Monday, October 31, 2011

Monday October 31, 2011

31 de octubre

An ordinary day seeing the 90-year-old woman with the left calf burn, the big man with a healing injury to his left leg and the chronic ulcer patient that refuses compression even though it would help heal the ulcer mas rapido.

The evening clinic was packed and I had to leave to find a laboratory that would give me a culture media to culture the Zinacantan woman's foot that looks (and smells) like there is a deep possibly necrotic infectious process. I'm not sure culturing it would help as I think the patient needs to go to the hospital. Sergio has cleaned her wound so well that the patient actually looks better. It would be miraculous if he succeeded in saving her foot. Many of the indigenous are resistant to go to the hospital: they would rather die than go. It is a hard observation to swallow but Sergio knows them well and accepts it and does the ABSOLUTE best he can to help. Hence, we will start her on oral antibiotics pending the culture..we'll see.

I was assured by the lab technicians this is what I needed for wound culture and sensitivity... 200pesos ($15USD).

Upon returning a couple of other sad cases were waiting. There is a young man in his early 20s that had an on-the-job injury to his left leg fracturing it severely over a year ago. It was surgically repaired but he continues to have an open wound – with the tibia (bone) exposed. Kieu and I saw him six months ago (see previous blog post). The granulation tissue around his wound had healed but has left a 1.5 x 2.0 inch of exposed bone. Before returning to San Cristóbal I showed this case to wound care specialists Drs. Bolhack and Quick in Tucson and they both agreed the patient has osteomyelitis. This is so hard to treat: the bone is infected, it needs to be debrided and probably grafted. The patient may have to be on antibiotics for a very, very long time. Ay, what is one to do? I mentioned my concerns to Don Sergio and he will find an x-ray facility he trusts and send the patient. In the long run this does not look good.

The second sad case I saw briefly as I was with another patient. This was a Chamulan woman who is missing her fingers on her left hand and has a severely burned right arm with some finger contraction on her right hand. The burn is almost healed as there is only one area that has exposed granulation tissue on the right forearm. In the US: skin grafting, surgery to correct the contractures, physical and occupational therapy. Here, she's lucky to have Don Sergio.

It is hard for an American woman to grasp just how second class women here are treated – even third class. This is a perfect example of how women are trained early on to do the most of the hauling/work.

There are so many sad cases here in Chiapas and the trust people have in Don Sergio is impressive. Many have chronic conditions that he can't possibly treat but because of his reputation with burns and wounds they think he can do anything. He's savvy and knows when to refer or if conditions are out of his realm of knowledge. I think he'd rather stick with burns and wounds, this is what he's come to know best. Habitantes de San Cristobal are lucky to have him. We were done by 6:30 pm so we headed home.

Posted by Patricia Ferrer.

Sunday, October 30, 2011

Sabado: Day of Rest

Sabado 30 de octubre 2011

With the clocks turned back all in Casa de Bela were happy with an extra hour to sleep in. Kathleen and Susannah (curly blonde in dinner photo) went to the well known pottery community of Amantenango de Valle and Teopisca. They returned several hours later with a few cute straw-woven baskets for the museo clinic and a few painted pottery souvenirs.

Bela and I stayed at home and read and relaxed. Around noon, Bela took me to the market and plastic stores so I could buy better containers for Sergio's medical supplies. In the US we take it for granted that plastic items are so cheap. Here, imports are expensive and locally grown healthy food is cheap.

This is what 375 pesos will buy (~$30USDs)....I think it would have been less than $15 USD at Walmart.

Bela wanted to do some shopping for her Dia de los Muertos alter so we split up after she oriented me with the four different plastic stores. Walking through the market gave me the urge to shop but I was on a mission as was determined not to stray.

Bela preparing her alter.

The weather in San Cristobal at this time is perfect: crispy cool at night and in the morning and solar warm during the day. Bela's garden attracts many butterflies, bees, and large hummingbirds.

Posted by Patricia Ferrer.

Saturday, October 29, 2011

Saturday October 29, 2011

October 29, 2011

It rained last night and streets were slightly slick so we tried to flag a taxi as we were running late to the museo. The taxis were all ocupados so I walked on while Kathleen was able to finally flag one down... we arrived at the same time.

Two female patients (non indigenous) were waiting at the museo when we arrived. One had a back problem from falling down the stairs four years ago and still had neck and back pain. It did not help that she was wearing four-inch stiletto boots on a regular basis, which we informed was contributing to the chronicity of her problem. Kathleen worked on her while I organized the new clinic room. We still have to buy small boxes to properly organize and store the supplies.

This field trip our first stop was on the fringe of town. Everything is relative and San Cristóbal is no different. We found our patient who lives in a shack with her son who, Don Sergio explained, is mentally challenged. The patient, a 90-year-old woman, fell asleep by the fire and her wool skirt caught fire and she burned 40% of her calf – deep 2nd degree. She did not bother to tell anyone of her injury until one month later. She does not speak Spanish and Don Sergio spoke to her in Tzotzil.

The patient's home shown in this photos is typical of the poor and why they are so many burns. The proximity of fire to indoor activity is because many people can not afford proper or safe housing. The tarp is the roof, the dirt is the floor.

An altar made for the Day of the Dead on November 2, when people remember and celebrate with their departed. The 1st of November is Day of the Innocents - for the departed children.

We made a few more house calls and walked back to Bela's. A hotel along our route had a beautiful Dia de los Muertos display (above).

The evening clinic had a moderate amount of patients even though it started drizzling. Usually the patient flow is decreased with any precipitation due to the side walks becoming slippery. The baby from one of the poorer parts of San Cristóval was brought in by her mother. I found it interesting that there was one place left to sit, so the father of the child took the seat and let the mother holding the baby stand. Women are treated differently here.

Once the clinic cleared out a three people came in for a tour and Kathleen was able to be part of the group. He then showed them other rooms displaying children's trajes (outfits). I did not know he had these. He's change quite a bit in the museo and has organized his collection.

Kathleen walked over to Emilio's Mustache with the three visitors while I went back to Bela's to change clothes. Bela and I, Susannah and Jim (fellow Texans and Bela's guests) walked to the restaurant and found Kathleen with her fast-made friends. We had some of the best tacos in town with those freshly made tiny tasty tortillas. ¡Provecho!

Sergio is grateful to all people that help support his work. He wanted me to be sure to thank the teenagers from Glenbrook HS and their teacher, Ms. Reyes, for their fund raising and donation earlier this year. We will find frames for these photos and will proudly display them in his museo.

Posted by Patricia Ferrer.

Friday, October 28, 2011

Back to Work with Don Sergio

October 28, 2011

Our morning started off waiting for Don Sergio at his museo with a patient with his father and grandfather from Amantanango de Valle. They drove an hour for the son, Maurice, to have his bandage changed.

Sergio arrived on time and entered the museo to do the bandage change. This eight-year-old child's injury occurred when the family was burning trash and he was near the fire. Four months ago the child was standing by the fire and a wind whipped up and burned his left arm, left abdomen and chest. These were superficial and deep 2nd degree burns that are now well healed but will leave him with permanent burn scars. There is one area on his left abdomen that is a bit slower than the rest probably due to the depth of the burn and the natural mobility of the stomach expanding and contracting. Originally the patient went to the hospital in Teopisca and stayed for two days with no proper bandage change. A female doctor told the parents to take the child to Don Sergio. Sergio said the burns were cleaned but very dry. After four months of care the child is doing well.

Thanks to Maricopa Burn Center and Pongratz Prosthetics, the donation of the burn garments are put to good use for Don Sergio's burn patients.

Afterwards Sergio showed me the room he made (he says for me) but obviously its for the patients. Previously this room stored extra artifacts and supplies. He cleaned it out, put a partitioned wall, painted the walls and brought in a work table, shelf and a bench: a model clinic room. He feels this will be better for the patients who prefer others not see their injuries.

The new clinic room Don Sergio made. Thank you all for your donations!

After unpacking and sorting we were off to a poor part of San Cristóbal to see a eight-month-old baby that had been burned with boiling coffee on her right arm, abdomen and right leg 12 days ago. These appear to be 1st degree burns as the child's skin is closed and just fresh pink now.

The stairs we had to climb to get to her home.

The way up included rock climbing.

Our next patient was a lady I had seen six months ago while here with Kieu. She had (and still does) profound lower leg ulcers that are healing slowly. She is quite resistant to compression and Sergio is challenged by this, but he continues to provide care as there is improvement. Kathleen showed her some lymphatic drainage techniques the patient can do and we hope this will help.

Our last patient of the morning was a very large man with a healing full thickness injury to the left lower leg. This was quick bandage change but it may take another month for his wound to close.

"Libre," as Don Sergio would say. This means we are free until 4:pm: that's when we have to be at the museo. We returned to Bela's for Manuela's comida especial, mole colorado, sopa de pan (bread soup) and a unique tasty desert - zapote negro (black zapote fruit).

The afternoon started at 4:00pm and Don Sergio's museo was full with patients. Kathleen (who is physical therapist) worked on a 17-year-old woman who reports her left leg started twisting inward since she was four years old. She had gone to a curandero (healer) who used hot herbs on her knee and leg and left her with significant scarring. She had no concern about the scarring but wanted to know what she could do about her knee and leg. Unfortunately, it seems her leg has been in this shape for so long that training her to do PT muscle exercises may not yield the results she is looking for. She could benefit from a brace that would give her support in addition to engaging muscles that need to be strengthened. This is a challenging case.

Sergio and I saw the burn and wound patients. The saddest case I'd seen in a while... well, since this morning, was a 45-year-old Zinacantan woman with her right foot that appears to be gangrenous. She has uncontrolled diabetes and appeared ill. When I removed her bandage, the smell was so bad the waiting patients scattered widely as if someone lit a fire cracker. We should have taken her in the new room but Kathleen was using it for another patient. Her foot was so swollen, infected, malodorous and weeping that I could not see how we'd be able to help. I whispered to Don Sergio, this patient needs to be admitted in the hospital, get IV antibiotics and get ready for an amputation. He said she's been told and she won't go, she's been there and they recommended amputation so Don Sergio as her last resort. He will try to convince her again. The challenges here are mind-boggling. This is an example of the faith people have in Don Sergio. He knows when to send them to the hospital but the continue to come to him.
Sergio's museo clinic was a full house. (Patients faces are blotted out for privacy reasons.)

We had various other minor wounds (in comparison to the Zinacantan woman) to see and our last patient was a young man who had a tattoo on his right arm. He worked for a local company and they told him he could not have tattoos. Tattoos are looked down upon here in Mexico as many people perceive you are part of a gang (it is difficult to get a job with tattoos). This 20-something-year-old male applied a gel that would help him get rid of his tattoo. The tattoos are gone and now thickened unsightly scars. The gel he used probably caused deep partial thickness wound and possibly full thickness. He's lucky he healed this well.

At 7:00pm the museo was quiet, patients were gone and there were no tourists. Our first day of work was very busy and I was glad to see Don Sergio in good spirits and well rested. His energy level is impressive... for a 70-year-old. Tomorrow we start at 9:15am.

Posted by Patricia Ferrer.

Thursday, October 27, 2011

Arrive in San Cristobal

October 26th and 27th, 2011

Wednesday was an ‘in-transit’ day that was very long: a taxi to the SMA bus stop, a one-hour bus ride to Queretaro, then a three-hour bus ride to Mexico City airport, a one-hour 15-minute plane ride to Tuxtla Gutierrez, then a one-hour taxi ride to San Cristobal (8:30am-8:00pm). We arrived at Bela’s Bed and Breakfast around 8:00pm pooped. We made it to San Cristóbal without problems and with all the supplies.

Bela’s place is as charming as it was when I walked in over a year ago, like a home away from home. Today, Thursday, is a day of rest for me and site-seeing for Kathleen. Our work day begins in la mañana por la mañana (tomorrow morning) when we will meet Don Sergio at his museum and start seeing his patients.

No photos today, there is a problem with uploading, will add tomorrow.

Posted by Patricia Ferrer

Wednesday, October 26, 2011

Sergio and Elsa in San Miguel de Allende

Tuesday October 25, 2011

Animated Don Sergio chatting with Ivan.

We all made it to San Miguel de Allende. Kathleen and I met Mary and Ivan at their home where they were hosting Don Sergio and Elsa. After visiting for a couple of hours we met Consuelo, John, Betsy, Jane and the Vice President of Patronato Por Ninos at their clinic. This organization was started 40 years ago by one woman and has become a primary care facility that works with the Mexican government providing care for children. If they cannot provide the care the patients need (specialty services) they find a way by outsourcing care for their patients. The work involved to get this organization where it is today has been tremendous and the children of the SMA area benefit.

A visit to Patronato Por Ninos.

Afterwards we went to El Mirador: a vista in San Miguel. We ran into Consuelo’s parents who were on a tour and just happened to stop at that same place. In two taxis we went to back to Mary’s for comida (lunch). This was a time we all had a chance to visit with Sergio and Elsa and see how we can continue to help support his humanitarian work.

The group at El Mirador. Left to right: Consuelo (director El Andalon), Betsy (My Mexico Tours), Don Sergio, Elsa, me, Jane, Consuelo's mother, Consuelo's father, Kathleen.

After comida, tres leches cake for Don Sergio and Elsa.

The showing of El Andalon started at 7:15pm. Afterward Consuelo, John, Betsy and I went up on stage for questions and answers while Mary and Ivan added information about Don Sergio and the people he serves. Many wanted to know, “Who is going to continue his work after he’s gone?”, “Who helps him with the schools?”, “Why doesn’t the government help these villages with the schools?”, “Why are there not medical organizations from the US coming to help?” We've all had these questions and there are no easy answers. This maverick humanitarian has the trust of the local people of San Cristóbal because he's answered the call when they need help.

The most important question: “How can we help?”. This is a typical response after seeing the film. Our answers were: buy the DVD (proceeds go to Don Sergio), show it to your friends, donate, and join our team in bringing awareness about his work. (Please contact me here if you are interested in helping Don Sergio in any capacity.)

Finally, Consuelo and John had the pleasure of introducing Don Sergio and Elsa. The audience stood in awe, many were to tell me later, “I felt like I was in the presence of a saint”. They were, and so were we. Sergio, in his humble manner, thanked us, Elsa, and everyone for coming and their support and invited all to San Cristóbal. He said his gift is to help people and his humanitarian work is why he is here on this earth.

We stood in the foyer of the theater answering questions as Mary, Ivan and Don Sergio quietly went home. The theater employees finally had to brush us out the door. We ended up across the street to sit and chat with each other and visited until 11:pm and then slowly walked to our respective hospedajes (lodgings).

Tomorrow Kathleen and I bus it to Mexico City to catch our flight to Tuxtla. Sergio and Elsa will stay in San Miguel and there will be a display at the library of Don Sergio’s textile collection where he will be present and answer any questions.

Today felt like two days in one it was so busy and productive. Mary and Ivan did an incredible job organizing the event and our host Louise made our stay very comfortable. After being here two days I can see why people live here: the climate is cool in the evening and warm during the day, the plants lush, the activities many, the aesthetics of the city impeccable.

Posted by Patricia Ferrer

Monday, October 24, 2011

Monday October 24, 2011 – San Miguel de Allende, Guanajuato Part II

In Transit to San Cristóbal

Part II

Up at 3:30 am and Bruce got us to the AZ Shuttle stop to catch the 4:30am shuttle to Sky Harbor Airport in Phoenix. Our flight arrived in Guadalajara on time at 1:50pm. This is where my nervousness kicked in. We have all these medical supplies and I’m always concerned the bags will be searched and confiscated. I had documentation for our legitimate charity support, that these donated items are expected by Don Sergio... all in Spanish... but I'm never sure if it will be enough. When one is carrying many items of the same thing, customs might think you are bringing things to sell under the table. I tried to relax by telling jokes to Kathleen.

The Guadalajara customs is a bit more sophisticated than the tiny Tuxtla Gutierrez airport that I'm used to. They x-rayed all our bags and of course started asking questions like, “What’s in your bags?” I explained our purpose and showed my documentation. Most of the customs people were women and seemed interested in our reason for coming to Mexico. One mature customs official, a man, came over and started asking questions. I showed him my documents and he was the only one that read them. As he looked through our bags a young fellow walked up and barely looked through our papers and started telling me I should not bring these items to Mexico without the consulate's permission (I was later to decipher). He was stern and I thought he was going to confiscate it all. Fortunately, the mature man intervened and brushed off the youngster. Once they went through two of our four bags they let us pass... but not before we pressed the red light/green light button.

In any Mexico customs you have to press a button and a light that's like a street light comes on. If it is green, that means pasa le, go ahead through and you won’t have your bags searched. If it is red, that means stop and all your bags are going to be searched.

I pressed… RED light. Kathleen pressed…RED light! The customs people laughed and went through all four bags and then our personals. I smiled and giggled… for some reason the whole thing was funny. Kathleen, la gringa, held the smoothest poker face you’d ever seen! The power of my mother’s prayers is astounding, no?! Getting through customs was my biggest concern.

Baggage tightly packed and through customs!

Our baggage was collected by a maletero and got us to a taxi and off we go to Central Camionero (main bus station) to catch an ETN bus to San Miguel de Allende. We knew there was a slim chance we’d catch the last bus going to SMA but we had good mojo with us today and we bought the last two seats and the bus was leaving in 15 minutes!

It was a long bus ride and Kathleen and I had to take separate seats; she was up front and I was in the back. Close to the end of our journey I chatted with a young lady from Poland who was visiting Mexico and on her way to the city of Guanajuato. She gave me a good history of Poland and told me that this was her first trip to Mexico. I told her about our trip, Don Sergio, Chiapas, and its beauty. It sounded like she's on a fairly small budget as she's staying in hostels. To my surprise as she gathered her things to get off in Guanajuato she gave me 100 pesos to donate to Sergio. I don't know why but I'm always amazed at the generosity people show spontaneously.

This is not your Greyhound bus... comfy luxurious bus! Five hours to San Miguel.

We arrived in San Miguel safely by 8:30pm. A nine-year-old malatero gathered our bags and took us to the taxi row. The next driver up saw our bags and had a face of "You're kidding... all those bags". I asked if he could take us to our hosts' house and without enthusiasm, "Si quepan," (if the bags will fit). I saw the other taxis and all were tiny cars. We made the bags fit and I had to half sit on Kathleen's lap. We arrived at Louise's house (our kind host) and she had a turkey salad waiting for us. We chatted with her and her friend Leslie and felt right at home. She has a charity, Casita Linda, that she is devoted to that is similar to Habitat for Humanity... again, there are many kind people in the world helping others.

The garden at our host's house in San Miguel de Allende. When I see homes like this I wonder, why we don't live in Mexico.

Posted by Patricia Ferrer

Monday October 24, 2011 – San Miguel de Allende, Guanajuato

In Transit to San Cristóbal
Part I
After several months of planning this sixth trip to San Cristóbal – el viaje a San Cristóbal – and we are finally on our way. This last week of packing the medical supplies has been more challenging than ever. Comrade, Kathleen McLoughlin, a physical therapist and fellow Clinica Amistad volunteer, is accompanying me this trip. We have trimmed our each of four unsightly suitcases to just under 50 pounds… a feather will tip the scale into the higher checked baggage range.

Ninety six tubes of triple antibiotic donated by my Mom!

Supplies before packing.
First Stop: San Miguel de Allende
This trip to Chiapas has a side stop in San Miguel de Allende, Guanajuato. Avid Sergio Castro supporters Mary Murrell and her husband Ivan have put together a fund raising event to present Sergio’s humanitarian work to the residents of San Miguel.
The producer and director of the film, El Andalon, Consuelo Alba and John Speyer will be in attendance as will be Betsy McNair, owner of from My Mexico Tours and her friend Jane. And, to my extreme surprise, Don Sergio and his wife Elsa will be there! I once asked Sergio if he would be interested in coming to the US and he flat out said he cannot leave San Cristóbal. This has to be Don Sergio’s first vacation in decades, if ever.
The documentary about Don Sergio, El Andalon, will be showing at the Angela Peralta Theater in SMA October 25th, at 7pm. Tickets are $150 pesos (~10.30USD). On Wednesday, October 26th, Mary has arranged a reception exhibiting some unique textiles from his museum. This will be in Sala Quetzal at 7:15 pm and tickets are at the Biblioteca box office for $250 pesos. Profits go to Yok Chij, A. C. which supports Don Sergio's work. Don Sergio will be in attendance for both.

Tucson Friends

Jim and Carol from Tucson.
Since my last trip in May I’ve had the pleasure of meeting two wonderful people: Carol and Jim who love everything about Mexico. They have kindly shared their support for Don Sergio after seeing El Andalon, which was shown to them by their friends Janet and Barbara. Thanks to Betsy McNair, who corresponded with Janet, I sent them a copy of El Andalon and a circle of kindness has been created. Carol and Jim live close to us and Carol, a retired Spanish teacher, has given her time generously with Spanish lessons for me. I am spoiled with one-on-one classes in her Mexican style home. Thank you Janet, Barbara, Carol, Jim and please tell your neighbors thank you por el apoyo también (for the support).
Janet and her sister Barbara.
Our neighbors, Sue and Jerome always make it a point to come by and give a donation for Sergio days before my departure. !Muchisimas gracias!

Our neighbors: The Kings!
Thank you World Care
Again, the success of this trip is in great part due to World Care, a non-profit organization that is basically a recycling center of much needed goods (medical, educational) for third world countries. The medical supplies we are taking have been carefully collected over the last six months. Not everything we need is available at one time so multiple trips have to be made. Lisa Hopper’s staff (referred to as the "Pats" – there being five Pats there, Bernadette, and the gang) have been incredibly helpful in putting aside items they know only we would need and holding them for me. Their supplies and support are invaluable for Sergio and his patients. They also provide supplies for Clinica Amistad. If you live in Tucson and want to donate locally, check out World Care!
This summer and fall I was able to see first world burn care given at its highest standards. I spent two days at The Maricopa Burn Center in Phoenix with the help of their outreach educational nurse, RN Suzanne. Their staff is very supportive in helping to educate providers that go abroad and that are abroad. This is Arizona’s only verified burn center and the quality of care they provide is outstanding. Depending on the extent of burn injuries, when these patients are all admitted a long-term relationship is established. All aspects of burn care are addressed: pain control, proper bandage changing, fluid control, social work, diet, physical therapy, occupational therapy, immediate and post burn surgeries (grafting, burn scar corrections, etc). This has put a light on the limitations Don Sergio faces daily due to lack of resources, however he provides the basics which is better than nothing.
There are two wound care centers in Tucson and both offer top-notch care for chronic wounds – the same type of wounds Sergio encounters daily (diabetic ulcers, venous stasis ulcer, injuries etc). Dr. Quick at St. Mary’s and Dr. Bolhack at NW Medical shared their knowledge and the importance of basic healing techniques of chronic and recalcitrant wounds regardless of pricey dressings. This training helped me to know better how to choose the items needed; hence I could order more items that will yield greater benefit to Sergio’s patients. Although in Chiapas we don’t have half of what we need, their shared skill is very helpful.
Gracias a mis padres (A thanks to my parents)
I always sense concern from my parents when traveling to Mexico. Both parents were born in the US and Spanish is their first language. They’ve heard all the unfortunate stories and problems in Mexico from their parents. As a young adult my father made a trip back to Mexico and experienced firsthand the truth of some of those stories. I wish they could see and experience the true beauty of Mexico and their people, in spite of the problems. Their concern is not without reason, but we are careful and safe, and their prayers and blessings are gratefully appreciated.