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.

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