cris home. The rooms are decorated with local artesanía textiles and crafts and I get to feast my eyes on a beautiful garden and planted succulents when walking downstairs to the salon for breakfast al gusto that always includes fresh squeezed orange juice. Last year Bela added a room with a loft that has a king bed on the bottom floor and 2 twin beds in the loft, perfect for a family with 2 children. The beds are so comfy and the location is perfect: in the el centro zone and one block from the Santo Domingo Church and market.

If you are looking to get off the beaten 'gringo path', but not too far astray, San Cristobal de las Casas is definitely worth the visit.

Posted by Patricia Ferrer.

Suffering and Service

June 23, 2017

Suffering

Every visit I see someone who has suffered from an injury or problem that touches my heart deeply more than others.  This visit's story is of a young man of 23 years old who was working in Teopisca (30 minutes from San Cris) that was electrocuted while at work.  The electricity went through his right hand and out both feet on the outer sides and blew off his left great toenail.

His feet are healed but his dominant right hand was severely damaged. He lost his right index/pointer finger and part of the electricity came out his wrist.  He went to the hospital and when the doctors tried to stop the bleeding they cut all his tendons in his wrist leaving his already damaged hand completely useless.  The wound created by the injury and the surgery has healed, albeit slowly, thanks to Don Sergio's care. However, his arm bone remains exposed which will lead to eventual osteomyelitis and it is possible the skin will close over it, but possibly not.  In the long run, the best thing to do may be amputation of his hand, which still has some life but it does not move, grasp or contract. The right hand is left in a semi-grip state.

Caution looking at the photo below.

This bright energetic young man's life is significantly altered. When I see suffering like this, I think this could be me or a loved one and it reminds me how privileged I am to be a healthcare servant to humanity and I could not ask for a better role model than Don Sergio and his volunteers Anita and Edith.


Service

When choosing a career in healthcare and to work in underdeveloped areas of the world we need to explore the reasons we do this.  Is this to have the 'unique' experience to see conditions we normally don't see in the US?  To work in challenging conditions and finding ways to improvise and test our mettle? To help those already drowning in the overwhelming number of patients? To elevate our own status in others eyes? Or is it out of guilt for feeling you don't do enough in your daily life? Or guilt for having such a good life?

Regardless of any answer, when coming here our own personal gain needs be left at home, egos stripped, and desire to push our knowledge on those doing the daily work suppressed.  It is we who need to listen and learn in order to help and serve.  Those here have to accept us first and see our dedication is to help them. We need to respect them, use caution in implementing 'what we would do' and not take more of their already expended energy. Attitude and action speaks more clearly than any medical or clinical jargon and is better understood by all. Once a connection is made then slow implementation of what could benefit their treatment(s) will be accepted.  I am so grateful and privileged to have learned this from humanitarians I have known in my life time and to serve along side them.

Sergio directs and helps Anita debride slough from a burn injury.

Posted by Patricia Ferrer, PA-C

Summer 2017

June 17, 2017

It's been almost a year since I have worked with Don Sergio. Accompanying me this trip includes Ethan, my nephew who has been twice before, first year med student Khiem Tran, his wife Dr. Vivian Shi and Dr. Ken Iserson and 5 large bags of medical supplies. 

Our travels getting to Chiapas were delayed due to American Airlines failing transfer our luggage to our DFW - Mexico City flight causing us to miss our connection to Chiapas. We arrived a day late at Bela's; thankfully we made it safely. Dr. Iserson made it the night before as he took a different flight to Mexico City.

L>R: First year med student Khiem Tran, Ethan, Dr. Vivian Shi, Dr. Ken Iserson, and our exceptional host Bela.

We had a little time to clean up, have a wonderful home cooked meal at Bela's, then we were off to the museum. Sergio's museo clinic was packed with the usual cases: a child with a hot water burn, chronic venous stasis ulcers, diabetic ulcers, and older man who fell in the fire and whose back was severely burned along with a few other burn victims. Sergio had told his patients that we were coming so the museo was packed with many others seeking help our US medical team.

Drs. Shi and Iserson went to work quickly.

We were glad to see Don Sergio, Anita and Edith; their constant dedication continues to amaze me. They work quietly and efficiently with what few things they have available.  We all found our places of need and went to work.

After a long first evening we went out for pizza then home to Bela's for a much needed good nights' rest.

House call for a recently injured man who will remain a paraplegic has a bed ulcer Don Sergio has been attending.

Team work, L>R: Dr. Shi, Don Sergio, Patricia.

Dr. Iserson, an ER physician, was in great demand for his general medicine skills.

Working from Within

 July 6, 2016

Photo taken from Mexican Destinos website.

This is my 8th year of coming to San Cris to work with Don Sergio and I have seen some beautiful changes develop, albeit very slow from US cultural perspective, it is nonetheless in the making and  hopeful. I have learned my place in this process.

When I started working with Don Sergio I saw much that could be done to improve things and I wanted to jump in and help out but I'm not here day-in and day-out. So, by my own means I kept returning, supporting and attended to people along-side Don Sergio and doing what I can by being aware of what they need: NOT what I THINK they need.  When formulating this sentence, it is the epiphany that all of us need to accept when coming from 'our world' into 'their world' wanting to help. 

Don Sergio's day time assistant is a nurse, Anita, that has not been paid for 6 months from her nursing job at a community women's' hospital. She started working with Don Sergio on the morning rounds and he pays her when he can. She is smart, confident, aware, mature and attentive. Anita is a single Mom with 3 children and is aware of the fluctuation of Don Sergio's financial dependency on others, so when he doesn't have money, she continues to work with him, knowing funds will arrive some day.  Pure trust.

In the evening, one medical student, Cesar, and a nursing student, Edith, come in to help Don Sergio. Cesar is in his 2nd year of medical school and when he has free time he is always working with Don Sergio. Even on the weekends.  Edith, is there every evening. She lives far away but takes a collectivo to be at the evening clinic. She is shy, quite, smart and takes in everything.  Don Sergio pays Edith when he can and occasionally he will give Cesar a few pesos. Cesar asks for nothing and has family support.

L>R: Don Sergio, Edith, Cesar.

Cesar wants to come to the US in a year or two during summer break and learn how we, in the US, practice medicine. Edith wants to be able to finish her nursing training. It is very possible both may one day be the successors to Sergio's clinic.  Don Sergio is 75 years old and still has great compassionate energy but he will not live forever.  Cesar and Edith are constants that can step in as healthcare professionals, they are both Coletos (locals born here - which is important), and are building trust of the patients and community with their dedication.

Cesar is in his 2nd yr of med school in San Cris. Ethan has applied to US med school this year.

Our roll is to facilitate their needs; observe, listen, accept, support and follow through. They know what they need and we need to be there for them.

Thank you to everyone who has contributed on all levels and those who, in the future, will.

Posted by Patricia Ferrer, PA-C.

School Construction

Escuela 5th of marzo

The small center room with the sheet metal roof is the nurses exam room, being completed soon.

The situation in this part of Mexico is on shaky ground with the 'bloqueados' (road blocks). From what I'm told, teachers are protesting for the rights to teach children what they need to learn in life to do well for themselves and to know their rights. Some teachers have been paid and some have not; same for healthcare professionals. A nurse I know was only partially paid. I would imagine if this happened in the US, there would be a major revolucion.  Just imagine what it is like for everyone here.  Nonetheless, those suffering at this moment are the minds of children not being educated at all.

The library, currently is also being used as the ground keeper residence.

Another view of the library.

Recent educational math activities remain on the board.

Outside the grounds-keeper's home.

Don Sergio's 5th of marzo school project continues and the community it serves is involved with the school and they remain open with the exception of summer break. So, for now construction continues.  Sergio has completed the latrines and the school library, there is a room for a school nurse and he is completing a home for the school's grounds-keeper.  This school complex has been in the making for 6 years now....typical poco a poco.

Completing the ground keepers home.

Fortunately, for Don Sergio, foreigners have stepped up to help. One couple, R&L, have generously donated a nice sum to help complete the library, nurses room, water pump for the latrines and roof.  Then, out of the blue, Don Sergio was contacted by a newly formed US solar company to see if they can donate solar panels for one of his projects. They worked out a visit to San Cris while on a family vacation, visited with Don Sergio and took a tour of the school and all agreed it is an excellent place to add the solar panels. Everyone is happy about this as there is only one business in San Cris that has solar panels, this will be the second and it is a community school.  All are excited about not being dependent on the city's electricity. For those that may not know, electricity is very expensive here.

Summer 2016: Effects of the road blocks

Flowers at Bela's are in full bloom.

This summer trip finds Sergio with good energy and nice support so that he can complete his local projects.  As usual, on the medicine side, we see the same health problems but different people.  As for the local turmoil, teachers and healthcare professionals are striking and protesting and have control of the flow of traffic in and out of the San Cris.

Ethan and I arrived Tuesday night with a few glitches but we knew everything would work out.  Our taxi driver What'sApp'd us and said he could not pick us up at the airport. So when we arrived in Tuxtla at 630pm it turned out the OCC bus was getting ready to depart to San Cris and unknown to us, we purchased the last 2 seats (the bus was packed). Eleven kilometers outside of San Cris we had to detour via a dirt road to get on the old highway into the city.  Safely we arrived at Bela's around 9pm.

Driving against traffic, these are the lines to get into the gas station, double file.

We had been aware of the recent protesting and violence in Oaxaca and although we did not see any protesting, we definitely experienced the effects. Teachers and health professionals (to my understanding have not been paid) create road blocks which prevent certain items to come in and out of the city. Tourism numbers are low and gasoline is limited. The lines at gas stations are long and they run out quickly. We cannot go out to the communities so we only treat the local patients....keeps us busy enough!

2016 Some things never change

Advertisements for Sergio's museo. 
After seeing patients all day, if there are enough
tourists, he will give them an unforgettable
cultural and Mayan textile tour. Donations
partly support his ability to do his
humanitarian work.  

Its hard to believe I met Sergio 8 years ago and how little things have changed in his world of wound and burn care. At least as far as patients go: same accidents, different people. Our patients are the young, the old, and everyone in between.

On New Year's Eve a 5 year-old boy, with his 23 year-old uncle from Chamula, were planning to use fireworks and pulvora - literally in English 'gunpowder' -  and somehow it when 'boom'.  Both their hands and faces were burned.  The boy's complete face (excluding his eyelids) has a superficial second degree burn and he looks like a kid from a horror movie. The back of his hands suffered a 1st degree burn in which the superficial aspect of his skin will peel and probably won't leave any scarring. At this point we really don't if he will be left with any facial disfigurement, but his function of blinking, and use of his mouth should be fine. Sergio cleans his face and applies cream and this 5 year-old does not cry. His absolute attention and caring in doing this must have some calming affect...plus the boy knows Sergio will give him a piece of chocolate afterwards.

The uncle does the whimpering when we change the bandage on his right hand which has a superficial 2nd degree burn. His face suffered a burn equivalent to a chemical peel that many women in the US pay hundreds of dollars to help with wrinkles. His face is recovering very quickly but his hand will take longer.

The older patients have diabetic or venous ulcers we see on a regular basis. The blindness from diabetes continues to amaze me and lack of education for diabetes prevention is sorely lacking (as it is in the US). It also continues to amaze me how people get along with their maladies that interfere with their daily activities of living and their quality of life. They seem to blame no one and accept their fate.

An ornate decoration from one of Mexico's oldest churches in San Cristóbal.

Posted by Patricia Ferrer, PA-C