Learning from Each Other = Making Progress

June 25, 2017

As our time comes to a close, our connection with Anita and Edith continues to bond.  They are receptive to our ideas that make sense and are interested in us showing them how to make wound care solutions from locally available inexpensive products.  Most importantly, we are receptive to listening to their needs.

Anita, Edith and Ethan.

A former visitor and wound care physician Scott Bolhack has been a constant resource for this project over the years and sent me the recipes for these homemade wound care solutions. Bela had most of the ingredients, I simplified the recipe, and Ethan translated the recipe for Anita and Edith.  We gathered in Bela's kitchen and went to work.  There were a few experimental mishaps but we managed to do what we wanted.  Vivian's and Ken's idea of making iodine gel was also helpful and with adjusting the recipe we were able to make homemade iodine gel.

Anita, Edith, and Ken.

 Anita had told us that she has used the vinegar solution before helps considerably with many wounds. However patients complain of pain as the vinegar solution burns.  Ken talked with Anita and Edith for a while showing them how to apply hypnosis to help people through the pain. As I watched him I immediately recognized that Don Sergio performs the same method but without telling the patients what he's going to do; he just slides into and it works.

Posted by Patricia Ferrer.

Generosity 2017

 June 19, 2017

Thanks to the Friends of Don Sergio, our Generosity Campaign exceeded our expectations.  So many of you gave generously to our humanitarian of Chiapas. I presented him with the mock check and as always, he is grateful.  These funds will help keep him afloat over the next year.

Our day home visits include two young people who have endured severe accidents. One 25 year old who was injured in a motorcycle accident and is now a paraplegic. He has a bed ulcer that is healing nicely and his family takes very good care of him. The other young patient is a 12 year old girl who had an appendectomy. When she went into the surgery she was normal, but she never woke up afterwards. Her body is tiny and bony, legs and arms contracted, eyes roll to one side and she has a feeding tube; she has been like this for 2 years now. The family feels she was given to much anesthesia, but Dr. Iserson believes that someone must of intubated her incorrectly, causing her to go with out air for an extended period.

In the evening, Drs. Shi, Iserson and I gave lectures to the medical students which are Cesar's compadres.  Cesar has volunteered with Don Sergio for years and is now in his 3rd year of medical school. Due to his busy schedule he is unable to work with him as much, but he is in close contact and works with him when he can.

Third year medical students of San Cristobal Medical School.

Dr. Iserson's lecture was on ER procedures in limited resource environments.

Dr. Shi's lecture was on dermatologic emergencies.

My lecture was on recognition of skin cancers.

 

 

 

 

 

Sergio Presents to the Local Medical School

L>R: Elsa, Don Sergio, Ethan.

Cesar and his girlfriend Lupe (both 2nd year medical students) invited Don Sergio to talk to their peers at the local medical school UNICH.  Sergio asked me to bring the video, El Andalon, to show the students then afterwards he'd say a few words about caring for wounds and burns.

Display put up by Cesar and Lupe about the care Don Sergio provides.

Sergio was clearly nervous, which was refreshing to see: indicative of the importance of speaking to future local health professionals. After the film, he quickly went into a dialog of how best to assess and treat burns, then onto ulcers. I never seen Don Sergio talk so much. If he knew how to do a powerpoint he may have talked for hours.

Don Sergio talking about burn and wound care.

The university emphasizes cultural awareness of the local indigenous population and opened the medical school 3 years ago.  It will take a total of 6 years for Cesar and Lupe to finish their training, then one year of social service to obtain their medical degree.

Sergio and his wife, Elsa.

Sixteen medical students came to the lecture.

L>R: Don Sergio, Cesar, Lupe.

A special thank you to Veremos Productions, Consuelo Alba and John Speyer for their generosity of creating this well told story of Don Sergio and his work.

Posted by Patricia Ferrer, PA-C.

Summer 2016: Indiegogo Generosity Campaign

-->

Ethan presents our mock up five thousand USDs award raised via the Indiegogo Generosity Campaign.

Our 2nd annual fundraising campaign, thanks to everyone who donated, was an absolute success! Our goal of $5000 USDs was reached and we are able to help fund Don Sergio over the next year.  As usual, he is grateful to all his friends that continue to support him and his work.  The never-ending influx of patients with burns and wounds seems endless and all donations help reduce the suffering in this part of the world.

At this time we have a 2 and a half-year-old that was pushed into a tub of hot water by her brother, which burned her back, legs and genitalia.  These are first-degree burns (epidermal blisters) and superficial second-degree burns (the superficial portion of the dermis).  These types of burns are so painful and although the little girl cries when we change her bandages, she lets us do our job. We do it as quickly and smoothly as possible.  The poverty she, her family and neighbors live in astounds us: no clean water, no toilets, they cook with wood, the walls are thin planks, and discarded items are used in any way possible for shelter. There is no waste for the poor; they find utility in everything, just as nature does.

Neighborhood kids wait for us to finish our burn care for the 2 1/2 y/o girl.

30% of her body surface area was burned, 1st and superficial 2nd degree burns.

Anita, a nurse works with Don Sergio M - F for his morning rounds. She has not been paid at her hospital job in 6 months. She has 3 children ages 12, 9, and 4. Sergio pays her what he can, when he can.

Progress at a snails pace

January 24, 2016

In some parts of the world progress moves at a snails pace...or as Don Sergio says, 'poco a poco'.

I am back home now after spending 2 weeks with Sergio in San Cristobol.  It was a rewarding visit finding Sergio well and busy.  Below are some thoughts I have about the state of Sergio's mission.

The Supply Line
Don Sergio is always in need of burn and wound care supplies. He can never have enough gauze, gauze wraps, ointment and gloves. Thankfully, there is a Tucson organization where I can request these items and check them as luggage when I visit him. Also, my medical network seems to come through when I request items they no longer need and a friendly physician who ships me boxes of good, unused supplies from Michigan throughout the year (Thank You, Dr. Beckmyer).

Some supplies I repack as tightly as possible and have friends (Thank You, Alejandra) who visit family in Mexico and postal ship them from Sonora. This system has worked well and supplements Sergio's inventory.  He does have friends from France that send him creams and other items as well.

The Help

L>R: friend of the team, Nataly, Esmeralda, Deborah and Edith.

Edith, is now in nursing school and doing well. She continues to help Sergio on a regular basis. I believe her nursing school is 5 years long and this is her first year. She had recruited a few others students to come help as well and they love it. They love the hands-on care and knowing they are making a difference in their community working along side Don Sergio.

Alfonso also continues to help Sergio. His unwavering admiration and respect is palpable. He has decided to pursue an engineering degree in San Cris and help Don Sergio until his compadre Cesar completes his medical training. Alfonso told me he looks to Don Sergio as a wise grandfather and spends most evenings working with him.

L>R: Sergio, Juanito, Alfonso.

Cesar, El General, is in his second year of med school and is doing well. Only when he is on break is he able to come help Sergio. He says his studies are going well and he is learning so much about medicine and loves it. He will be an exceptional physician!

Newbies: Esmeralda, Deborah, and Nataly. Esmeralda has a permanent smile on her face and is in nursing school with Edith. Nataly is a gymnastic teacher and helps in the evenings as well. She took up running a year and a half ago and has run 2 marathons already...she's a natural athlete.  She usually comes in the top 10 of various races...usually 15 to 42 kilometers. She was there most nights these past two weeks. Deborah is 15 years old and loves to hang out and hand out supplies to everyone working. I love the feeling of camaraderie and family that has developed over the years.

Gymnastic teacher and runner by day, volunteer at night.

Iker has been gone for almost a year now. He's ridden his bicycle over 9000 kilometers and is putting on another 3000 more as he heads to Usuiasia in Argentina.  We still hope for his return one day. We all miss him.

Having gloves, good blades to care for wounds is a plus.

Here we use a bucket for a stool.

Indiegogo Fundraiser
Last year's fund raising was a tremendous help for Sergio. This fundraiser helped support him over the last 8 months. His life is easier because of all of your donors. We plan another Indiegogo this spring. 

The Patients
It is a dream to one day, to find a way to integrate a patient education program...alas..for now, just a dream. Sadly, same conditions, different patients. It seems there is no end. We are making a difference but albeit, a bandaid..speaking metaphorically.  Each patient, young and old, are always expressing their gratitude for Sergio's (and his team's) help. The care they would receive if Sergio were not there, may not be adequate or sufficient to heal their wounds. As I've mentioned before, sometimes its more cost effective for the hospital to cut off the limb as oppose to nurse a wound back to health.  Sergio has nursed many limbs back to life.

Stop here, the following is for strong eyes and stomachs only.

His family brought him in 4 days after the injury.

This photo, left, is the young boy who was accidentally burned with polvora (flammable power used for fireworks). See posting Jan 9th. I cannot paint the picture with words of how quietly and calmly this child sat while Sergio applied vaseline and silver sulfasalazine to his open facial wounds.

Day 15 after initial burn and 11 days of burn care.

Sergio believes when one is calm during receiving wound care, their bodies heal quickly.


We hope all who know and/or who've met Sergio continue to provide support in some way, every bit helps. Stay tuned, we will keep updating the blog.

My nephew Ethan, a pre-med student, joined me this trip. He will do great things in his life!

My First Day With Sergio - by Ethan Hartman

After breakfast, Patti runs to call a taxi as I wait with the medical supplies that we have gathered for Don Sergio. The taxi takes us to Sergio’s museum, which doubles as his clinic. We unpack the supplies that we need for this morning’s house calls, and we leave almost as soon as we arrive. The taxi driver, a very good friend of Sergio’s, greets us at the door. “You’re late,” Sergio bellows. The two of them laugh and embrace. I receive a handshake, and notice that he has no thumb on his right hand—an amputation? “Me llamo Juanito, mucho gusto” he says with much gusto. “Soy Ethan, es buen conocerte,” I reply with a smile.
The four of us jump in Juanito’s taxi and begin an unexpectedly long journey.
It is possible to tell the generosity of a person by many measures. As we drove through the mountains, I begin to realize the true generosity of Don Sergio, a man willing to pay for a taxi to travel an hour and a half just to change the bandages and clean the burn wounds of a man he barely knew. The roads twist, rise, and fall, as we go deeper towards our destination; the town of Chanal. Patti feels nauseous and I hand her a plastic bag just in case.
I enjoy the long periods of silence between small talk when I just sit and think. I imagine myself living in Chiapas, writing medical blogs or working at Bela’s to pay for my rent. Above all I imagine helping Sergio with his work. I think about Brazil, and how much I long to visit the friends I made last summer. There is something about travel that I find so romantic, it truly is the greatest teacher. Learning a language introduces a new way of thinking, and a knowledge of 3rd world medicine is difficult to get in the 1st world. Maybe I can do all this in my year off between graduation and medical school…
No sei.
Plans are difficult to make in such an uncertain future.
When we arrive in Chanal, Sergio leads me into the home of burn victim, and I see what real 3rd world looks like. An entire family of 8 lives in 2 rooms, with no shoes, no clean water, and few sources of light or heat. One light bulb illuminates the room where a 41 year old man lies, cachectic and moaning. After greeting us with a weak smile, he uncovers himself to reveal his naked lower body. His legs, thinner than arms, are wrapped in bandages, oozing with green pus. My job for today is to hold the LED light, retrieve supplies, and take pictures. As Patti and Sergio take off the bandages, we can see that most of his right leg and half of his left is covered in 2nd and 3rd degree burns. This man had gotten drunk and fell into the fire at the center of his home. This story is all too common in Chiapas, and Sergio knows from experience that these wounds take a long time to heal without surgery. As we packed up to leave, I notice Sergio leave 100 pesos for the man on his dresser without saying a word.
The rest of the day is very busy. Juanito delivers us to people with various problems including diabetic ulcers, venous/arterial ulcers, and burns. I am thankful for my strong stomach, because many things we come across would destroy most of my friends’ desire to eat for days. 

After about 8 patients, Patti and I return to Bela’s for lunch; beet soup with salad and pepper empanadas…tan delicioso! After a quick nap, we are off to Sergio’s museum again. Only this time, patients are coming to him. Sergio also has other helpers, an 18 year old man who wants to go to medical school, and two 20 year old girls that are studying to become nurses. I struggle to get into the flow of where everything is, and I quickly become overwhelmed by all of the supplies, and how to get organized. I learn the ropes, however, as Patti scolds me a few times, and I observe how the other volunteers work with the patients and Sergio.
A child with terrible burns to his face from a firecracker accident is brought in by his parents. His face is inflamed and covered in pus. He sniffles slightly as Sergio cleans, debrides, and wraps his wounds, but he does not cry. What a champion. Another kid, who had cut his thumb open and received stitches several days ago, cries and thrashes as if we are torturing him when we take out his stitches. Not quite the same level of champ in that kid. I can’t blame him, I was the same way as a child.
Throughout the night we see infections, fistulas, eczema, ulcers, burns, and scabies. It’s amazing that Sergio can send these people home with some sort of treatment, from a limited amount of antibiotics, to various topical medications and wrappings. It’s great to know that people believe in his work and send things from all over the world. The end of the shift working with Sergio and his team brings a warm feeling to my heart, and I can’t wait to play a larger part in it.
Patti and I leave just before 7pm. I buy us some sandwiches and we walk home. After a quick workout, I head to the kitchen to eat my sandwich and Meli stops me, asking me to help her translate what a man named Jose is asking her. Why she asks me, I haven’t the slightest clue. I probably know less Spanish than she. By the end of our conversation, however, Jose asks for my email, and wishes to stay in touch with me. As I write my email down for him, he expresses interest in my pen, which has a flashlight at the end. I tell him that it’s his, and his face lights up with delight. How wonderful to make someone so happy with such a simple thing. Whether it’s treating a burn, or giving a gift, we can all make a difference.
Patti and I meditate on this before we chow down our sandwiches and discuss the clinical presentation and treatment of ulcers. You know that you are medically inclined when you can eat and look at disgusting photos…

Vistors from Kenosis Spirit Keepers

Earlier in 2015

Spiritual leader Carla Woody, founder of Kenosis Spirit Keepers (kenosis.net) has been traveling to Central and South America over the years leading tours in efforts to educate others of Indigenous traditions that may be on the verge of extinction. Somewhere along the way she met Don Sergio Castro and during her trips to Chiapas, she makes his museo/clinic one of her stops. She has noticed and appreciates Don Sergio's ability to heal wounds by the compassion and care he provides and does not miss an opportunity to share the experience with others.

Ms. Woody gives a portion of her proceeds from her tours to help Don Sergio carry on in his work. Below is a photo of her latest trip to Chiapas in 2015.

Team Work

January 11, 2015

View from Iglesia Guadalupe, looking westward.

Don Sergio's history is unique in many ways. Just the story of his humanitarianism stirs many to come write about him or make videos (see El Andalon and New York Times Article).  However, his personal history is quite remarkable as well.

Don Sergio has told me that his mother died when he was 6 years-old the father, an actor at the time, split him and his sisters up to live with their tias (aunts). He ended up at a boarding school and over the years became well educated and tutored other students to pay for his room and board as his father did not pay the bill nor did he return for him. He considers himself growing up as an orphan and luckily he was smart enough to go to University and obtain a degree in agronomy, veterinary and teaching and subsequently did his social service here in Chiapas, where he found his home.


His father, now older than 96, lives in Mexico City (Districto Federal: aka DF) and over the years they have reunited. He is frail and having health issues and Don Sergio would like to see him before too much time gets away.

Never asking for anything, he had mentioned this to Iker who shared it with me. Don Sergio agreed that this is a good time to go visit and that we (me, Ricci, Iker, Alfonso, Edith) can take care of the patients. He left on Friday and is returning later today. Ricci and I did house calls on Friday and Alfonso joined us during the day on Saturday. During the Friday and Saturday evening clinics Iker, Edith and Alfonso joined us and we took care of the all the patients that came.

Currently, one of two of our most critical patients. This patient is
very poor in that his living conditions are not optimum for someone
with a burn as bad as his. Fortunately, he is not diabetic, young, and
otherwise healthy (I don't think he will be touching alcohol and time soon).
Ricci preps the bandage while Alfonso and Iker debride this deep burn wound.

One badly burned patient, the usual 'this is the worse case' of the this trip, needed wound care on Sunday, our usual day off, and thankfully Iker and Alfonso joined us and did the most difficult work (Ricci and I were glad to take a break with this case). This 26 year-old with an 11-year drinking problem consumed to much on Christmas Day and fell into a smoldering fire and passing out for 4 or 5 hours. His right leg was burned horribly: partly 3rd (down to the fat) and deep second degree burns to the whole circumference of his right leg from ankle to upper thigh.

Notice newspaper used as a drape to catch wound debris, we re-use spray
bottles and leave the debriding instruments, supplies and silvadene with
the patient for daily care.

Wrapping the wound. We try to do all the wound care efficiently as
this can be quite traumatic for the patient. We have no pain medication
to give, nor the best of instruments or supplies; just as what
Don Sergio has done for more than 40 years  

Don Sergio and I had been caring for this young man daily since the day after my arrival which was 8 days after the accident. It is not unusual for patients to seek help more than a week after the injury. This patient did not want to go to the hospital for fear of cost and he has no money. Properly caring for this wound to maximize healing requires daily care so our Sunday attendance was necessary. Ricci and I assisted Alfonso and Iker as they worked on this young fellow, doing what we can to make the job easier for everyone.





It makes me very happy that Don Sergio trust us and los jovenes to man his post while he was away. He is able to see his father without worry and we were all glad to be there for him as he has always been there for so many.

 Posted by Patricia Ferrer.

El Problema es.........

-->May 11, 2014

The same in the United States but at different levels:  lack of nutritional and health education, public health services, reasonable access to healthcare with cultural awareness, and in San Cristobal, adequate resources for healthcare professionals to deliver optimum healthcare.

These statements are my personal observations while working intermittently with Don Sergio over the last 6 years. Seeing the consequences of these deficiencies brings me to these conclusions.

Lack of nutritional education.  

Sweets are hard to find in nature so our bodies have not evolved to handle consuming large amounts of sugar. This early and chronic consumption can result in type 2 diabetes (T2DM) at an early age as the pancreas’ ability to produce insulin wears out in keeping up with elevated blood sugar…hence the term ‘impaired glucose tolerance’, aka IGT. We often see many 30-somethings with out-of-control diabetes and horrific foot ulcers are their first obvious signs of this disease - they are unaware they have diabetes.  Interestingly, these people are not obese, as in the US,  some may carry 2-10 kg too much, but not all.

Typical aborrotes packed with soft drinks.

It is not unusual to see a mother pouring a refresco in her baby or toddler’s drinking bottle, or just letting them drink straight from the soda bottle (I see this in the Hispanic US population too).  The sugar content in these 400ml/~12 oz drinks is about 46 grams. There are 4 grams of sugar in a sugar packet. That means there are 11 packets of sugar in one bottle. When this starts early in life, the taste of water does not ‘taste good’, therefore continued consumption of sugary drinks seem normal. 

It is not unusual to see a 3 year-old child with deciduous (baby) rotten teeth. The acid in the soda breaks down the enamel and the oral bacteria feed off the sugar creating an imbalance of oral flora and therefore damaging the teeth.  I saw this clearly with our 3 y/o boy that was burned with hot liquid on his chest, abdomen, and hand. He had a dark brown nub of one of his front teeth and a few others were beginning to rot. His parents fed him soda to try to distract him during these wound-dressing changes. Pain medication would have been ideal but it is not available.

In some places you have to ask the staff to unlock a door to buy toothpaste, or it's behind the counters in the pharmacy.

For some reason in Mexico (this is in the north and the south) for the poor population, oral hygiene is not advocated. In Tucson, many of our Mexican immigrant patients need emergency dental care due to tooth abscesses, sinus tract development and grotesque caries due to lack of basic dental care and oral hygiene. Poor oral hygiene and early soda consumption appear to be a bad mix.

Lack of health education, aka PREVENTION, ¡por favor!

Diabetes is at ~11 % in Mexico and at ~7% in the US; these stats reflect the number of those actually ‘diagnosed’! There are numerous people with IGT in which 30% of these people will go on to develop T2DM if they are not educated and informed on how to prevent the progression. 

Global T2DM is increasing in mid- to low-income nations but high-income nations have their burden too. If we don’t educate our youth (and all for that matter), we will exhaust an enormous amount of resources.

Diabetes puts in motion the following problems: heart and vascular disease, kidney and eye disease, and neuropathy. This can lead to high blood pressure which increases the risk of stroke; kidney failure resulting the need for dialysis; eye disease leads to blindness. Neuropathy (burning, tingling, numbness of lower legs and feet) results in inability to feel a pebble in a shoe which can lead to a small ulcer, then infected ulcer, then amputation, etc. Complications from diabetic neuropathy is the main reason so many wound care centers have popped up in the US over last 15 years.  Don Sergio tries to fill the local wound care void; hence the 120 + patient visits per week.

Public health promotion.

I have not lived in Mexico long enough to comment with complete understanding of the public health (PH) system. However, Bruce and I were living in Oaxaca for 3 months in 2009 during the ‘Swine Flu Epidemic’ and it appeared the public health system rose to the occasion as did the government. PH vans roamed the neighborhoods knocking on doors asking specific questions about symptoms of illness. Well-publicized professional soccer games in large stadiums cancelled, as were schools and offices to contain the spread. It was quite impressive how Mexico responded. I don't think we in the US would cancel any professional sporting event to contain an infectious disease.

Common cooking stove.

Some people can't afford a stove and wood burning to cook is their only option.

 This being said, in the San Cristóbal region, education on preventing common burns and diabetes seems non-existent. Small children frequently get burned with hot water or oil, the ubiquitous fire crackers use can cause serious damage, and neurocysticercosis can cause epilepsy and those centrally located, non-enclosed fire blocks in the home seem to be a magnet for one experiencing an epileptic seizure. Public service announcements, posters, television blurbs could make a huge impact. The US population can benefit from these public service announcements as well and we have resources to do so, but for some reason don't implement.

Don Sergio finds remnants of feugos artificiales.

Cultural awareness is so important.

This is one place in the world, in the Americas, that still has a heavily populated Mayan/indigenous culture with their own style, beliefs, dress, language and ways. These cultural identities can vary from town to town. It is a pleasure to be able to experience the diversity.  However, with healthcare, there must be a bridge and understanding their culture as to yield the best results when caring for these unique groups.

Resources for the healthcare system.

I often hear the Mexican physicians and nurses go on strike not for money, but for resources to provide better care. These physicians and staff want to help and do their job well, but resources are limited which can result in bad outcomes.

So what is the solution?

Do what we can within our abilities to improve these flaws. It has to come from within a community and we (wherever we are) must have the desire to be part of the solution. However, this is difficult when the infrastructure to support these ideas is not in place.  As with every visit here, I ask Don Sergio, “Why do you do what you do?”. His response this visit is, “I don’t want to be closed in and think about myself, I want to think of others and be part of the help and solution”….”people need help”.

Okay, I’m stepping off my soap-box. To reduce the suffering and needless life/limp/game changing ailments we must invest in education: not just in Mexico but in the US as we are no better. We have our own burden of T2DM and it appears to be taking the globe by storm…..we’ll soon match Mexico’s 11% of diagnosed diabetics if we don’t do something.

Posted by Patricia Ferrer.

February 2, 2014 Sergio's Keen Eye

 Sunday Feb 2, 2014

Sergio playfully uses his museo camera to photograph Ricci.

Our work week ends on Saturday night.  The day-time patient load is constant and fortunately the evening patient visits vary and Saturday night was lighter than usual.

A visit to el campo, a family grows their own vegetables: cauliflower.

This is the high season for San Cristobal due to the cool temperatures and fortunately tourism is moderately bustling.  Sergio has given evening tours at least 4 times this week and our being there caring for patients frees him up to give more attention to his visitors.

While he was ocupado with a tour, a new patient arrived with an poorly healing abdominal surgical wound. This the story of this ~38 year old male:
Nine months ago he had his gallbladder removed and 6 months later he complained of abdominal pain and returned to the hospital. They found the surgeon left a gauze in his abdominal cavity and it became entangled around his intestines requiring another abdominal surgery and partial removal of his small intestines.  Now he has one vertical abdominal scar and one horizonal scar that have not healed over the last 3 months. The patient is unable to work and the surgeon is requiring the patient to pay 250 pesos ($20USDs) per visit to help heal these unclosed wounds.

He shows up on Don Sergio's doorstep asking for help. With Sergio just starting his tour, knowing he'd be at least 40 -50 minutes, of course we cleaned the wound, dressed the wound and told him to return tomorrow.  What would these people do without Don Sergio?: they would suffer unnecessarily.

Our evaluation revealed his wounds have a build up of bacterial slim which need cleansing and application of a topical antibiotic and the appropriate dressing to allow drainage. However, the following day, Don Sergio's keen eye and experience revealed he had a tunneling effect, hence the tunnel is probably coated with slimy bacterial debris as well. I am confident this man will achieve good results with Don Sergio's care.

Sergio has started a well project between Zinicantan and Chamula.

Near the catchment tank, the locals leave their water containers to collect water.

This is the catchment tank they obtain their water.

After moving to Tucson in 2009 I have been fortunate to meet many wonderful medical professionals, several of which have become good friends. One fellow PA, Ricci Silberman, I met at Clinica Amistad: Tucson's free evening clinic for the low-income uninsured.  I was thrilled to see another PA volunteering for the under-served and knowing she worked full-time I asked why volunteer at this clinic, she simply answered "it's the right thing to do".  Four years later here we are in San Cristobal extending our skills beyond Tucson.

Amigos.

Ricci leaves tomorrow and returns to her full-time practice and I will remain the rest of week. Bela has made her stay comfortable and welcoming and had an immediate connection their being from the same generation. The charm of this city, the people, working with Don Sergio I hope have a tug on her heart to return.  Mil gracias Ricci, eres una santa.

7th de noviembre 2011

Scott and Linda (farmers from Dinuba, CA) left Bela's today but plan to return in six days for a week. They came to see Don Sergio's work and were very generous in their support. This is their first real vacation from their business Peacock Family Farms in five years.

Sunday – a day of rest – so I spent the it reading, packing and getting ready to leave on Wednesday. I did go to the market to buy purses for my sister in Colorado and a few things for friends. The day flew by.


I walked around in my old neighborhood (area I used to stay before discovering Bela's) and saw the little markets that used to be in carts on the street.

A nice taco dinner at Emiliano's Mustache: a local family restaurant with great tacos!

Monday, today, Sergio and I took the young man with the exposed leg (tibia) to have an x-ray to better evaluate what can be done. As suspected there are significant changes that may be ominous for this poor guy. We will take him to an orthopedic physician tomorrow and see what can be done if anything. One fear I have is eventually a segment of his bone will deteriorate if not treated properly.


Good x-ray equipment and competent technicians. No radiologist, the physicians read their own x-rays... just like the old days.

The usual bandage changes for the morning then home to for Manuela's lunch. She cooked the beans that were given to us by a patient's son and homemade pico de gallo, quesadillas and natural papaya drink. We were all ready for a nap afterwards.




Agua del dia: papaya, sopa: red beans.

The afternoon patient load was heavy, I walk in and without a hello and start seeing patients until all are taken care of. Sergio was so busy, I really don't know how he does it. We have to decrease the patient load by half and if we weren't here he would still be seeing patients beyond 7:00 or 8pm.

The same list of sad cases:

A 58-year-old Zinacantan woman looks terrible, her right lung sounds congested, her blood sugar is still in the 450+ range (she needs insulin), she has a low-grade fever and is coughing. I urge the family to take her to the hospital and Sergio reiterates my suggestion. "Okay," the family says, "We'll bring her back tomorrow." Most of these Mayan folks really fear the hospitals (it's where you go to die, partially because they don't go there until they're dying) and/or have so much faith and hope that Sergio can save them. If they don't go the outcome does not look good.

The other Zinancantecan woman with the worse foot of the two, actually continues to look and feel better (definitely more chatty). We will see what happens here. My guess is still the hospital on IV antibiotics and probable amputation may be the best. But it is unlikely they will opt for that.

The man with the large lower tibia ulcer in which you can see his muscle move when he flexes his foot, he seems to be doing better after I debrided the ulcer base a few days ago.

The 26-year-old woman with the severe left hand burn (all five fingers are gone) came in and Kathleen spent a good amount of time with her doing some PT exercises. Her right arm and hand have significant contractures.

The new patient from Teopisca was brought in by his daughter. This patient's right great toe is missing the joint that connects his toe to his foot. I will spare the details.

Patients come in for anything. I had two elderly (older than 70 here is considered elderly) patients that complained of hearing loss. One was 82 the other was 76, I checked for for wax impaction and other obvious causes that may contribute to hearing loss but I had to chalk these up to old age (and noise pollution)... just as their doctor here told them, I guess hearing aids are not as common here as they are in the US. Nothing I could do.

There was a young boy who has to breath through his mouth when he sleeps because the mucus membranes in his nose are so swollen it leave his little room for air passage. The patient did see and ENT and was prescribed medication that would cost his family 3000 pesos (230USD) every month. They can't afford it! I tell them to ask for generic but I'm not sure they can afford that either.

So the day ends and I feel depressed walking home. A wave of sadness over took me in thinking about all these well-meaning people with chronic and limb threatening maladies. I'm here to help but it only seems like a drop in the bucket. How can Sergio do this six days a week at the age of 70? I felt sad knowing that we are leaving on Wednesday and he will be overwhelmed as he has to see everyone.

Posted by Patricia Ferrer.

The Top Ten Things To Do in San Cristóbal de las Casas, Chiapas, Mexico

This post will stray from working with Don Sergio. I've been in San Cristóbal enough now that I want to inform anyone interested on the best things to do when here.

1. Visit Sergio Castro's Costume Museum... of course I am biased. This is a local humanitarian (see this blog) who gives tours every evening at 5:00 or 6:00pm at his museo in the center of town – Calle Guadalupe Victoria #38. His tour orients and educates his visitors about the different ethnic groups in Chiapas and displays his private collection of trajes (regional dress) from these groups. Go to Yok Chij, or see the side panel on this site to find out how to make a tour reservation.
2. Stay at Bela's Bed and Breakfast. This is the number one rated B & B on Trip Advisor. She has a lovely centrally-located small B & B that serves a healthy breakfast and regional-type comida (lunch upon request).
   
3. Visit San Juan Chamula and Zinacantan – there is a daily tour from the cross in the plaza in front of the cathedral at 9:30 am. You need merely show up and you will be found by very knowledgeable tour guide Cesár, who will take you to both villages and return you around 2:00 pm.
   
4. Visit Amantenango de Valle and shop for gifts of hand-made and hand-painted pottery. The clay and quartz used for making the pottery is local. On your way back stop to eat in Teopisca at the zocalo in the Restaurante Central and buy their special tostadas de manteca.
5. Visit the Museo de Medicine Maya – the Maya Medicine Museum on the north end of town.
6. Visit el Cañon de Sumidero in Chiapa de Corzo.
7. Visit the Nemi Zapata store that is a cooperative and supports the autonomous communities on Real de Guadalupe pedestrian street.
   
8. Visit Lleñateros cooperative workshop where they make gorgeous paper and books from recycled and homemade paper – they take you on a tour of their facility.
9. Visit Jardines de Orquídeas Moxviquil on the north end of town.
10. Visit Huitepec Ecological Reserve for climbing, walking and birdwatching.