Tuesday, July 4, 2017

Where in the world is Ken? Chiapas, Mexico

The following post is from Ken Iserson, MD.

Dr. Iserson is an Emergency Medicine physician and Professor Emeritis at the University of Arizona, author of several medical related books and numerous medical publications.  He accompanied me, Ethan, Dr. Vivan Shi and her husband Khiem on this trip to work with Don Sergio.  Ken treated and counseled numerous patients during the past two weeks in San Cristobal and he gave invaluable insight about how we can continue assist in this wound care clinic project.

Where in the world is Ken? Chiapas, Mexico
            Mayans speaking their indigenous languages and wearing their colorful traditional dress, Zapatistas intermittently blocking roads and occupying the zocalo (central city square) [Fig 1], abandoned 8th century cities and pyramids, awesome mist-covered mountains [Fig 2], great food and a cool climate (during Tucson’s heat extremes). That does not sound much like my typical developing world experience—but it was.
            As part of a 5-person team, including two wound-care experts, I recently spent two weeks caring for severe wounds and burns, as well as other medical problems, under the auspices of Don Sergio Castro [Fig 3], in the indigent indigenous community in Chiapas, Mexico. The team, organized by Pat Ferrer, a dermatology/wound care PA who helps support the Chiapas operation [Fig 4], was mostly drawn from the volunteer clinicians working at Tucson’s Clínica Amistad, a facility for primarily Spanish-speaking medically indigent patients. It included Vivian Shi, a U of AZ dermatologist and wound care expert [Fig 5], her husband, Kheim Tran, Ph.D., a second-year U of AZ medical student [Fig 6], Pat’s nephew who will enter medical school this Fall, and me.
            As Pat noted, each day felt like two full workdays. Starting early, we first did home calls in the city and outlying Mayan communities. Working in both Spanish and one of the two regional Mayan languages, Tzeltal and Tzotzil (Don Sergio speaks both), we cared for patients in subsistence communities who were too ill or injured to get into the clinic. Typical patients included those paralyzed from accidents or medical disasters and those suffering from extensive diabetic- or vascular-induced wounds [Fig 7]. Our wound care supplies were those we could carry on our backs, sometimes hiking to get to the patient’s home.
            In the afternoon and evening, we helped staff the makeshift clinic outside the small museum used to help support the operation [Fig 8]. Patients, who were seen in the order that they arrived, ranged in age from infants (usually suffering burns from hot water boiled over open fires) to the very elderly [Fig 9]. Some injuries were minor; others required weeks of daily care. The medical supplies were an amalgam of donated materials from multiple sources and those we improvised [Fig 10]; there usually seemed to be barely enough supplies to care for our patients [Fig 11].
            Don Sergio Castro [Fig 12], a remarkable man who has been doing this work for 50 years, first came to Chiapas as an agronomist. With some veterinary training, he quickly abandoned his government job to help build schools and sanitation systems, and to care for wounds in the Mayan communities. While he came from a wealthy background, he lives frugally, having spent most of his funds on his work. A blog describing his work can be found at: http://sergiocastrosc.blogspot.mx/. A fascinating 2013 New York Times video about Don Sertio and his work is at: http://www.nytimes.com/2013/08/14/world/americas/in-mexico-a-healer-who-asks-for-nothing-in-return.html?pagewanted=all&_r=0.
            Over the years, many clinicians and groups have assisted him. Pat Ferrer has helped him financially and on-site for many years. On this trip, I had the opportunity to assist in an ongoing, sustainable effort for an indigent population. As a side benefit, I was able to learn a great deal about wound care from experts—and, of course, the weather was great!

Fig 1. Zapatistas occupying the San Cristobal zocalo

Fig 2. Mountains surrounding San Cristobal, Chiapas

Fig 3. Don Sergio Castro caring for burned child in clinic

Fig 4. Pat Ferrer, PA, caring for ulcers in paralyzed patient in his home

Fig 5. Dr. Vivian Shi examining woman with gout in clinic

Fig 6. Kheim Tran, U of AZ MS II, blocking large leg wound in clinic

Fig 7. Dr. Ken Iserson examining girl during home visit

Fig 8. Dr. Ken Iserson working in Don Sergio’s clinic

Fig 9. Typical open-flame kitchen—the cause of many burns

Fig 10. Anita, RN, making medication powder with hammer

Fig 11. Vivian, Ken & Edit (nursing student volunteer) treating man’s extensive burn in clinic

Fig 12. Don Sergio Castro and Pat Ferrer, PA, treating elderly woman’s infected foot at home

Post written by Dr. Ken Iserson, posted by Patricia Ferrer.