Friday, June 22, 2012

Success and futility

June 21, 2012

At this moment we have only a few burn patients but many diabetic and venous ulcers (foot and leg ulcers). Burn patients, depending on the severity of course, are much easier to help heal. They are usually young healthy individuals with good immune systems. Most of the burns I've seen this trip have been superficial or partial thickness and are almost healed over. These are the successes.

21st century juxtaposition: napkin (servilleta) with the Aztec image holding a cookie (galleta) with a Spaniard in Armor image. The cookie is processed sugar (which the western world introduced to the new world) and paper is made from natural products although refined. The weight of the Spaniard on the thin Aztec serving napkin to collect the crumbs.

The diabetic ulcers are far more challenging. Two steps forward, one step back, these seem futile… but eventually, for most of these wounds, Don Sergio will have success and will possibly have saved a limb.

Here is a simplified version explaining what happens, wound-wise, for those with diabetes. When one has high blood sugar the hormone insulin, produced by certain cells in the pancreas, take the sugar out of the blood stream into the cells so the glucose (sugar) can be used as energy. If there is too much glucose in the blood stream, it is toxic to the inner vessel walls, especially microscopic vessels that are at the ends of the toes, back of the eyes, in the kidneys, etc. This glucose also damages the nerves at the ends of the hands and feet which cause neuropathy (most symptoms are numbness, tingling, or burning sensation). If one can't feel their feet and they are stepping on a small stone that can cause trauma, they are unaware of an injury. Or if the end vessels are so damaged, no blood can perfuse to supply the toes with the nutrients it needs and take away the waste then the tissue of the toes starts to die. Whether it be injury or dead tissue, amputation or open wound, bacteria will settle into the wound and infection begins… or colonization of bacteria begins and interferes with wound healing. If the blood sugar is high, the bacteria will continue to grow, the vessels continue to be damaged (poor circulation) and the wound persist.  Hence, control of high blood sugar during wound healing is so important.

Here, for us, the other part of the equation is that we don't have a good set up to clean the wound properly.  The environments in which we work are not the cleanest, we don't have adequate clinic set up, our supplies are limited; we can do cultures but this can get costly and not yield the most useful information, plus we don't have the antibiotics (creams and pills) to treat properly. It seems to be three steps forward and two steps back.

Every visit I see this well-taken care of old Dodge.

On the brighter side, as always it is a pleasure working with someone who doesn't complain or protest but takes action on what is at hand. Don Sergio uses the resources available and makes the best of it, even when I express my opinion that things look hopeless… one day I will learn to keep my mouth shut. I'm reminded every trip, to do my best with what I have and that it does matter here and now to those you are treating.

Posted by P. Ferrer.

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