Thursday, March 31, 2011

San Cristóbal - It's a Hard Life

March 30, 2011

On my final two days our driver finally shows and we don't have to find and change taxis anymore. When I mention that we have a driver it's not like a limo, but someone who drives us around in whatever vehicle they have. This particular model comes with an extra-large stellated crack on the passenger side windshield with no backseat seat belts and missing a few hubs.

My backpack is kept in a side room at Sergio's museo and the light switch is a little faulty so Sergio decides to ditch the switch. He connects two hotwires to turn on the light.

As we were departing for the day, the mother with her young child from Teopisca came running to stop our car. She brought the child from Teopisca so we could change her bandages. It is quite a trek for her as she had to catch a collectivo (probably a public transportation Volkswagon van) and probably a taxi ride too which could be more costly.

After being here a while you get immune to seeing the military trucks loaded with soldiers and guns. I never know where they're going, what they're doing and why there are so many.

When I first saw a woman street sweeper I thought, "Surely men do this task as well". I made it a point to pay attention and the only employees I saw cleaning the streets or picking up the trash were women, although Bela assured me that men do it to - it is civil service and actually does pay a pension someday. I do like the broom though.

On our way to Nishnamtic we stopped at an abarrotes (grocery store) so Sergio could by candy for the two-year-old boy we're treating. I needed to empty my bladder and it was either this or the road-side option. At least there was an option as there is a beautiful roadside rest-stop between Tucson and Phoenix that is completely closed down.

Coming back from Nishnamtic, we stop and see the 14-year-old. His parents have yet to buy him crutches so he can get around better. They must not have the money so he uses a broom stick as support and hops on one leg for ambulation.

Returning to the museum we see a fresh blob of concrete with the label "Sapam" impressed on it. Sergio explains that the water company turned off the water. He said he's paid the bill but there seems to be a discrepancy and he's tired of arguing with them. They left the large rock they extracted in the sidewalk for someone (me) to trip over.

So, we use a bucket of water to wash our hands and dump water in the toilet to flush. Sergio rents the museum for 5,000 pesos per month. The rent a year ago was 3000 pesos per month: a hiked up price of 60%. It is hard to believe that one can do this knowing that Sergio give so much to the community, but it seems;.. it's just business.

The free range animals are always hungry and have their noses to the ground. It was nice to see this pair taking a rest in the shade.

Life is not hard for everyone in Mexico. Anyone with modest financial security can live a high-quality life in a nice colonial home, maid included. Not all indigenous are poor as they live off the land and food is available most the time (in the good times). They just don't have any money to buy things and they barter instead. In my opinion, it is when people don't have access to an adequate diet, an opportunity for good education, access to clean water and access to healthcare of all types and especially for injuries such as burns or accidents then that is when the poverty reveals itself.

Sergio relieves this stress by going to their homes and providing wound care for them or their loved ones. It is the donations from his museo and donations from those who support his work that allow Sergio to reduce the burden and bring relief and healing to lives of those in need.

If you are looking for a cause to support, Sergio Castro, the Maverick Humanitarian would be highly worthy cause. All funds go to Sergio Castro minus PayPal fees. Any amount is appreciated. Thank you.

Posted by Patricia Ferrer, PA-C.

Wednesday, March 30, 2011

San Cristobal - Its a hard life

March 30, 2011

Chiapas, Mexico, in my opinion, has to be one the most beautiful places in hte I've in

Monday, March 28, 2011

San Cristóbal - Day Ten - The Day of Rest

March 27, 2011

It was a day off for me but Sergio insisted on seeing four patients: the Sister at Hospital de Madres with a chronic venous ulcer, the three-year-old girl with the hand and leg burns, the 14-year-old with the left leg burn and the two-year-old from Nishnamtic.

I took the opportunity to rest and shop. While doing so I ran into a lady I had met a week ago so we sat and chatted for a couple of hours. It was a nice afternoon.

The is the new style of clothing in Zinacantan that Sergio had pointed out to me. This is not the best photo, but look – the base of the skirt is scalloped.

Back at Bela's I ate, checked the internet and am planning my departure for Wednesday.

Sunday, March 27, 2011

San Cristóbal - Day Nine - The Day of Taxis and Pain

March 26, 2011

Taxis. Another day without our driver, we take a taxi to another taxi stand to get a ride to Teopisca, then come back to San Cristóbal, get another taxi to the market to get another taxi to Nishnamtic (that's four taxis). The driver from the market initially said he would take us, then Sergio explained where we needed to go in Nishnamtic and so then he refused. I thought to myself, "Does he know he just declined driving a saint?". I had a bad feeling about him anyway. We hopped out and got another taxi who took us to the village... I trusted this guy.

A taxi driver's rear view mirror ornaments. Presumably a religious chicken lover.

Again the three-year-old girl, exhausted in pain from changing her bandages.

Pain. In the US, in the medical community, we are trained to provide the proper anesthetic/pain relief prior to inflicting undesirable pain for elective and necessary procedures. Bandage changes for burn wounds require pain medication and are frequently used in the US. Here it is not and I perceive that many people feel that you just have to be tough or brave it out for various reasons: 1. Pain meds are not readily available/lack of access, 2. If it were it may not be affordable, 3. The people here are used to enduring pain, 4. The medical community has been influenced by the anti-drug campaigns from the US and are afraid of addiction, so don't properly treat pain.

When it comes to children suffering it is hard to watch a child cry in REAL pain. From the parents and Don Sergio I hear comments that the children just fear their bandages being changed and that's why they cry. They say, "Don't cry, don't cry". They've lived with putting up with discomfort and pain all their lives, why should it be different this time for this child of Mexico? In the US we know much more about the psychological consequences of enduring pain and we're trained not to let our patients suffer, that knowledge and philosophy has not made it down here yet. Nor has the accessibility and affordability.

We stop at the 14-year-old's home to change his bandage. It is much easier to do it outside in the sun than inside the home.

The boy is in obvious pain but does not cry. Sergio gave him 200 mg tablets of ibuprofen yesterday and says take one. I told him to take two and add 500 mg of Tylenol, hopefully it will take the edge off. The boy is not hungry, probably because he is so uncomfortable.

Walking the streets of San Cristobal on my way to the museo.

This boy had about 8% partial first and second degree burns and is almost completely done with the wound care. Sergio says this boy has a strong spirit because he never cried or expressed pain with dressing changes.

When I asked Don Sergio, "Do you have a strong spirit when it comes to pain?", he said, "Sometimes yes, sometimes no".

All posts are my own personal observations and opinions. Patricia Ferrer, PA-C.

Saturday, March 26, 2011

San Cristóbal - Day Eight

March 25, 2011

The day begins with juicing three oranges which yields one large glass of orange juice. This is much better than pouring it out of a plastic jug.... I love slow food.

Our regular driver has not shown up the past couple of days. This happens at times; some days he will be there everyday and others he won't. So we take a taxi to the market to find another cheaper taxi to go to Nishnamtic.

The drive through the country-side is beautiful, here we see a family herding their sheep.

Our taxi driver is a young man in his early twenties and I hear him asking Sergio many questions. I enjoyed the conversation and his curiosity about Don Sergio as Sergio explained matter-of-factly what he did.

We saw the two-year-old with the hot liquid burn and he tolerated the dressing changes well.

A group of onlookers were behind us whispering amongst themselves. Several scamper away as I pull out my camera to take a photo.

This is a photo of the part of the family's yard. In a Mexico history book I had read, "The man who farms the land owns the land."

Back to San Cristóbal, we see the three-year-old and quickly do our work. The child tolerates all dressing changes well until we get to her left hand and arm. Bandage changes are always done without pain medication as we have none.

Making our rounds through San Cristóbal we saw four more patients and called it a day. We were both so tired today we kept falling asleep in the taxi ride back from Nishnamtic.

Later, back at the museo a few people trickle in and out and our patient load is light this evening.

This young lady who gladly poses for this photo came in last week while Kieu was here. After a history and physical exam and we recommended lab tests which yielded the cause of her complaints. Today she brings the results in and we put her in the right direction for the medical care she needs.

Our last patient of the evening is a 14 year old with a circumferential burn of his left lower leg that happened the day before yesterday. His parents took him to the Red Cross where they gave him an antibiotic and ibuprofen. At this point his wound looks like a superficial second degree burn caused by boiling hot water from a broken ceramic pot.

Between patients with down time, I browse through the museo and I have the luxury of getting my own private explanation of certain pieces. This old pot was made for a fiesta and held atole, a liquid grain breakfast food. After the festival, corn is stored in these pots. Sergio took care of a burned child and the father saw that Sergio admired the pot and gave it to him.

Sergio said this mask is made out of cartón (cardboard) and found it years ago in place he can't remember.

Friday, March 25, 2011

San Cristóbal - Day Seven

March 24, 2011

Yesterday after the morning rounds there was a man waiting on Don Sergio's museum steps. He explained that his two-year-old son had been burned with boiling coffee eight days ago. This will make three children under the age of four that we will be caring for.

Today, the man met us at the museo at 9:30 this morning to take us to a community called Nichnamtii, which is about a 30- 40 minute drive.

As we were leaving San Cristóbal we were halted by a parade and many children were dressed in costumes.

Nichnamtii is on the road to Tenejapa at a higher elevation. It was a bit cooler, more green, and there are more crops and small villages dotting the landscape. This is a cemetery in the style of the local people. Tall trees around the blue Mayan crosses (that are pre-Hispanic) and signify 'the tree of life'.

This is a drive-by photo of the local school children.

I have photos and a video of this two-year-old but they are a bit graphic so I will put them on a powerpoint or video link at a later date. It turns out most of his right leg from his thigh to ankle were burned to the superficial dermis. It appears that 13% of his body surface area is a first and second degree burn.

These are the women of the house of the two-year-old. They walked us outside and gave us many thanks for helping this child.

As we left their home I saw a man and two women preparing the soil for planting.... was this what it was like in the US before WW2?

Returning to San Cristóbal we saw our usual patients and afterward I met Bela and Sheri for lunch. Sheri is a guest at Bela's and is an expert in Mexican textiles and lives in Oaxaca. Her website explores the traditional textiles of Mexico and she highly recommends going to Don Sergio's museo. Her website is Living Textiles of Mexico.

As usual we had a tasty lunch – we went to a restaurant called La Canela. A close up of Sheri's quesadilla: home-made blue corn tortilla with potatoes and chorizo and a small pasta salad with small chunks of apples (not in photo) . My quesadilla had nopales and mushrooms with a just enough cheese. So yummy!

Back to the museo at 4:000 pm and the psoriasis patient had returned and said he was doing much better, however, he complained of a few annoying problem areas. It is difficult to explain that the medicine can take up to two weeks for best improvement and it had only been three days. Since all we had was weak topical cortisone I used the poorman's treatment of applying the cream to the bothersome and thick areas and occluding it with tegaderm (a cellophane-like tape). He will on return on Monday and I will have to explain again, this is not curable but we can try to control it. The sun is strong here and it would help his psoriasis but he is resistant to that idea.

Shortly afterward the patient with the hugely parasitic infected foot I saw six monthw ago came in. I did a biopsy and took him to the lab for blood work. I'm hoping we can find what ails him. He saw a physician a few years ago and was offered amputation of his leg which he declined. This has been present for 12 years.

I have better clinical photos which are to grotesque but this one gives you the idea of how this infection is deforming his foot.

Two blocks from the museo is a laboratorio. The patient did not speak Spanish but he had an interpreter with him. I explained the need for blood work and that I would pay. The lab tech and I soon discovered his interpreter spoke limited Spanish so we spent 20 minutes explaining what needed to be done. Once he understood he agreed. Notice the tech not using gloves: this is not unusual in Mexico.

With that taking up most of the evening, when I returned the women from the day prior were there. Kieu left her tennis shoes and socks for the girl with scleroderma as her feet get cold and painful. Many of the locals wear cheap plastic sandals and I admire the ability to do that but in this particular case, the girl would benefit from shoes.

It was a long day and I was in bed by 9:30..pooped.

Thursday, March 24, 2011

San Cristóbal - Day Six - Observations

March 23, 2011

To follow are observations of women in the indigenous culture and it seems basically they work all the time. Three years ago when Bruce and I drove through Mexico, we commented on how the women did quite a bit of heavy labor. We know men are stronger physically but we saw women (young and old) carrying wood on their backs, a young girl balancing a tree trunk on her head carrying it uphill, women tilling the land, minding the sheep, shearing the sheep, spinning the wool, weaving the wool, then carrying and selling their products with babies strapped to their backs. I'm assuming they do all the cooking as well. We did see some men doing the labor but not as prevalent as the women.

Young girls getting water. There is nothing wrong with working hard but the balance of work between sexes may be off kilter favoring the male sex.

Women doing laundry the hard way.

Sergio showed me photos of building a water filtration system which basically the walls are made of concrete blocks and mortar. Here the women mix the mortar. My father did some masonry work and we, as children, mixed concrete in an electric concrete mixer.

Fortunately, my father did not make us carry concrete blocks on our backs, with no shoes!

At the museo over the last four or five evenings there has been a young lady, sitting to the far left and her friends sitting to the right, bring me gifts of food and a new patient (always a woman) from there village. It is likely these women would not otherwise seek medical consult. The patients are in their indigenous garb and she translates from their native tongue to Spanish. It makes me happy that this young woman is an advocate for the women of her community.

Sergio informs me that the women do most of the work, it is their culture and jokingly says (I think jokingly) the men are "to think".

This 70 year-old-man carries his own bag uphill.

I'm glad to inform all that Kieu made it back home to her family safely and we already miss her!

Wednesday, March 23, 2011

San Cristobal - Day Five - Kieu's Last Day

March 22, 2011

Our first stop of the morning was a three-year-old girl that was burned a month and a half ago. Evidently, she was playing near a burning trash fire with a friend and fell into the fire. In our minds we may think, "What was she doing near the fire playing?". The trash pick-up infrastructure is not the best here and the family may have limited land on which to burn their trash, which is fairly typical here, as it is in rural USA. This photo depicts the first time she is able to walk after the accident.

True to my word of not displaying more clinical photos, I want to explain the extensiveness of her injuries. The palm of her left hand is a deep 2ndº burn, Sergio is concerned that her hand will heal contracted palm-side and she will lose a significant mobility. Both of her dorsal feet (top side) have second degree burns as does her left inner arm. The areas with 1stº burns are healing well and she will recover well, the other areas will take more time.

While at this home, other relatives knew we were coming so they bring us a baby that is crying, not eating well and appears cranky. Kieu is great with babies! She evaluates lungs, abdomen, eyes, throat and find the baby has otitis media (ear infection).

There were two men talking with Sergio after we saw the babies so we decided to take a mini-break.

We made it home by 12:30 pm – a good hour and a half before lunch. Kieu sat down in the dining area to read and quickly fell asleep. She is learning the way of the Latin American life: the siesta.

Manuela made pollo borracho (drunken chicken) for lunch which was perfect for me as I was not feeling well. Kieu as usual asked for seconds.

Today is Kieu's last full day with us as she departs tomorrow. The quality of this trip is due to many factors, the major factor is Bela. Her B&B is like a home that you feel like you've known forever. She treats her guests and staff as family which gives an ambiance of peace and comfort.

Back at the museo at 4:00 pm we had few patients. Since we had time to kill Sergio showed us some artifacts and items that most people do not see or recognize. He told us he found many things as he searched for water sources to build water treatment systems for various villages. There are many facets to this man and this private tour and explanation was a great treat for me and Kieu.

A group from San Miguel de Allende of mostly US citizens came in for a tour at 6:00 pm. Kieu and I saw a few more patients while he gave the tour and I ran back to Bela's to get more DVDs of "El Andalon" to sell. A friend of the director, Consuelo Alba, had bought and donated several DVDs and the proceeds of the sales go to Sergio. Kieu and I were so excited to speak (in English) to the tour group about Sergio. The wife of one man had to finally break him away from us.... of course I could have gone on and on!

Our day ends around 8:00 pm. I was not feeling well so Kieu heated up some pozole (hominy soup with pork) and toasted bread before going to bed. She and I hugged and cried in celebration of this unique experience we both have had together this past week. Unforgettable!