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.

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