Friends of Sergio Indiegogo Campaign 2015

Thanks to Don Sergio’s Friends, our Indiegogo campaign was a success beyond our goal. I presented Don Sergio with a mock check disclosing the amount raised from the campaign. Several people gave to the campaign outside of the Internet process.

To all we THANK YOU!!

"Thank you all my friends for supporting my work."
Don Sergio Castro.

Don Sergio was surprised and very pleased. This money will tide him over for the next 4 – 6 months, relieving his financial burden of wound and burn care.

For those unaware of medical wound and burn care, it is very costly. The US has many burn hospitals to care for these horrific accident victims, and Mexico opened up their first burn hospital in 2011 (Mexico City). As for wound care clinics, there are many throughout the US: you will not find a major city without one. Here, there are none, at least in Chiapas. Sergio is a one-man wound care clinic, however, as I will post later, this may be changing....at least this is our hope.

Wound care is very costly due to the frequent visits and constant changing of dressings (wound care supplies are not cheap). Diabetes is rampant and once an ulcer starts it is hard to heal when the patient has uncontrolled diabetes and lives in poor conditions. Mexico has one of the highest rates of diabetes.

For those interested in continuous support we have extended the Indiegogo campaign to ‘indemand’, to accept funds indefinitely.

For those of you who’ve never visited Chiapas or San Cristóbal de las Casas, I encourage you to see this magical city and pay a visit to this incredible human being.

Summer Trip 2015

Colleague and friend Jennifer Eldred, FNP has joined me this trip to help Don Sergio. We arrived on Sunday, 3 hours later than planned due to a cancelled flight and bad weather in Mexico City. Thankfully, we arrived safely at Bela’s at 1030pm. As always, she and her staff welcome us as family.

Monday morning we did our patient home visits that extended out to Teopisca, which is a 35-minute drive out of the city. We saw several patients from the area with various conditions: venous stasis ulcer, diabetic foot ulcer, slow healing leg wound on a diabetic, and 3 year old with a hot water burn on the top of the foot and a young man with an impressive lip dermatitis.

After a long day, we started at the museo/clinic at 430 and stayed until 8pm. There was standing room only. The number of foot ulcers continues to increase and, it appears, education about basic diabetes care is continuously lacking.

 

Exhausted from the day, Jennifer and I made it home at 830pm. We showered and crashed.

Thank you to Dr. Henry Beckmeyer at Michigan State University and his resourceful students. Your 4 valuable boxes of medical supplies are much needed and will be put to good use. 

Spectrum of Extremes

January 4, 1015

Small liquiteria en Real de Guadalupe.

Twenty-fifteen begins by coming to San Cristobal to help Don Sergio once again.  It has been five months since I was last here and it seems he never misses a beat and feels like I never left. There are a few changes and for they're for the best.

The help Don Sergio is receiving from 3 local jovenes (youngsters) continues: Alfonso, 17, is in preparatory school prepping for medical school; Cesar, 20, started medical school last semester; and a young woman, Edith, who wants to learn and become a physician. Los jovenes are so mature, motivated and clever. They love working with Don Sergio and look up to him. In return, Don Sergio appreciates the help and teaches them all the wound care he knows.

Cesar is doing well in his studies and can only work with Don Sergio on Saturday night and on Sundays. He was so happy to tell me of all the things he is learning and how hard he is studying. Alfonso, quiet and shy, and a hard worker, is dedicated and has been coming almost every night. Our new gal, comes when she can and is like Alfonso: shy and quiet. The three of them are pure gems.

They have the best beet, carrot and papaya liquados!

Our friend Iker also continues to come help but not for long as he plans to start a journey on his biciceta heading south through Central and South America. There is no doubt this rare bird will help many along the way as he can.  A free life he has and his physical needs are minimal and he has so much love and caring to share.

The day after my arrival, Don Sergio and I made our usual house calls to those too incapacitated to come to the museo. I was surprised at how there was one serious case after another. Two of our 8 house-call patients appear to have terminal cancer. One with a severe foot ulcer in which Don Sergio had to amputate one of his toes and is trying to save the rest of the forefoot, is so thin that his ribs poke out and the signs of anemia are obvious. The other has a myosarcoma (cancer in the muscle) in the right upper thigh that is the size of a cantaloupe. Both don't eat much and are miserable with nausea and fatigue.  There is really nothing that can be done at this point, but to make them comfortable.

I only bought one....and a couple of dark kakao bars.

Our other patients are blind from diabetes, frail with age or have another serious maladies in which they can barely walk.  The age range is 45 - 70. They have gone to the hospital or have seen a doctor but they are not comfortable with the system and they have hope that Don Sergio can cure them.  Regardless of how terminal their illness Don Sergio continues to care for them as if they will live forever.

How is it that we can have such beautiful and free lives and then there are those that suffer intensely for many years of their lives...slowly dying?  We all know what it feels like to have a belly ache and these terminal patients are constantly nauseous, have no energy, and can barely walk from one side of a room to the other.

The spectrum of our lives seems extreme: those of us doing what we want with our freedom and good health (always in a beautiful growth phase), and those that suffer beyond what we would ever want anyone to endure. We all see these differences and it makes us so grateful to be who we are and privileged to help.

Panaderia Frances - I had no resistance.

Posted by Patricia Ferrer.

First World Medicine in 3rd World Conditions

Peach tree flowers.

From a US trained medical perspective it takes some getting used to in these working conditions: poor lighting, dull instruments, bad ergonomics, modifying dressings and being creative with medicinal products obtained locally.  This is good in that it takes us from our comfort zone an pushes us to learn "poor man's medicine".

Tucson wound care specialist/physician, Scott "Mateo" Bolhack and his staff have been very generous since my seeking them out for good/unused wound care supplies 4 years ago. They are always interested in hearing about my working in Chiapas and after seeing photojournalist Janet Jarman's video in the  New York Times piece, the timing is right for Mateo's first visit.

Mateo works on one of Sergio's most challenging cases.

He arrived on Tuesday morning (red-eye) and that evening we threw him right in to the fire. I prepared him as much as possible about the conditions and he's adjusted well, although it has been physically uncomfortable for him with the knealing, bending and contorting himself to work on patients that sit on small wooden chairs.  And, like our patients during their wound dressing changes, he does not complain.


 Sergio gives Mateo all the difficult patients then quietly watches him work, learning new techniques and proper use of branded products. Many supplies that have been donated are good quality but Sergio and I are not sure of which wounds would benefit most. Mateo patiently explains how we can maximize these products. He has also brought supplies donated by companies that are interested in his coming to work here. We hope his being here will help improve what Don Sergio already does and knows so well.

Wound care team.

From Don Sergio, we learn from watching his quiet ways, his compassion and persistence in providing care and his not getting frustrated with a few non-compliant patients. Most importantly,  we are learning Sergio's own "poor man's medicine"

While watching a fireworks display at church, this 5 year-old was severely burned by a stray fireworks rocket. Sergio visits him daily to change his bandages. The child tells his parents he does not want to go to church anymore.

Posted by Patricia Ferrer, PA-C

Conditions of Care: August 2013 Trip Summary

For Don Sergio's make shift wound care clinic the conditions we work in are not the cleanest. He does the best he can with what he has and its all the locals have.

His stocked travel bag is always by his side.

The chairs we use are tiny, Don Sergio always looks up to the patient, never downward.

For house calls he adequately stocks his travel bag with what he needs for the daily rounds.  For the museo/clinic he keeps this bag at his side, on the floor and uses small chairs for a foot rest for dressing changes and the burn patients sit in an larger chair.

The 'dispensary' room.

There is no privacy as those waiting are sitting on one of two benches behind him. HIPPA patient privacy rules don't apply. He does have a dispensary/supply room with poor lighting which is where I usually work. Thanks to Clínica Amistad in Tucson, they donated a wall mount oto/ophthalmoscopy that I use for focused lighting when necessary as well as it's functional purpose.

As for supplies, here's how it works:
 - people from France and the US with access to medical supplies ship them to him. The supplies he receives differ depending on what people have access to.
 - from the US, I ship donated and purchased supplies to San Cristobal from Nogales, Sonora via Correo Mexico. (I drive across the border, have aduana's search through the items and give their stamp of approval.)  If anyone would like to donate supplies to Sergio it would be best to send them to me in Tucson. Contact me by email if you are interested.
 - if patients can afford it, they will bring in their own supplies which Don Sergio will use.
 - visitors who are aware of Don Sergio's work will have collected supplies and bring them down as well.
 - donated money allows Don Sergio to buy medications, creams and supplies locally.

Many people ask "what does Don Sergio need?".  From my observation:
 - Funding: although this is a small operation it is costly and time consuming as Don Sergio sees about 100 patient visits per week.
 - A constant stock of medical supplies (gauze, gauze wraps, wound dressings, medicated ointments, etc - see Yok Chij website Support page).

These conditions are not easy for a US-trained healthcare provider to work in. One has to keep an open mind and adjust to the patient's culture, mindset and expectations. This is challenging and satisfying when results are obtained and a positive difference is made; its disheartening when resources are so limited there is nothing that can be done.

This visit completes my 8th trip working with Don Sergio over the last 5 years and it is so gratifying to assist this septuagenarian provide needed medical services that are otherwise not available.  Don Sergio is unstoppable even after his auto accident in Febuary 2013 that caused him to lose all his upper teeth (his face hit the dashboard). An avid supporter of Don Sergio has given him the money to have him fitted for dentures, I hope he uses this for himself and not others.

Don Sergio lost some mobility in both wrists and hands in his auto accident as well. A physical therapist from Monterrey Mexico had been on his small tour the night before and came by to work on him.  He does accept help from others.

I plan to return January 2014.
Post by P. Ferrer, PA-C

Giving and Receiving

San Cristobal has the same magical charm I find every visit. Walking to the museo daily I get to experience the aesthetics of this colonial town, seeing the different and updated styles of the various Indigenous clothing, shop for hand made textiles and recuerdos, eat at tiny restaurants with wholesome food and enjoy the cool weather. This offsets the world of Don Sergio's daily work: the real depravity of what some people experience. This brings a much greater appreciation to all, those of us in the US, have and should never be forgotten.

Over the last 5 years there has been a dramatic shift from mostly burn wounds to diabetic ulcers.  Currently, we have no burn patients almost all diabetic ulcers with a few skin injuries and 3 of our 4 house-call patients have bed sores.

One of the saddest cases I've ever seen is a 20-something year old man that broke his neck 4 months ago in a motor cycle accident. He is now a quadriplegic and is in chronic 'full body' pain.  His wife and family care for him but there is much more that can be done: physical therapy, a soft foam mattress, a bed or device that can move his body preventing him being in one position too long and for God's sakes pain relief medication.  All this is just a dream and what would be done for an insured person in the US.  His sacral (lower back) bed sore is healing, thanks to Don Sergio, but this probably won't be the last. Without the proper care, he will probably have many as long as he lives.

The past week Don Sergio and I have had the pleasure of working with Amethyst, a Reiki and Massage therapist from Cozumel, Mexico.  So many people have musculoskeletal complaints that she was kept quite busy this last week especially at the museo clinic.  She also helped me with interpreting, she did blood sugar finger stick testing, bandage changing and Reiki on almost all our house call patients.  This was her annual 3 week vacation (from the heat in Cozumel) and she spent her last full week working with us. She said she enjoyed helping those that would not otherwise be able to have access to her services: pure giving of herself and con mucho gusto. Don Sergio and I, and his patients, really appreciated her being with us this week and we look forward to her coming again next year.

Summer Rain in San Cristobal August 2013

August 20, 2013

 
Another day of taxi rides from one end of the city to the other.  In between seeing patients Don Sergio takes me to a nearby village to show me the plans of his next water treatment system. The area is well farmed with a variety of vegetables and I recall being in this area with him a few years ago.

The homes are separated by beautiful farmland that grow cabbage, beans, corn, broccoli and other vegetables.  A site for sore eyes for any veggie-lover. This area would like to have a larger holding tank and access to clean water and Don Sergio has a plan however, it is a big project.  Currently they go to a water holding take and scoop the water out by bucket. The new system will have 4 or 5 diverted pipes to areas in which they can easily access the water.

 

Don Sergio has known the families in the area for years and he says the 200 or so families get along very well.  The area is is 2500meters above sea level, overlooks the village of Zinacantan and appears to have incredibly fertile tierra.

As for patients, the foot ulcers and out of control diabetes are overwhelming. There is only so much one can do. It seems there is not one endocrinologist in San Cristobal (the population is ~200K)!  Many of our patients should be on insulin and those that are on insulin need better training on how to adjust their insulin to improve the sugar control.  It is so hard to heal a wound with poorly controlled diabetes....this story repeats itself.

Our special case of the day is a 10 y/o boy that got in a fight with a cousin and his cousin's tooth caused a puncture wound.  This happened 15 days prior. He went to the hospital and according to the sister, was told nothing is wrong after they took an xray. When we take off the bandage, the small puncture wound puts off a smell causing you to involuntarily step back.  Not good.


We repeat the xray (to rule out gas gangrene - negative) and it appears his 4th finger/knuckle is displaced along with this deep skin infection. We go to the ortho, get an RX for antibiotics, get a culture and sensitivity but start him empirically on the antibiotics. The ortho informs us surgery may be necessary for cleaning out the infection. If this is the case, he will have to go back to Hospital de las Culturas and hope the right thing will be done. Otherwise, this 10 y/o's right hand may be in jeopardy.

La vida de Chiapaneco....

Don Sergio in the New York Times August 2013

Don Sergio Never Changes

This visit I find Don Sergio doing the exact same thing he has done for many years: ".......crisscrosses this city to treat the intimate struggles behind its closed doors." as quoted from the recent New York Times article written by Elisabeth Malkin and video by photojournalist by Janet Jarman.

Arriving last night and expecting to have Sunday off was a mistake. Don Sergio had four patients to see today: two of which we seem to be providing palliative wound care (bed ulcers) and the other two with chronic ulcers that will take a very long time to heal with his resources. Not much has changed: same difficult wounds and ulcers, different patient, limited resources.

Our day started at 1030am and passed very quickly. Don Sergio happened to have a visitor he met several days prior during one of his tours:  an alternative healthcare provider (a Reiki and massage therapist) who has lived in Cozumel for the last 15 years. Her English and Spanish are impeccable which came in very handy for me.  I consider myself proficient but not fluent and her ear is much better than mine.

I had the pleasure of showing Don Sergio the hard copy NYT article today as he rarely gets on the internet and of course does not receive the NYT on his doorstep. He was very pleased with this, more so than I expected. He knows Janet put and enormous amount of time in doing the photos over the last year which required several trips. The 'behind the scene's team' that has been helping Don Sergio for the last several years was elated. We've known all along the value and magnitude of his work, the need of support and we've embraced his "just do it" ideas for the betterment of his community for the short and long term. 
 
From Don Sergio "Gracias por su apoyo".


  
Monster Green (the suitcase) has carried hundreds of pounds of medical supplies over the years..its time to leave it here. Don Sergio will use it for storing the extra Indigenous gifts he's received over the years.

 

 Succulents at Casa de Bela

Success and futility

June 21, 2012

At this moment we have only a few burn patients but many diabetic and venous ulcers (foot and leg ulcers). Burn patients, depending on the severity of course, are much easier to help heal. They are usually young healthy individuals with good immune systems. Most of the burns I've seen this trip have been superficial or partial thickness and are almost healed over. These are the successes.

21st century juxtaposition: napkin (servilleta) with the Aztec image holding a cookie (galleta) with a Spaniard in Armor image. The cookie is processed sugar (which the western world introduced to the new world) and paper is made from natural products although refined. The weight of the Spaniard on the thin Aztec serving napkin to collect the crumbs.

The diabetic ulcers are far more challenging. Two steps forward, one step back, these seem futile… but eventually, for most of these wounds, Don Sergio will have success and will possibly have saved a limb.

Here is a simplified version explaining what happens, wound-wise, for those with diabetes. When one has high blood sugar the hormone insulin, produced by certain cells in the pancreas, take the sugar out of the blood stream into the cells so the glucose (sugar) can be used as energy. If there is too much glucose in the blood stream, it is toxic to the inner vessel walls, especially microscopic vessels that are at the ends of the toes, back of the eyes, in the kidneys, etc. This glucose also damages the nerves at the ends of the hands and feet which cause neuropathy (most symptoms are numbness, tingling, or burning sensation). If one can't feel their feet and they are stepping on a small stone that can cause trauma, they are unaware of an injury. Or if the end vessels are so damaged, no blood can perfuse to supply the toes with the nutrients it needs and take away the waste then the tissue of the toes starts to die. Whether it be injury or dead tissue, amputation or open wound, bacteria will settle into the wound and infection begins… or colonization of bacteria begins and interferes with wound healing. If the blood sugar is high, the bacteria will continue to grow, the vessels continue to be damaged (poor circulation) and the wound persist.  Hence, control of high blood sugar during wound healing is so important.

Here, for us, the other part of the equation is that we don't have a good set up to clean the wound properly.  The environments in which we work are not the cleanest, we don't have adequate clinic set up, our supplies are limited; we can do cultures but this can get costly and not yield the most useful information, plus we don't have the antibiotics (creams and pills) to treat properly. It seems to be three steps forward and two steps back.

Every visit I see this well-taken care of old Dodge.

On the brighter side, as always it is a pleasure working with someone who doesn't complain or protest but takes action on what is at hand. Don Sergio uses the resources available and makes the best of it, even when I express my opinion that things look hopeless… one day I will learn to keep my mouth shut. I'm reminded every trip, to do my best with what I have and that it does matter here and now to those you are treating.

Posted by P. Ferrer.