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.

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