Wednesday, April 30, 2014

Resilience and Animalitas

April 30, 2014

In one home, the women dry the corn, maiz.
The evening clinics have been packed: as many as 50 -70 people coming through. When one family member comes in for wound care it's common for 2-4 other family members to come with them.  Grandchildren bring in abuelitos, sons, daughter-in-laws tag along, and of course the smaller children come. If a child is receiving treatment, then cousins, aunts, uncles, parents; it can be as many as 5-7 people tagging along for one patient. The Latin social support is one reason why many believe the Mexicans are so happy.  Its a pleasure for me to see the family love and caring of one's clan.

Our latest tragedy is a 3 y/o boy that was burned with hot liquid (I'm not sure how this accident happened) but his left hand, palm and back, and his abdomen and chest, 23% of his body surface area. This happened last Friday and he was hospitalized for 3 days, then the parents brought him to Don Sergio for continued care. After changing the dressing in the clinic, Don Sergio tells them he will come to their home to reduce transporting the child. These appear to be deep second degree burns: the most painful.  No pain meds are available, other than Tylenol, so our routine will be to lay everything out and change the bandages quickly. The child will soon see us coming and the anxiety will begin. Fortunately, he is healthy otherwise so should heal well, the subsequent psychological trauma will not be known. The extent of the chest burn is not yet determined as the burned tissue has to die off to uninjured tissue (damaged tissue will be removed). In the US, no doubt he'd be in a burn center and appropriate measures taken.

Our Teopisca man, the one who suffered the electrocution injury is doing well. The injuries to his feet are profound, however his grit is so strong and he manages his way through Don Sergio's debridement treatments (removal of dead tissue).  Afterwards he is fine and lets Erick shoot a photo of us.
Resilience and support. This 43 y/o man has his mother by his side during his wound care treatments. They are so grateful for Don Sergio's care.

Another reason the clinic is so packed is many people have basic dermatology questions.  Since I specialize in dermatology, many patients have questions about their skin ailments.  I see a lot of eczema, fungus and sun sensitivity rashes (surprisingly common), the latter in the agricultural worker. The convincing that some of these conditions are not curable but need maintenance for control can be difficult; try telling an agricultural worker to stay out of the sun:imposible (sombreros, guantes y mangas largas).

Bela's garden in full bloom, a Mexican paradise.
My easiest derm case was this young woman with a small child that complained of "tengo animalitas en mi pelo" (I have small animals in my hair). Ah, so easy: lice..and so easy to see along with the eggs. In Spanish, piojos y liendres. When I ask how many people live in her house and do they have the same problem, her response, "Si, todos" (yes, 15 people have it). This young woman is poor, so Don Sergio and I agree to buy the medicine and have the family treated.  I'm not so sure how successful treatment considering the crowded living conditions.

Sunday, April 27, 2014

Prepping for Growth

April 27, 2014
This time of year the ground is a bit drier and the agriculture workers are prepping the land for the fall crops. It involves burning the dried debris and according to Don Sergio, it helps to release potassium in the soil for planting, then the rains will come and things will grow. Food will be harvested and life goes on. 

The sky is a bit hazy, but brings brilliant orange colors as the sun sets
Over the last week a colleague, Erick, who has worked at the Shriners Burn Hospital in Galveston for 3 years, has contacted me about working with Don Sergio. He's been traveling through Mexico and has developed friendships with Mexican physicians that have passed through Shriners for additional training. Erick, originally from Connecticut, like many people has found Mexico wonderful and his connections make it that much richer. Over the last year he has returned 3 times and once to Chiapas, however he was not aware of Don Sergio at that time.

Saturday was my first full day back joining Don Sergio and its like I never missed a beat, however there are two critical cases we make house calls to and one is in Teopisca (25 miles out of town). This gentleman, age 43, was laying rebar for masonry work and it touched a live wire.  The electricity went through his forehead and out both feet. The ulcer on his forehead is healing well but the exit points are horrible. Erick, has seen injuries this severe or worse many times before. When I asked his thoughts he said, “take him to the OR” (operating room). Well, that’s out of the question. Don Sergio has been working with this guy for several weeks and slowly removing the dead tissue to help the healing process. Always, ‘poco a poco’. This trip takes most of the morning.

Our second case is one of the saddest. I know I’ve said this before in other postings but....  This 26 y/o man from Chenoló became intoxicated and, in his drunken stupor, decided to rob a home. He was caught in the process and was taken by the owners who pored gasoline on his legs and set him on fire. The end result is loss of his left leg (badly burned and amputated above the knee) and the other severely burned behind the knee that the contracture will not allow him to straighten his leg. He is now wheelchair bound.  Its hard to believe the brutality, but it happens world-wide.

On the brighter side the local fair had a dance show that was in full swing during 'comida'.

The fashion in the old days.
It is a pleasure having Erick here who has experienced seeing and taking part in treating these intense injuries.  However, knowing what would have been done if there were resources and what we have to work with…well, these are different worlds.

Sidewalk art, now faded.

Displaying murals.

Sergio continues to provide care to any and all in need. I find his storage room empty of the staples he needs: gauze, gauze wraps, petrolatum impregnated gauze, tape, and gloves. My large suitcase with supplies was held up in Guadalajara and just now arrived. Just in time before running out...for the moment. One objective this trip is to estimate how much he needs on a monthly basis, find a local distributor and make arrangements to keep Don Sergio in supplies.