Thursday, January 30, 2014

January 2014

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.

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.

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.

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.