Thursday, November 10, 2011

Amigos del Andalon

November 17, 2011

This trip has solidified a group of people that are highly motivated to help Don Sergio. Our meeting in San Miguel three weeks ago was the first time some of us met face-to-face even though we've been corresponding via email for a couple of years. The common denominator of our connection is that we are deeply inspired by Sergio Castro's tireless humanitarian works.

We call ourselves Amigos del Andalon and our mission is to help Don Sergio continue his humanitarian work.

If you are interested in helping in any way, please feel free to contact us via our respective email address below.

Amigos del Andalon
  • Mary Murrell, PhD, resides in San Miguel de Allende and has known Don Sergio for more than three years. She is the main contact for fund raising and arranging group donations.
  • Consuelo Alba and John Speyer, Veremos Productions, are film makers of El Andalon which has won several awards and is still on the International Independant Film Festival circuit. The film is available at Amazon El Andalon.
  • Betsy McNair, owner of My Mexico Tours and avid lover of Mexico, met Don Sergio in the 1990s and has lead numerous tour groups through Mexico and includes a tour to Don Sergio's museum. She introduced the film makers Consuelo and John to Don Sergio.
  • Patricia Ferrer, MPAS, PA-C. After meeting Don Sergio in November 2008, I travel to San Cristobal semi-annually bringing medical supplies and working along side this maverick humanitarian. See this blog.

Wednesday, November 9, 2011

Beautiful San Cristobal

8 de novembre 2011

Sergio and I with taxi driver Jose Luis. Kathleen ended up using Jose Luis' services and we liked him so much he became our regular driver.

We had a new house call to see today. The daughter of a 78 year old man had met us at the door of the museo to take us to her home to evaluate him. His significant water retention in his lowee legs and poor eyesight lead me to believe he probably has diabetes. His wife said no, his last visit to the doctor was for joint pain and was given a strong anti-inflammatory which helped but I don't think he was checked for diabetes. Per the patient, the doctor said there was nothing else that could be done. The patient developed a superficial abrasion on his left foot which we cleaned an dressed, however we could offer nothing for the swelling, other than he elevate his legs.

On the way to see other patients we stopped by a building to inquire about the cost of desks for Don Sergio's most recent school project, Vista Hermosa. The store was located in the more industrial side of San Cris next to a mechanic shop. These desks are basic but will do nicely for the students. All we need now is the funding to buy forty.

Two more patients later and I was free for the day, until 330. Bela and Manuela had a celebratory final luncheon ready at 230 that was delicous: empanadas, green beans, home-made salsa and jimiaca.

There is a local dermatologist that comes to San Cristobal on certain days that I've been wanting to meet to take our patients that needed biopsies for diagnosis. I finally met him today and it turns out he does not do biopsies: he sends the patients to Tuxtla where, from what I could understand, a dermatopathologist does the biopsy. This seems odd to me: a dermatologist that does not do biopsies. Such an inconvenience and expense for the patient for something that can be done so simply.

The evening clinic was light and only chronic ulcer patients showed. The oldest of the two Zinacantan women did not show. Yesterday she looked ill and the new cough she developed did not sound good. I hope she's in the hospital.

Ana, who is interviewed in El Andalon, is one of Don Sergio's god children (one of many). Occasionally she will come to help Don Sergio and try to get supplies for him. She came by tonight and I was so happy to see her. Ana stayed and visited with us as long as she could but had to go home.

Two guests from Bela's and a few other people from a local language school showed up at 530 for a tour. Sergio was ready to get on with his tour as he had another large French group coming at 630pm. The owner of the language school La Casa en el Arbol is a young woman named Nadia from Italy that I met her 3 years ago. Nadia was the one that directed me to Don Sergio. I was only able to connect with her briefly a year ago but today I had a chance to catch up with her.

My camera flash quit working. Nadia, me and Ana under dim lighting in el museo.

Nadia explained to me how she's been here for 7 years and she still has so much to learn about the people, cultures, history and life in this area. She still travels back to Europe but when she returns to San Cris it feels home. There is something magical about this place: walking the streets, seeing the different ethic groups of Mayan people, the food is fresh, the aesthetics of the churches, the plants, and the surrounding mountains. Her appreciation for Sergio museo was obvious, Nadia quietly looked around and said there are many signs of the history and people from this area.

It was late by the time the French group left and there was a group of young volunteers with a local NGO that had joined the group for a tour. They hung around for a bit and I could tell Don Sergio was ready to lock the place up. Don Sergio and I said our good-byes and as usual he thanked me and Bruce Lee (mi esposo en Tucson) for everything. My heart was heavy in the morning as we started our day and I was not ready to leave him with the daily heavy load of patients. By the evening I knew it was time to leave, get home and plan the next trip.

More photos:
My sister request simple leather purses. I found this one for her...but on second thought I'll keep it. Hecho en Chiapasa, Mexico!

Perros casajeros.....these are sweet playful dogs.
Local fruit... the oranges may have been imported from the coast (not too far).

Kathleen with severe burn patient. She was so grateful for Kathleen's PT work with her, she wants a copy of this photo to put on her wall at home. She hugged us both and gave us many blessings.
You can smell the sweet cantalope as you walk by.

Monday, November 7, 2011

7th de noviembre 2011

Scott and Linda (farmers from Dinuba, CA) left Bela's today but plan to return in six days for a week. They came to see Don Sergio's work and were very generous in their support. This is their first real vacation from their business Peacock Family Farms in five years.

Sunday – a day of rest – so I spent the it reading, packing and getting ready to leave on Wednesday. I did go to the market to buy purses for my sister in Colorado and a few things for friends. The day flew by.

I walked around in my old neighborhood (area I used to stay before discovering Bela's) and saw the little markets that used to be in carts on the street.

A nice taco dinner at Emiliano's Mustache: a local family restaurant with great tacos!

Monday, today, Sergio and I took the young man with the exposed leg (tibia) to have an x-ray to better evaluate what can be done. As suspected there are significant changes that may be ominous for this poor guy. We will take him to an orthopedic physician tomorrow and see what can be done if anything. One fear I have is eventually a segment of his bone will deteriorate if not treated properly.

Good x-ray equipment and competent technicians. No radiologist, the physicians read their own x-rays... just like the old days.

The usual bandage changes for the morning then home to for Manuela's lunch. She cooked the beans that were given to us by a patient's son and homemade pico de gallo, quesadillas and natural papaya drink. We were all ready for a nap afterwards.

Agua del dia: papaya, sopa: red beans.

The afternoon patient load was heavy, I walk in and without a hello and start seeing patients until all are taken care of. Sergio was so busy, I really don't know how he does it. We have to decrease the patient load by half and if we weren't here he would still be seeing patients beyond 7:00 or 8pm.

The same list of sad cases:

A 58-year-old Zinacantan woman looks terrible, her right lung sounds congested, her blood sugar is still in the 450+ range (she needs insulin), she has a low-grade fever and is coughing. I urge the family to take her to the hospital and Sergio reiterates my suggestion. "Okay," the family says, "We'll bring her back tomorrow." Most of these Mayan folks really fear the hospitals (it's where you go to die, partially because they don't go there until they're dying) and/or have so much faith and hope that Sergio can save them. If they don't go the outcome does not look good.

The other Zinancantecan woman with the worse foot of the two, actually continues to look and feel better (definitely more chatty). We will see what happens here. My guess is still the hospital on IV antibiotics and probable amputation may be the best. But it is unlikely they will opt for that.

The man with the large lower tibia ulcer in which you can see his muscle move when he flexes his foot, he seems to be doing better after I debrided the ulcer base a few days ago.

The 26-year-old woman with the severe left hand burn (all five fingers are gone) came in and Kathleen spent a good amount of time with her doing some PT exercises. Her right arm and hand have significant contractures.

The new patient from Teopisca was brought in by his daughter. This patient's right great toe is missing the joint that connects his toe to his foot. I will spare the details.

Patients come in for anything. I had two elderly (older than 70 here is considered elderly) patients that complained of hearing loss. One was 82 the other was 76, I checked for for wax impaction and other obvious causes that may contribute to hearing loss but I had to chalk these up to old age (and noise pollution)... just as their doctor here told them, I guess hearing aids are not as common here as they are in the US. Nothing I could do.

There was a young boy who has to breath through his mouth when he sleeps because the mucus membranes in his nose are so swollen it leave his little room for air passage. The patient did see and ENT and was prescribed medication that would cost his family 3000 pesos (230USD) every month. They can't afford it! I tell them to ask for generic but I'm not sure they can afford that either.

So the day ends and I feel depressed walking home. A wave of sadness over took me in thinking about all these well-meaning people with chronic and limb threatening maladies. I'm here to help but it only seems like a drop in the bucket. How can Sergio do this six days a week at the age of 70? I felt sad knowing that we are leaving on Wednesday and he will be overwhelmed as he has to see everyone.

Posted by Patricia Ferrer.

Saturday, November 5, 2011

Another Busy Day

5th de noviembre
Santo Domingo Church near Bela's.

Don Sergio received a call from a young woman whose two-year-old child was burned and was admitted to Hospital de Madres and wanted to know if there was anything he could do. He told them to call him when they bring the baby home, depending on the severity he will either go to their house or they can bring the child to his museo.

I was nearby the hospital today so I went to see the baby to assess the severity. This appears to be a hot water burn to the left face, ear, neck, upper chest, upper back and partial right arm that occurred three days ago. She was well bandage but with dry gauze and so far the burn looks to be mostly epidermal (1st degree) and possibly superficial partial (2nd degree) burn in some places. With burns several days have to pass to see the full extent of the injury. The parents are worried about the cost of care as they have a bill running at this private hospital. "How much does Don Sergio charge?" they asked. The relief on their faces was obvious when I said, "He does not charge". They are obviously under extreme stress. In my broken Spanish, I explained she will receive good care, call him when they get the child home, which should be in a couple of days.

Our afternoon ended early and the group at Bela's wanted to take her to lunch. She chose a Lebanese restaurant which was very good. San Cristóbal is probably the most unique colonial city in Mexico as it attracts different cultures. It has the best Italian restaurants, Argentinian restaurants, French bakeries all operated by their respective nationalities. This is a great town to visit for many reasons, the food and music are just a couple.

Could not resist this photo, bicycles are not used for recreation but for transportation. These items are kept up as long as they are useful. Conservation is a necessity.

Our evening clinic was packed... it doesn't matter that its Saturday night the patients still come. The cases are as follows:
  • 41-year-old woman with chronic arthritic problems and pelvic pain, I remember her from two years ago. She has hypothyroidism and it is not clear if she takes her medication regularly. All I can do is offer Tylenol and recommend she see her doctor.
  • 52-year-old man with a large mass growing from his backside extending into his scrotum. Clinically this mass appears to be a cancer. He had it removed four years ago but it has recurred. At the Hospital de las Culturas it was recommend that he see a doctor in Tuxtla but he does not have the funds to get transportation there. If the patient will schedule his appoint, I will gladly pay the transportation cost, he will let me know on Monday.
  • 24-year-old woman with wide spread rash on her face, arms and neck (body is spared) that has persisted for two years... a classic case of contact dermatitis; however it appears to be secondarily infected. Seven months ago she was given Celestone injection which cleared the rash but it recurred (probable re-exposure to allergen), it was recommend she get another injection but she went to another doctor and he told her the injections were bad for her. This is not true, two to four injections per year is fine but one may do the trick if the allergen is avoided. She had an RX with a high potency corticosteroid cream, so I recommend she at least go buy that. We see this often: patients go to multiple people, get different advice then they don't know what to do... we are just another stop.
  • 55-year-old diabetic man with a perforated hole at the base of his right great toe. Sergio examined the toe and it appeared to be detached from joint and was just hanging on by the soft tissue. The patient claimed he worked in agriculture and stepped on something months ago.

Of course, since wound care takes multiple visits we saw the usual suspects in addition to the above: the two Zinacantan woman who are miraculously getting better (if Sergio saves their feet, it will be a miracle), the young man with osteomyelitis, another man with a large ulcer in his left tibia, a wheelchair bound man with two ulcers on his right foot (his left leg was amputated seven months ago due to a foot ulcer secondary to diabetis)... the list goes on.

As we were closing shop, a lady shows up and wants an antibiotic from Sergio for her sister's baby whose been throwing up for two days. The baby is eating and drinking and has thrown up twice each day, no fever, no projectile vomiting, no diarrhea, per this lady, the baby is active and does not look sick and is not vomiting after every meal. I informed her antibiotics may not help, take the baby to a doctor tomorrow if she's not better. As we were walking out a young couple comes by to ask Sergio if he can help their 70-year-old father who was diagnosed with kidney stone. The people here do think he's a miracle worker. He told them to try a benign remedy and take him to his doctor.

Many family members come in with the patients, this is the Mexican and Mayan culture. Sons bring mothers in, the grandchildren come with them, sisters, bother- and sister-in-laws... the museo/clinic is packed with people. One patient's son brought us a bunch of short yellow bananas and a kilo of red beans. He proudly told me this food is todo organico all grown by him. I happily accepted this gift and thought, "These people don't have money, they are grateful for your services and they bring one of the best gifts of all: organic healthy food: and I wonder he knew he was contributing to my good health... the circle of life.

Posted by Patricia Ferrer.

The Top Ten Things To Do in San Cristóbal de las Casas, Chiapas, Mexico

This post will stray from working with Don Sergio. I've been in San Cristóbal enough now that I want to inform anyone interested on the best things to do when here.
  1. Visit Sergio Castro's Costume Museum... of course I am biased. This is a local humanitarian (see this blog) who gives tours every evening at 5:00 or 6:00pm at his museo in the center of town – Calle Guadalupe Victoria #38. His tour orients and educates his visitors about the different ethnic groups in Chiapas and displays his private collection of trajes (regional dress) from these groups. Go to Yok Chij, or see the side panel on this site to find out how to make a tour reservation.
  2. Stay at Bela's Bed and Breakfast. This is the number one rated B & B on Trip Advisor. She has a lovely centrally-located small B & B that serves a healthy breakfast and regional-type comida (lunch upon request).
  3. Visit San Juan Chamula and Zinacantan – there is a daily tour from the cross in the plaza in front of the cathedral at 9:30 am. You need merely show up and you will be found by very knowledgeable tour guide Cesár, who will take you to both villages and return you around 2:00 pm.
  4. Visit Amantenango de Valle and shop for gifts of hand-made and hand-painted pottery. The clay and quartz used for making the pottery is local. On your way back stop to eat in Teopisca at the zocalo in the Restaurante Central and buy their special tostadas de manteca.
  5. Visit the Museo de Medicine Maya – the Maya Medicine Museum on the north end of town.
  6. Visit el Cañon de Sumidero in Chiapa de Corzo.
  7. Visit the Nemi Zapata store that is a cooperative and supports the autonomous communities on Real de Guadalupe pedestrian street.
  8. Visit Lleñateros cooperative workshop where they make gorgeous paper and books from recycled and homemade paper – they take you on a tour of their facility.
  9. Visit Jardines de Orquídeas Moxviquil on the north end of town.
  10. Visit Huitepec Ecological Reserve for climbing, walking and birdwatching.

Friday, November 4, 2011

Work and Pleasure

4th de noviembre

Today was a special. I mentioned to Sergio yesterday that I wanted a morning off to go on a tour and he said he would take us on a tour. The eight-year-old boy who was healing from 35% body surface area burn lives in Amantenago de Valle which is well known for its hand-made and hand-painted pottery.

Our taxi driver Jose Luis was so friendly and attentive. He had to fill up with gas, add some oil and change a spark plug on the way to Amantenango de Valle.

This was a privilege and I was glad that we were mixing work with pleasure: this worked out well for everyone. We hired a cheerful taxi driver we'd met several days before and that Kathleen had used him when she went to Zinacantan. We drove to Amatenango and waited at the patient’s relatives home until he arrived. As we waited, a woman was making pottery. We watched and asked questions and I tried to do what she did but I quit before I created more work for her as she would have to correct my mistakes. She was happy, chatty and pleasant as she asked Don Sergio about us. Sergio says the people in Amantenago are very happy and hard workers.

While we waited Don Sergio educated us on the various fruit trees growing int the family's yard. He picked a lime and scrapped and sniffed the rind and said these are sweet limes. He peeled one for us and he was right, it was the sweetest lime I’ve ever tasted.

The sweet lime tree in Amantenango.

After the bandage change Kathleen worked with the boy with physical therapy to show how to start moving his wrist so the burn contractures won’t limit his mobility. This kid is so happy it was easy to make a game of it.

This fire block is outside the house which is better than inside.

Clay pots are used to cook items for long periods. These can weaken over time and break while being used.

On the way back we stopped at the road-side pottery market and I was overwhelmed with choices I just started picking what I liked… for friends of course. I overloaded one bolsa and needed another. Our next stop was in Teopisca and we bought tostados de manteca of various flavors: these are regional to Teopisca. Sergio bought a few things as well.

Two years ago when working with him he'd just started a school project in Villa Hermosa. The ground was being prepared for the foundation at that time. A year later the building was started and now he has a building for kindergarten and for primary school. Supporters from San Miguel Allende helped purchase the doors and windows and now the school needs desks and two black boards, and a teacher, which he said is ready once the desks are in. There are two rooms and they need 20 desks apiece and one blackboard per room.

The kindergarten building is cold because of a metal roof, so the teacher uses the new primary school building until it is in full use with elementary students.

New kindergarten built by Don Sergio.

The primary school was painted too soon and the rain washed it away. Don Sergio says he does the painting himself as its easy.

Leveling the ground for a court in front of the primary school.

Latrine used before.

New latrines after.

Today the sun is shining and it is warm outside, so we set up a little desk and chairs and had a picnic. This was the second time I’ve seen Sergio rest to eat; the first time was two years ago in this same spot but we sat on the ground.

Kathleen, Jose Luis (taxi driver) and Don Sergio.

Not too far up the road is a nature park and caves for tourists - foreign and national. He took us there and showed us how they used to get into the caves with ropes and said you used to be able to go very deep into the cave. Now it is a well paved concrete sidewalk that goes only 75 meters. It used to go about 500 meters, but some German tourists went past the allowed area where it wasn't lit and managed to get themselves lost, as their flashlight gave up. They had to be rescued, and since then that has been blocked off. Sergio recalled it had been 35 years since he’s been here when he and Elsa had two kids and they were small then. He recounted the entire day his family spent there and how the kids were so tired afterwards everyone slept well. The sad story of the park was a recent death of an eight-year-old boy who wanted a horse ride horse (the park offer rides): he and the horse were struck by lightning and both died quickly. Don Sergio expressed his sympathy for the father who had come up to San Cristóbal from Tuxtla and who had wanted to indulge his son in a fun day.

Outside las grutas (caves).

Old entrance 35 years ago, one used to have to use a rope to climb out.

Horse rides. Look how perfect his print is.

The evening museo/clinic was very busy again. The two Zinacantan women came and the one with the severe infection seemed in good spirits, although her wound does not look any better. The other woman appeared more ill, tired and now had developed a cough. Her blood sugar was still high, mild fever and I could here fluid in her right lung. Oh boy, please go to the hospital, I’m thinking. The family showed me the medicine she was taking (just restarted) but she really needs insulin. Somewhere along the line she was given cipro (antibiotic) but was not taking it, so I convinced them to restart that. They will be back at the same time mañana.

This was a good week for tourists – maybe Sergio’s right – the tourists will return. A group from Norway came and were shy to ask questions but they were very impressed with Don Sergio’s work. A woman, Violeta, I met yesterday via the blog, has supported Don Sergio’s water treatment projects over the years also came in with two friends from Wisconsin as well as another guest from Bela’s. I knew Sergio was tired when the day started but he gave two outstanding tours and our day ended after 7:pm.

Violeta is an artist and has known Don Sergio’s for many years. She is from Mexico City and has been coming to San Cristóbal since 1983. She gave me more insight on the significance of the many facets Don Sergio’s work. She, I and her guests went to a soup restaurant, El Cauldron near el centro and had sopa saboroso. While eating, a trio of musicians came in and played Cuban music: a drummer (small bongo drums), a flutist and a guitar player... it was a magical night to end this special day.

Posted by Patricia Ferrer.

Thursday, November 3, 2011

Dia de los Muertos en Chiapas

2 November 2011

Bela's garden is so lush, one morning I saw 4 different varieties of butterflies, 2 types of hummingbirds and various sizes of bees.

Because of the holiday and that we had few home bound patients we had a light load however, the evening clinic was very busy. The good news of the day is that Sergio had a tourist group of 25 ppl from Sweden come through. The guide seemed to know Sergio fairly well, he brought him a few handsome Mexican style (cowboy) shirts that Sergio was proud to receive.

One visitor was a nurse and she watched me change the wound dressing of the young man with the exposed bone (see previous postings). She was, as I was when I first saw the horrific injuries, very sympathetic to the man as she was aware of the gravity of his condition.

Sergio spent a lot of time with the group and they all left asking for his website. Kathleen and I handed out his cards and answered any questions we could. Afterwards Bela's guests came by: Scott and Linda (from Dinuba, CA) and Suzanna (Austin, TX). I thought Sergio was going to be exhausted giving another tour but he gave them a lot of time and attention. He enjoys the giving the tour and he is able to sustain his energy level.

Sergio's feral cats. He tells everyone, don't touch they bite.

A new found friend, also named Pat, came by and we all (except Don Sergio) went to Tierra Adentro for snacks and a glass of wine. It was a lovely time chatting with everyone and of course the conversation is always, 'what can we do to help'. All I can recommend is to financially support his work or if you can find the supplies he needs and send them directly (see Yok Chij website Ayudar). He's working on improving his clinic, he feels the amount of tourists he had before the financial crisis will come back. I'm not that optimistic, but hopeful.

Another way to help is to bring medical expertise in wound care to him and work with him. The longer one stays the better however, one MUST be open minded, non-judgmental, have acceptance and patience of beliefs and know you are not going to change things for the best right away. One must show dignity and respect and suppress your frustration....for us 'outsiders' it can be difficult...but that's the way it is.

So, the typical evening clinic started with atypical wounds and ended with friendship and support of the Humanitarian de Chiapas. (I will spare the verbal detail of our patients' wounds this evening.)

Posted by Patricia Ferrer.

Tuesday, November 1, 2011

Understanding Cultural Differences

1 de novembre 2011

Party of the dead.

Today is Dia de los Santos Inocentes: it is day of the dead for the children that are now deceased. Tomorrow is Dia de los Muertos. Kathleen is taking it all in as there is much to see and I encourage her to do so as the Mexican culture is so lively and creative.

The museo clinic was busy tonight with the indigenous population. The Zinacantan woman with the horribly infected foot arrived on time with her family. Sergio carefully cleans and bandages the wound. I checked her blood sugar (she is not eating much because she feels so ill) and it was 380... pretty high. We gave her the antibiotics we had (ciprofloxicin) pending the culture which will not be ready until Friday. Again, I express my concern with Don Sergio about the severity of this case. He explains, but they do not want to go to the hospital.

Thirty minutes later a young man walks in and tells us his mother (60-something-year-old) has an infected foot and can Don Sergio see her. We see the patient, also from Zinacantan, and she has the same problem: a severely infected foot but not as bad as the other woman. However, this patient was in the hospital but the family took her out! I checked her blood sugar and it was 498, temperature was 103.7 and her blood pressure was 110/58. In my mind, I'm thinking, "Yikes!" she needs to be in the hospital. I explained to the family all the above and to really get better care she needs to be in the hospital. They said, "Okay, we'll be back tomorrow". Argh, right?!

Sergio knows this. He's been working with these people for more than 40 years and he know their response and behavior. He does not press them to follow instructions, he knows they'd rather die than go to the hospital or have an amputation.

El hombre finds the treasure. The hat is a dermatologists' dream, Arizonans take note!

Before volunteering outside of the US, I read a lot about the problems first world citizens have accepting other cultural beliefs when the risk of cure is minimal and lack of is severe. We cannot impose our beliefs no matter how right we think we are because, just as we must respect one's religious or political beliefs, we must show dignity to any and all we care for no matter where they come from. They are more likely to listen to and respect you. This is what Don Sergio does so well. He accepts they don't want to go to the hospital, even if he knows they will die if they don't. He encourages them to go, but when they won't he treats them with dignity and respect: rich, poor, indigenia, Mexican, no importe. I hope this attitude comes to me in time.

In sum, if you do not show human dignity your message and effort are worthless....they may be worthless anyway but at least your patient dies with dignity.

Posted by Patricia Ferrer.