My
return to work with Don Sergio finds him as I left him in August: still no
dentures, in need of funding, and a heavy load of patients with severe
wounds. We have 4 children with burns, some severe, all of which will
leave them with a mild - severe disability due to the contractures.
Bela framed Don Sergio's NY Times article by Janet Jarman and Elizabeth Malkin.
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This
trip my Tucson friend Ricci (primary care PA) has come with me. We arrived at
2am on Sunday and awoke to perfect San Cristobal weather: 70 and sunny.
Bela and a couple of her guests took us to for a lovely lunch and we walked all
walking streets and shopped a little.
We
meet Sergio at his Museo on Monday morning and it felt as if I never
left. Our day begun with 4 patients in the museo then 8 house calls. Mostly
diabetic ulcers as these people can not ambulate too well.
Ricci does knee evaluation at one of
our house calls. During housc calls many relatives come out of the
woodwork to seek our consult when treating one of their family members.
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We were done with morning rounds at 230pm we then home to Bela's for lunch and back to the museo at 4pm
where we saw patients until 7pm. This was Ricci's first 'real' day which
contrasted considerably from Sunday's shopping outing. Many tragic cases of
hard to heal wounds. I think she and I were glad when a patient presented
with basic primary care or dermatologic conditions (these are easy if they are
fixable).
These ceramic/clay pots are used over
and over on hot fire grills, eventually they can break or explode their hot
contents on the near bystander resulting in a hot liquid burn. It seems
usually a woman or child.
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The
main changed since August seems to be the severity of the ulcers and the young
age of when these patients present. The diabetic patients are not overweight,
but thin and usually diagnosed in their 30s. Most need insulin and sometimes
they take it, sometimes they don't. I was told some people believe they will go
blind if they start insulin. There is no diabetic clinic, diabetic education or
endocrinologist (at least that I know of) in the city.
53 year old male, blind secondary to
diabetes with bilateral leg ulcers.
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