Wednesday, August 11, 2010

Last day — More patients

August 10, 2010

Two days prior to my departure Sergio and I were asked to see a young lady in a pueblo in the mountains on the old Pan American highway. On Sundays Sergio usually only cares for patients with significant wounds (the children with burns) and I have my only day off, however, this case sounded pretty grave.

Two women arrived at the museo in their indigenous garb and a driver took us to this village called Navachuc (probably grossly misspelled). It is a 30-minute drive into mountains southwest of San Cristóbal. This two-lane road was very foggy and the road somewhat serpiginous. We passed Zinacantan, a small pueblo that has a good economy growing and exporting flowers augmented by the women's incredible weaving and embroidery.

We arrived at a concrete block home near a tranquil lake that had several homes overlooking this peaceful vista. Inside this clean and organized home which was no more than 300 sq feet was a bed with a young lady, less than 20 years old, with a tented sheet over both lower legs. This patient is an epileptic which seems somewhat common with the indigenous and had an “attack” and fell into an open fire. The woman with her had not been there - she was away to wash clothes by hand and upon returning found her collapsed in the fire (usually a large concrete block or modified BBQ pit in a central area of the home) and was unsure the length of time she had been in the fire.

The end result was a full thickness burns (to the bone) on the right leg and deep dermal burns on left leg. These burns are circumferential involving most of both legs. Fortunately, her feet were spared.

She was hospitalized in Tuxtla for 15 days then transferred to the Centro de Salud in San Cristóbal for seven weeks. I’m sad to confess the care here is suboptimal at best and it is difficult to say what had been done. When we removed the tent we found her wounds unbandaged, superficial aspects of her right tibia bone necrotic and she had a catheter placed for more than 15 days. The parts of the wounds that were not dry were oozing fluid and appeared not to be infected. The family was not given any instructions on care that we know of but it appeared the patient had excellent and willing family support. She had been on her back for so long at this point she developed a 1 x 2" bed ulcer over her lower back.... indicative of little movement for two months.

This type of burn in the US would have been cared for at a burn center, probable graft or other type of tissue graft done on her right leg and physical therapy implemented at this point. She has ~30% body surface area affected which means ~30% of her skin gone! These patients lose water constantly and quickly and their bodies have a difficult time regulating their temperatures, hence she gets cold and shivers burning much need energy that should be going into her body’s healing process.

We gently cleaned her legs and applied petrolatum impregnated gauze and gently wrapped her legs in a telfa-like dressing. We explained she needs to be kept warm and eat a healthy diet while her body is trying to heal.

Our second day out she complained of severe back pain, not her legs. My concern was the indwelling catheter possibly causing a kidney infection. The family said the local doctor was coming out to see her that afternoon and the problem will be addressed. In my opinion the patient needs to start moving, urinating and defecating on own with a bed pan. Sergio explained to the family that they should make an overhead bar so she can lift herself and use her upper body muscles which will help with a bed pan potty. Her attentive family support will augment her healing progress.

Note: These severe burns are mostly caused from floor open fires and anafres which are modified BBQ used indoors on the floor in kitchens, hallways, etc, for cooking and heating. This has been their culture and way of life for eons and change comes slowly.

The family fed Sergio and me authentic corn tortillas as they’ve been made for generations, chicken soup (killing a chicken for us is a considerable expense) and gave me a handmade tote bag. I’m not sure they knew I was departing for the US soon but they showed their gratitude with hugs, food, the gift and smiles.

Prior to my leaving they brought in an elderly woman with a large basal cell skin cancer on her left forehead and incidentally another smaller one on her left cheek. In addition she had several large precancers. My plan is to return in February and I will do my best to have the equipment necessary to treat these lesions so she doesn’t end up like the man with the large basal cell on his chin (out of my comfort zone for treating).

The following day I departed this magical city with many things to think about: continued medical supplies, planned minor surgeries, meds to bring, searching for funding to support Sergio, the upcoming premier of Sergio’s documentary and the Yok Chij A.C. charity (the equivalent of a 501(c)3). While here I met with others involved with operating local Mexican NGOs who offered a tremendous amount of help. However, there will be much work to do to get all the ducks in a row to make it work. Any suggestions? I’m all ears.

I caution the reader beware the following intense photo.


This city has so much charm and simple aesthetics that adds to its richness. For any health care provider that may be interested in coming to San Cristóbal and helping out, please contact me at:

Posting by Patricia Ferrer.

Wednesday, August 4, 2010

The good thing about Mexico is...........

you see things you most likely wouldn't see in the US. The bad thing about Mexico see things you most likely wouldn't see in the US.

Good: Adults lovingly caring for their elderly parents, mother and daughters unabashedly walking arm-in-arm, siblings genuinely and attentively caring for their younger siblings when crossing the street and protecting them from the rain.
Daughter cares for incapacitate 102-year-old father with chronic bed/decubitus ulcers.

Bad: Dogs uncared for with obvious disease lying around the streets. Children and adults with serious physical disabilities begging on the street.

Good: The most beautiful flowers, well-cared for lush gardens everywhere and many different types of butterflies. Fresh wholesome vegetables easily accessible and always available (mas economico tambíen).

Bad: Children with serious health problems and lack of resources to address them.
I suspect this child is moderately mentally delayed. We care for his brother, burned by boiling water, and this child greets us with the purest of hugs.

This 10-year-old was hit by a car, his leg broken and surgically repaired with metal prosthesis. He was left with large open wounds which Sergio does basic daily wound care. The child is still unable to walk and DOES NOT complain in any way.

All-in-all, I love this place. Just like the US in that we have our 'good' and 'bad' as well.

San Cristóbal de Las Casas is the most charming colonial city Bruce and I had the pleasure of visiting two years ago. It is 7500 ft above sea level, the soil is so rich that everything grows and many visitors (Mexican and foreigners) comment on the various shades of green, the wild flowers and the richness of this area. When returning to Mexico I am in awe of the food as I find beautiful vegetable markets just about everywhere.

This charm offsets the sorrow of many lives here in Chiapas. One learns to detach themselves from the horrific injuries and circumstances that present daily. Although sometimes I have no control over detachment and a pang of sadness overwhelms me momentarily, I am here to help because I want to and if I let the sadness take over, I wouldn't get anything done. I'm not sure how Sergio handles this day-in, day-out.... just a way of life I guess.

Added to our usual patient rounds was a mother with an infant seeking help. This three-month-old Tzotzil infant girl had a unilateral cleft palate and unable to suck properly to consume her mother's milk. The mother took the infant to the local doctor and was told that nothing could be done until the child was two years old. In modern medicine, this is not true. How is the baby to get any food down? Conventional wisdom recommends that these malformations are repaired within the first year of life. Luckily, Sergio's goddaughter Ana, was with us today and explained to the mother that there is a group of surgeons that come annually to do these types of repairs and they are scheduled to be here in September. We'll do all we can to connect the infant's family with this group.

This three-month-old child will fail to thrive as she is unable to suck food from her mother's breast (or bottle). She will need to be fed drop by drop.

Other tragedies include one gentleman that comes to the museo every other day for wound care for his mangled foot from an auto accident years ago. He has a chronic ulcer, uses home-made crutches and he can not work. Another woman shows up at the museo obviously ill as she was pale, bloated and appeared very fatigued. She has one functioning kidney, her face is swollen, her lungs sound congested with fluid, and she has more heart sounds than normal. Her physician told her she needs to get additional studies before he could recommend treatment. She has no money for the tests.

As for "Things you'll most likely never see in the US" is a 30-something Tzotzil man with a parasitic infection of the left foot. This condition has been brewing for 10+ years. A visit to a doctor a few years back included the recommendation of amputation.... which he rightfully avoided. Last year I saw this same man and explained to Sergio he needed a tissue biopsy to identify the culprit of this fungating, malodorous, overgrown foot. The patient has no money nor means or desire to see a doctor. Hence, Sergio does basic/chronic wound care. Upon my return this year, I see the man and his foot is a little bigger and a little worse. Again I explain my concern about a parasite - Sergio continues his wound care. Two days ago I change the bandage and out from this fungating foot came several 1/4-inch tiny worms! Still, what do we do? What is this parasite? Which lab can we send it for proper analysis? There more than likely is a medicine to treat it but where do we get it? Who will pay for all this?

Some days it seems there's a hole that can't be filled. We do what we can with what we have and hope and pray for the best. As Sergio says, "Poco a poco," (little by little) we get things done.

This and all previous posting are from Patricia Ferrer.

Sunday, August 1, 2010

Some things never change

We drove out a long distance to see a young girl with both legs burned and this indigenous cemetery was near her village. The crosses signify the tree of life.

My fifth day here reveals the same traumas I've seen over the last two years since meeting Don Sergio: boiling water burns, gasoline accidents, lower extremity ulcers, dog bites and various ailments that need proper medical attention.

Many people come to Don Sergio's museo complaining of UTIs (bladder infections), arthralgias (chronic joint pain), headaches, etc. They see Don Sergio as a healer although he readily admits he is not. He gives people Tylenol or Advil when he has it and directs them to the appropriate health care facility, however, in many cases it is unlikely they will go.

One patient's home we visit has jugos awaiting for us. For politeness sake we sit for a moment and enjoy the fresh fruit juice of the season in their central patio (always the most pretty and cared for part of the house).

Amidst his giving tours to visitors of his museo for a 35 pesos donation, rhwew ia this constant stream of patients coming. As of now there are few foreign tourista due to the economic recession. However, one recent visitor was his landlord requesting his monthly payment for his museo who recently raised his rent 66%. Paying consistently has always been challenging for Don Sergio because when he receives money it goes directly to the need at hand. This can be anything from a hungry family that presents at his door, medical supplies or paying his driver for patient rounds. Don Sergio has no car and it is much cheaper to have someone drive him around than pay for a taxi every stop along the way.

The colonial homes all have indoor patios, which make so much sense to let the outside inside.... always a lovely site.

Most recently we owe thanks to the IF Foundation for their recent donation to Don Sergio. They are a non-profit seeking hopeful alternatives to end the violence, greed and destructiveness of our world. They're based in Watsonville, California. Please click on the above link to visit their website.

Be forewarned; following are photos of various wounds:
Boiling hot water fell on this young child whose wounds are recovering well.

This elderly man shows up from Ocosingo, a town a few hours away. He has a basal cell carcinoma (not life threatening but it can be if he lives a long time an it is not taken care of). I recommend he go to Tuxtla to see a general surgeon (no Mohs around here) to have it excised. Per Sergio, it is "unlikely he will go", hence wound care and slow progression of this massive tissue destroying lesion.

This girl grabbed my hands, cried and held on as Sergio changed her bandages. Afterward, she's fine. These kids never fight, resist or complain.... they may cry, but they know it has to be done and they know there is an end to the pain.

This patient is the one that seems to suffer the most during his visit to Don Sergio. Changing the bandage is so painful for him as he screams, "¡Me duele!" (It hurts me) but never does he pull back, put his hands in the way, or interfere with application of the wound dressings. In the US, we would never allow a child to endure so much pain.... here there is no choice. When we're done I see sweat droplets on his nose and upper lip and his hair is drenched.