Another event was held for people of the Tercera Edad. A lot of people from the community came, and we did a charla on oral hygiene and practiced relaxation exercises!
--Calla
Sunday, December 20, 2009
Sunday, December 13, 2009
9 December 2009
A couple months ago, Dr. Guerrero called me on a Friday afternoon. Dr. Guerrero is a general surgeon that works in the Gotera Hospital, the hospital closest to the clinic where we work. I got to know Dr. Guerrero after he admitted a few of our patients from the clinic. I told him that I wanted to be a general surgeon like him after medical school, and we immediately hit it off.
This Friday, Dr. Guerrero called to tell me that he would be performing an operation tomorrow in the capital, and I was invited to tag along. I was thrilled and told him I would be on the next bus to Gotera. Two hours later, I arrived at the Gotera hospital as he was finishing his shift in the emergency department.
Dr. Guerrero lives in San Miguel, the largest city in the eastern part of the country and an hour drive from Gotera. We drove to his house and arrived by 6. I met his family, had a glorious dinner, and we were asleep by nine. The next morning we left at six for the capital.
Dr. Guerrero has a private surgical practice and also works in the public health system. He was operating on a private patient this morning in a private clinic. We arrived to the capital around nine and pulled up to the clinic shortly thereafter. The private clinic appeared nothing like the public hospital. The most noticeable difference was the utter lack of patients. My experience thus far in the public health system is that wherever you go, there are already 20 patients waiting in front of you. This private clinic was clean and tranquil.
Shortly after arriving, I introduced myself to the patient, and we changed into our scrubs. Dr. Guerrero was going to remove the patient’s gallbladder laparoscopically, which means he was going to make 3 tiny incisions and operate by using cameras. Laparoscopic surgery is ubiquitous in the United States. The surgery was performed without incident. I was thrilled to be in the operating room again and had a great time.
I have probably seen 20 gallbladders removed in the States. It was interesting to see the same operation in a developing country. Because we were in a private clinic the operation was nearly identical to what I had seen before. The operating theatre was smaller and the equipment was older, but it was essentially the same. Like I said, it was awesome to be back in the operating room. It reminded me how much I want to be a surgeon. After the operation we went out to eat with the anesthesiologist at Biggest, the Salvadorian equivalent to McDonald’s. Three hours later we were back in San Miguel.
Once we got back to Dr. Guerrero’s house he told me that he had to work that same evening and was wondering if I wanted to tag along. I said yes, we had a quick bite to eat, and went to the hospital.
Dr. Guerreo was pulling an all night shift in a social security hospital. This is a hospital somewhere between private and public, and as such it had elements of both. While it was very crowded, the hospital, Dr. Guerrero had access to the medicines he needed and could perform the tests he needed to make a diagnosis. Within minutes of arriving, we raced to another operating room where a surgeon had already begun an operation. He was removing the gallbladder of a woman. Although this was the same surgery that he performed in the private hospital, this operation was a bit different.
The operating room was the size of a large closet with concrete walls. The sterilized instruments were wrapped in old newspaper. The gallbladder was removed through an open incision. Unlike the three small incisions required to remove a gallbladder with laparoscopes, this open procedure required a 15 centimeter incision made across this woman’s abdomen. I had never seen a gallbladder removed in this way in the United States. In fact, there is clear evidence that open removal of a gallbladder is a significantly more morbid operation than with laparoscopes. You need a very good reason to perform this procedure openly in the States. But here in San Miguel, there was no other option. As always, I was thrilled to be in the operating room, but it was difficult to think about how much pain this woman will have and how much greater her risk of infection is because she was poorer.
The lack of laparoscopic procedures in this country is a result of a lack of equipment but also a lack of surgical training. Dr. Guerrero had to go to Europe to get his laparoscopic training. One of my career goals is to practice surgery in a developing country like El Salvador. I see a great need for a well-trained surgeon in a place like this. Besides the opportunity to help a lot of patients, I would also have the opportunity to bring the benefits of laparoscopic surgery.
--Bela
A couple months ago, Dr. Guerrero called me on a Friday afternoon. Dr. Guerrero is a general surgeon that works in the Gotera Hospital, the hospital closest to the clinic where we work. I got to know Dr. Guerrero after he admitted a few of our patients from the clinic. I told him that I wanted to be a general surgeon like him after medical school, and we immediately hit it off.
This Friday, Dr. Guerrero called to tell me that he would be performing an operation tomorrow in the capital, and I was invited to tag along. I was thrilled and told him I would be on the next bus to Gotera. Two hours later, I arrived at the Gotera hospital as he was finishing his shift in the emergency department.
Dr. Guerrero lives in San Miguel, the largest city in the eastern part of the country and an hour drive from Gotera. We drove to his house and arrived by 6. I met his family, had a glorious dinner, and we were asleep by nine. The next morning we left at six for the capital.
Dr. Guerrero has a private surgical practice and also works in the public health system. He was operating on a private patient this morning in a private clinic. We arrived to the capital around nine and pulled up to the clinic shortly thereafter. The private clinic appeared nothing like the public hospital. The most noticeable difference was the utter lack of patients. My experience thus far in the public health system is that wherever you go, there are already 20 patients waiting in front of you. This private clinic was clean and tranquil.
Shortly after arriving, I introduced myself to the patient, and we changed into our scrubs. Dr. Guerrero was going to remove the patient’s gallbladder laparoscopically, which means he was going to make 3 tiny incisions and operate by using cameras. Laparoscopic surgery is ubiquitous in the United States. The surgery was performed without incident. I was thrilled to be in the operating room again and had a great time.
I have probably seen 20 gallbladders removed in the States. It was interesting to see the same operation in a developing country. Because we were in a private clinic the operation was nearly identical to what I had seen before. The operating theatre was smaller and the equipment was older, but it was essentially the same. Like I said, it was awesome to be back in the operating room. It reminded me how much I want to be a surgeon. After the operation we went out to eat with the anesthesiologist at Biggest, the Salvadorian equivalent to McDonald’s. Three hours later we were back in San Miguel.
Once we got back to Dr. Guerrero’s house he told me that he had to work that same evening and was wondering if I wanted to tag along. I said yes, we had a quick bite to eat, and went to the hospital.
Dr. Guerreo was pulling an all night shift in a social security hospital. This is a hospital somewhere between private and public, and as such it had elements of both. While it was very crowded, the hospital, Dr. Guerrero had access to the medicines he needed and could perform the tests he needed to make a diagnosis. Within minutes of arriving, we raced to another operating room where a surgeon had already begun an operation. He was removing the gallbladder of a woman. Although this was the same surgery that he performed in the private hospital, this operation was a bit different.
The operating room was the size of a large closet with concrete walls. The sterilized instruments were wrapped in old newspaper. The gallbladder was removed through an open incision. Unlike the three small incisions required to remove a gallbladder with laparoscopes, this open procedure required a 15 centimeter incision made across this woman’s abdomen. I had never seen a gallbladder removed in this way in the United States. In fact, there is clear evidence that open removal of a gallbladder is a significantly more morbid operation than with laparoscopes. You need a very good reason to perform this procedure openly in the States. But here in San Miguel, there was no other option. As always, I was thrilled to be in the operating room, but it was difficult to think about how much pain this woman will have and how much greater her risk of infection is because she was poorer.
The lack of laparoscopic procedures in this country is a result of a lack of equipment but also a lack of surgical training. Dr. Guerrero had to go to Europe to get his laparoscopic training. One of my career goals is to practice surgery in a developing country like El Salvador. I see a great need for a well-trained surgeon in a place like this. Besides the opportunity to help a lot of patients, I would also have the opportunity to bring the benefits of laparoscopic surgery.
--Bela
12 December 2009
On Thursday night, Rebecca, Neal, Bela and I returned to our house after having an early dinner of beans and tortillas up at the clinic. Bela and I quickly readied ourselves for bed, and crawled under the mosquito netting to read a bit before falling asleep. I am slowly working my way through El General en su Laberinto, by Gabriel Garcia Marquez, and Bela is devouring La Teleraña de Carlota, a book he and I both have fond memories of from our childhoods.
Minutes later, the phone rang. It was Joel, the Doctors for Global Health site director for Estancia, calling to check in with us and discuss clinic happenings over the week. We lumbered out of bed, gathered Neal and Rebecca, and put the phone on speaker. After our conversation with Joel, we stayed at the table to chat a bit more.
Suddenly, something flew by right over our heads. I startled and jumped out of my chair.
“It’s a bat!” Rebecca yelled.
“Oh cool!” Neal responded quickly, as both Rebecca and I scrunched up our faces.
Bela jumped out of his chair, and moved behind me. “You had a rabies shot, so it’d be better if it got you!”
The bat continued to fly in circles around the room, probably becoming more agitated as our voices got louder. Bela explained that in Kenya people shoed bats out of their houses with brooms, and ducked outside to grab one. Neal enthusiastically took the broom from him and ordered us, “Stand back!”
Bela hid in our bedroom, and Rebecca and I cowered in hers, as Neal went to work. He swung at the bat every time it swooshed by. It appeared that we would spend the night watching Neal swing, and the bat fly circles around his head.
Abruptly, I heard a splat, and a dark object whizzed past my head. “Run Rebecca, run!” I yelped as I darted back into the common room and into our bedroom.
“Neal, get it out!” Rebecca exclaimed as she dashed out.
Neal ran in, opened the bedroom window and tried to shove the bat out. He was unsuccessful, however, and the bat flew back into our shared space. Out he charged, more determined than ever to rid the house of the bat. He stood in the center of the room, knees slightly bent, and choked up on the broom. Again, the bat swooped by, and he wound up and swung. I heard a crash, and saw, briefly, as our one and only light bulb exploded and rained down upon Neal, the bat swoop towards the wall.
The sound of glass tinkling on the ceramic floor continued for a few seconds.
“S%$#!” Neal exclaimed, as he tiptoed to his bedroom to grab his headlamp.
“That was amazing!” Bela responded, in awe.
“The bat’s still in here!” Rebecca reminded us.
Neal diligently swept up the glass, remarked that we would all have to be careful about being sure to wear sandals in the house for a few days, and steadied himself to continue the battle against the bat.
A few more swings, and Neal batted the bat out the front door. It landed, stunned, on the front porch. “Come take a look,” Neal said, “I’m going to throw it into the corn field.”
“You didn’t have to kill it,” Rebecca responded, despondently.
“It looks like a rat, or a tipisquintle*!” I remarked upon having a closer look.
“Neal, dude, you should not touch the bat with your bare hands. Get a bag,” suggested Bela.
Neal ran back inside, and covered his hand with a plastic bag. Outside again, he approached the bat, and grabbed for its wing. The bat, obviously recovered, rolled over and flew off. Neal walked back towards us, a smile on his face, clearly the victor.
--Calla
*A tipisquintle is a rat-like mammal that lives near the bank of the river, likes to eat guayabas and the bark of sweet trees, and has sharp enough teeth to kill a dog if it feels threatened.
5 December 2009
A few weeks ago, we went for a hike up a mountain that overlooks Estancia, called El Cerro Pelon. We started early in the morning, with a large group that included Rebecca and Neal, the other volunteer couple, Miguel, in charge of all of the maintenance of the clinic, Juan Carlos, the recent graduate of medical school, and Cesar and Javier, two early adolescent boys who live in Estancia. After a breakfast of plantains, tortillas, and cuajada, a soft cheese, we headed to the bottom of the mountain. After a forty-five minute walk, we began the ascent.
* * *
The mountains around Estancia are of particular historic importance. Many people say that the civil war, which lasted from the late 1970´s until 1992, was fought mostly here. Every family was affected. Some families left under the cover of night to cross the border into Honduras, where they stayed in refugee camps until the end of the 1980´s. Others stayed, but were forced to flee into the hills almost nightly, as bombs dropped from airplanes onto houses and schools. These families took cover in the numerous caves that cut into the mountains. Still others joined the resistance army, and fought against the United States’ trained and funded Salvadorian army.
* * *
The top of the mountain is flat like a table, and, once there, we sat and enjoyed oranges, chocolate, and sweet breads with pink frosting on top called novias. We watched the birds fly below us, and chatted about how small the River Torola looked from so far away.
We descended the mountain around noon, and shortly thereafter the sky broke open and rain poured down. The road back to our house turned to slushy mud, and in parts was covered by water that rose up over our ankles. However, we made it home and dried off. The difficulty of the climb in daylight left me both in awe of and horrified by what the people of Estancia have suffered. They have lived through things that I cannot imagine in nightmares.
--Calla
Sunday, November 29, 2009
17 November 2009
On Monday afternoons, a meeting is held at the clinic for all of the staff of Campesinos para el Desarrollo Humano. Bela and I were getting ready to attend the meeting, when three young children arrived at the clinic in order to talk to Etelvina.
The children explained to Etelvina that their grandmother was having trouble breathing. Etelvina knew the grandmother, and asked the children more about what was happening to her. She had been having fevers, a cough, and shortness of breath. Etelvina decided that rather than sending medicine, it would be better for someone to go to her home to evaluate her. Bela and I had planned on walking to her community in the afternoon to see another patient, after the staff meeting, so we volunteered to go. I walked in to the pharmacy with Etelvina to talk about the patient before going. She sent me with some medicines and also told me a little bit more about the woman.
“She has always had a cough,” Etelvina explained, but she has gotten worse over the past few weeks. She is such a hard worker, and a very strong woman.”
Bela and I left the clinic, saying goodbye to the staff before heading out the door. The three grandchildren led the way, across a cow pasture, down a hill, across the soccer field, and finally we arrived at the river.
“You will have to cross the river on a cable,” the granddaughter smiled at me, “I hope that you won’t be afraid.”
Torola is a large river, with steep banks on either side. There is one bridge that divides the two halves of the community, but many families live far from the bridge. In the past, before the bridge, many people would swim across the river to get to their homes or to visit people who lived on the other side. Now, however, the bridge has become the central crossing point. Additionally, as a source of income, some families have built cable cars which are powered by turning a large hand-made crank. In order to cross the river on the cable, you pay a small fee, and one of the family members will crank you across. This was one of those families. The “car,” however, consisted of a metal plate hooked to a wooden plan by three metal chains. The stops on either end of the river looked rickety, as they were also constructed of wooden planks. The children had no fear of crossing, and the two smallest ones hopped on the plate together. The plate was only large enough for one to sit, and so the boy stood, holding on to the metal chains for support. I was not pleased by the arrangement.
Bela went across next. As he sat on the plate, he turned and flashed a large grin, as if to say “This is going to be really fun, and you are going to hate it.” The crank was turned, and he flew across the river.
As the plate came soaring back across the river, I tried to ready myself. I took off my glasses, adjusted the strap of my purse, and tried to remind myself that my fear of heights is something in my own head. The plate arrived, and I think that the oldest girl noticed that I was nervous. She took my hand, and helped me sit. She took one of my hands, and put it on the metal chain, and rested the other on the wooden support. “Hold on tight!” she yelled as I started to zoom above the river. The trip was like flying.
We regrouped on the other bank, and trudged up towards the house. The grandmother´s son was sitting outside, and guided us inside towards the hammock.
An elderly woman was wrapped inside, breathing quickly through pursed lips. We began to ask questions, but it was clear that she was in distress. Prior to examining her, we asked her and her family how they would feel about taking her to the hospital. They were worried about transportation, and the cost, and so called Ramiro, the director of the NGO. Ramiro is also able to drive, and so often takes patients to the hospital in the CDH pickup truck. We examined the woman, so that we would be able to present the patient to the staff in the hospital. The house was located such that the pickup could not come to the house. No road leads there, and so, in order to bring the woman to the hospital in Gotera, the nearest city, we had to get her across the river. She was weak and had difficulty breathing, but was able to get out the hammock and walk out the door.
Her son and granddaughter were able to help her to the cable car, with difficulty because she had such trouble breathing. We were all wondering how she would possibly get across, but she plopped down on the plate and yelled, “Drive me!” The son complied, and she flew across the river. Her daughter-in-law went next, in order to wait with her. Bela went across next. I took a deep breath when it was my turn to go, and again went soaring across to the opposite bank.
Slowly but surely, the woman was able to trudge across a pasture and across a small stream to an opening in the road that leads out of town and up the hill. Ramiro picked us up, us being the woman, her daughter-in-law, and me. Along the way we picked up her two other daughters who had heard that she was on the way to the hospital. We arrived, and I went in to talk with the physician on-call. He was polite and serious, and came out of the emergency room to help me bring her in. He immediately set up a nebulizer treatment for her, and readied the radiology suite. A half an hour later, based on her clinical history, physical history, and chest X-ray, she was admitted to the hospital with suspected tuberculosis. Ramiro had waited outside of the hospital for me, and so we traveled back to Estancia together.
Saturday, November 21, 2009
16 November 2009
My parents visited us last week. They arrived on a Friday afternoon, and as soon as they arrived in the city we started touring around in the rain. We went to the Museo del Arte Moderno, and had pizza at a little neighborhood restaurant close to the hotel where we stayed. On Saturday we woke up early and took two buses and a pickup truck to a town called Perquin on the Honduran border. We stayed there all weekend, and on Monday we traveled to Estancia.
It was so wonderful to have my parents here for a little while. They were able to meet the staff members of CDH, the NGO for whom we volunteer, and go on home visits with me. My mom toured some community members’ gardens, and my dad hung out with me in the clinic. The night before they left Estancia, Ramiro and Lucia took us all to eat pupusas in a town called Corinto. I think that it will be easier for me to go home at the end of this year after having had them here. I will be able to talk about the people that I miss, and they will know who those people are. I remember that coming home from Ecuador was so much easier than it might have been, because my family had visited me in the town where I lived. I was able to reminisce about people and places, and they understood a little bit about what I was saying in a way that wouldn’t have been possible if they had not visited.
During the morning of the following Friday we began the trip back to the capitol. Griselda, one of our neighbors, accompanied us to Cacaopera, one of the towns along the way, as she had to run some errands related to the next school year. When we arrived in the capitol we went to see the Archeology Museum, and went on some long walks. We ate a delicious dinner that night, and woke up early the next morning to walk some more before my parents left for the airport.
* * * *
As Bela and I were already in the capitol, we decided to go to an event held at the campus of the Universidad de Centro-America. Twenty years ago, during the civil war, six Jesuit priests, the cook, and the cook’s daughter were murdered at night on the campus by the army. The four priests were very active in speaking out against the conditions that led to the civil war in the first place, and were seen as a threat by the right-wing government in control.
The event was beautiful. We arrived at the campus in the afternoon. Students at the university had spent the morning creating murals to commemorate the lives of the priests, the cook, and the daughter out of colored sand. Students worked as volunteer guides at the small museum on campus dedicated to the lives of the priests killed during the war. The university choir sang. After the sun set, a candlelight march took place on the road that runs through the university.
When Bela and I returned to Estancia, I talked with Etelvina, the health promotor, about the event. She explained that one of the priests, Segundo Monte, had visited the refugee camp in Honduras where she lived with her family during most of the war. He gave mass to the people living in the camp, and spoke about the injustices that the El Salvadorian people had suffered, and gave them hope that things would be better in the future. The people in the camp where she lived returned to El Salvador shortly after the murder of the priests, the cook, and the cook’s daughter. Most settled in an area close to Estancia, and as homage to the priest who had given them hope during the war, named the town Segundo Monte. Etelvina also explained that when she fled El Salvador for Honduras, her family traveled in the night, hiding in the woods during the day. They had to cross the river that divides Honduras and El Salvador at a town called Mozote. A few years before, in Mozote, over 1000 people were massacred by the El Salvadorian and Honduran armies while trying to cross the river. She told me that the river still stunk of dead bodies when she crossed, and that the smell is something that she will never forget. However, the return trip was different. After the murders at the University, the people of her camp walked on the roads, during the day, to return. She told me that there was a feeling of strength and unity in the people. The work of the priests, their words, and their violent deaths is still very present in the memory of the people. They are remembered as martyrs.
--Calla
My parents visited us last week. They arrived on a Friday afternoon, and as soon as they arrived in the city we started touring around in the rain. We went to the Museo del Arte Moderno, and had pizza at a little neighborhood restaurant close to the hotel where we stayed. On Saturday we woke up early and took two buses and a pickup truck to a town called Perquin on the Honduran border. We stayed there all weekend, and on Monday we traveled to Estancia.
It was so wonderful to have my parents here for a little while. They were able to meet the staff members of CDH, the NGO for whom we volunteer, and go on home visits with me. My mom toured some community members’ gardens, and my dad hung out with me in the clinic. The night before they left Estancia, Ramiro and Lucia took us all to eat pupusas in a town called Corinto. I think that it will be easier for me to go home at the end of this year after having had them here. I will be able to talk about the people that I miss, and they will know who those people are. I remember that coming home from Ecuador was so much easier than it might have been, because my family had visited me in the town where I lived. I was able to reminisce about people and places, and they understood a little bit about what I was saying in a way that wouldn’t have been possible if they had not visited.
During the morning of the following Friday we began the trip back to the capitol. Griselda, one of our neighbors, accompanied us to Cacaopera, one of the towns along the way, as she had to run some errands related to the next school year. When we arrived in the capitol we went to see the Archeology Museum, and went on some long walks. We ate a delicious dinner that night, and woke up early the next morning to walk some more before my parents left for the airport.
* * * *
As Bela and I were already in the capitol, we decided to go to an event held at the campus of the Universidad de Centro-America. Twenty years ago, during the civil war, six Jesuit priests, the cook, and the cook’s daughter were murdered at night on the campus by the army. The four priests were very active in speaking out against the conditions that led to the civil war in the first place, and were seen as a threat by the right-wing government in control.
The event was beautiful. We arrived at the campus in the afternoon. Students at the university had spent the morning creating murals to commemorate the lives of the priests, the cook, and the daughter out of colored sand. Students worked as volunteer guides at the small museum on campus dedicated to the lives of the priests killed during the war. The university choir sang. After the sun set, a candlelight march took place on the road that runs through the university.
When Bela and I returned to Estancia, I talked with Etelvina, the health promotor, about the event. She explained that one of the priests, Segundo Monte, had visited the refugee camp in Honduras where she lived with her family during most of the war. He gave mass to the people living in the camp, and spoke about the injustices that the El Salvadorian people had suffered, and gave them hope that things would be better in the future. The people in the camp where she lived returned to El Salvador shortly after the murder of the priests, the cook, and the cook’s daughter. Most settled in an area close to Estancia, and as homage to the priest who had given them hope during the war, named the town Segundo Monte. Etelvina also explained that when she fled El Salvador for Honduras, her family traveled in the night, hiding in the woods during the day. They had to cross the river that divides Honduras and El Salvador at a town called Mozote. A few years before, in Mozote, over 1000 people were massacred by the El Salvadorian and Honduran armies while trying to cross the river. She told me that the river still stunk of dead bodies when she crossed, and that the smell is something that she will never forget. However, the return trip was different. After the murders at the University, the people of her camp walked on the roads, during the day, to return. She told me that there was a feeling of strength and unity in the people. The work of the priests, their words, and their violent deaths is still very present in the memory of the people. They are remembered as martyrs.
--Calla
Saturday, October 31, 2009
A statue entitled ´Delirium Tremens´
Having a snack in a leftist coffee shop
Having a snack in a leftist coffee shop31 October 2009
Bela and I spent last week on a quest to renew our visas. We are here in El Salvador on turist visas, and so must renew them every 90 days. El Salvador is a part of a four country agreement with Honduras, Nicaragua, and Guatemala, and so in order to receive a new visa, we needed to travel to either Mexico or Costa Rica. We chose to travel to Chiapas, Mexico, and spent three days in a city called Tapachula, on the border of Chiapas and Guatemala, drinking coffee, reading, and eating spicy enchiladas. It was a nice break, and very interesting for me to see another country.
The day after we arrived back in Estancia a meeting had been planned for us in another community called El Tablon. It is about three hours away from where we are living. In the past, there was a relationship between the NGO for whom we are volunteering and the clinic there. However, a different NGO is now in charge of the clinic in El Tablon. Ramiro, the director of our NGO, is interested in renewing the relationship, and it is possible that in the future between Bela, Neal, Juan Carlos (a recently graduated physician from Estancia who studied in Cuba), and I will be rotating one week a month each in El Tablon, living and working there.
The meeting didn´t actually happen, because the health promotor had left the site to go into town, but we did see the outside of the clinic and volunteer house. Ramiro was frustrated about the cancelation of the meeting, and decided that we should head to the nearest town for street food. When we arrived we found a spot that sold pupusas, a traditional snack, that is made of corn and cheese and fried. We had a great time sharing stories and snacks!
Bela and I spent last week on a quest to renew our visas. We are here in El Salvador on turist visas, and so must renew them every 90 days. El Salvador is a part of a four country agreement with Honduras, Nicaragua, and Guatemala, and so in order to receive a new visa, we needed to travel to either Mexico or Costa Rica. We chose to travel to Chiapas, Mexico, and spent three days in a city called Tapachula, on the border of Chiapas and Guatemala, drinking coffee, reading, and eating spicy enchiladas. It was a nice break, and very interesting for me to see another country.
The day after we arrived back in Estancia a meeting had been planned for us in another community called El Tablon. It is about three hours away from where we are living. In the past, there was a relationship between the NGO for whom we are volunteering and the clinic there. However, a different NGO is now in charge of the clinic in El Tablon. Ramiro, the director of our NGO, is interested in renewing the relationship, and it is possible that in the future between Bela, Neal, Juan Carlos (a recently graduated physician from Estancia who studied in Cuba), and I will be rotating one week a month each in El Tablon, living and working there.
The meeting didn´t actually happen, because the health promotor had left the site to go into town, but we did see the outside of the clinic and volunteer house. Ramiro was frustrated about the cancelation of the meeting, and decided that we should head to the nearest town for street food. When we arrived we found a spot that sold pupusas, a traditional snack, that is made of corn and cheese and fried. We had a great time sharing stories and snacks!
Wednesday, October 28, 2009
19 October 2009
Breakfast in the morning, and the kitchen
As I continue to struggle with the language, I try to take advantage of any free time to study Spanish. This morning I am feeling particularly ambitious and get to clinic at 5.30 a.m. Calla bought me the Rosetta Stone, which I have come to love. I spent this morning studying the preterit tense as the sun rose over Estancia.
Calla ambles up to the clinic about an hour later shouting salutations to anyone who will listen. Neal arrives shortly thereafter, and we begin the morning routine, i.e. cleaning the clinic. The place is clean by seven and breakfast follows. Today is my favorite, oatmeal with fried plantains.
The clinic opens at eight. My first patient is a girl that I already know. Two weeks ago she came in with an infected toe that required an incision and drainage. Today, she has a cold, but her toe looks fantastic. She leaves 30 minutes later with Tylenol, multivitamins and a toothbrush.
The next patient is a 6 month old girl with a fever. When it comes to patients, there is no one that I fear more than a newborn. They are so delicate and precious. The girl´s mother took her to another clinic 2 days ago. The doctor diagnosed her with pneumonia, gave her 2 days of amoxicillin, an antibiotic, and told her to come back in 2 days. Instead, the mother came to CAIPES because it was closer. This situation makes me uncomfortable. I had not seen the girl before, so I could not tell if she was better. I need help and decide to call Dr. Kasper, a pediatrician from Harvard. She makes herself available to the volunteers for consults. Given that the baby lacks any signs of serious respiratory disease, we decide that she does not need to go to the hospital. Since the clinic has run out of amoxicillin, Dr. Kasper recommends an appropriate alternative. I feel comfortable sending the baby home, knowing that the decision was made by an attending pediatrician and not by a medical student.
The following patient is 17 years old and 3 months pregnant. After babies, pregnant women are the second most terrifying patient population. This woman has headaches. I am nervous that she might be developing a serious disease of pregnancy called preeclampsia. Fortunately she has no other signs of the disease and her physical exam was normal. Nonetheless, I am not feel comfortable sending her home solely based on my opinion. I call Dr. Tresler, a family physician from Texas. He agrees that her headaches are most likely an isolated problem and not linked to a more serious disease like preeclampsia. He recommends that she get some basic lab tests to be more certain. I write her a laboratory reference and ask her to return once she had the results.
The remainder of the day passes rather uneventfully. At 2.30, Calla and I head for Jaime´s house. He is a 6 year old boy with cerebral palsy. He lives about 30 minutes from the clinic in a sugar cane shack with a dirt floor. It is sad to see him and think about what his life could be like with adequate medical care. Instead, without speech therapy he can barely speak, without physical therapy he cannot walk, with occupational therapy he cannot even hold a pencil properly. Jaime applied to enter kindergarten last year but was denied access due to his disability. The clinic is rallying around this boy. The director of our NGO is formally petitioning the school to admit him. School starts in January, so our job is to to do all we can to get him physically ready. We spend time reading, drawing and walking. Jaime is a great kid. We will be updating the blog over the next few months with his progress.
From the Annals of Learning Spanish as a Second Language
When asking to pay for our coffee the other day I said: Yo quiero pegarle, which translates into: I want to hit you.
When I first started to see patients at the clinic and wanted to ask them about their bowel movements I said: ¿ Su bebe esta cagando normal?, which translates into: Is your baby sh#@€ing normal? Thank you to Calla for correcting this problem.
Calla ambles up to the clinic about an hour later shouting salutations to anyone who will listen. Neal arrives shortly thereafter, and we begin the morning routine, i.e. cleaning the clinic. The place is clean by seven and breakfast follows. Today is my favorite, oatmeal with fried plantains.
The clinic opens at eight. My first patient is a girl that I already know. Two weeks ago she came in with an infected toe that required an incision and drainage. Today, she has a cold, but her toe looks fantastic. She leaves 30 minutes later with Tylenol, multivitamins and a toothbrush.
The next patient is a 6 month old girl with a fever. When it comes to patients, there is no one that I fear more than a newborn. They are so delicate and precious. The girl´s mother took her to another clinic 2 days ago. The doctor diagnosed her with pneumonia, gave her 2 days of amoxicillin, an antibiotic, and told her to come back in 2 days. Instead, the mother came to CAIPES because it was closer. This situation makes me uncomfortable. I had not seen the girl before, so I could not tell if she was better. I need help and decide to call Dr. Kasper, a pediatrician from Harvard. She makes herself available to the volunteers for consults. Given that the baby lacks any signs of serious respiratory disease, we decide that she does not need to go to the hospital. Since the clinic has run out of amoxicillin, Dr. Kasper recommends an appropriate alternative. I feel comfortable sending the baby home, knowing that the decision was made by an attending pediatrician and not by a medical student.
The following patient is 17 years old and 3 months pregnant. After babies, pregnant women are the second most terrifying patient population. This woman has headaches. I am nervous that she might be developing a serious disease of pregnancy called preeclampsia. Fortunately she has no other signs of the disease and her physical exam was normal. Nonetheless, I am not feel comfortable sending her home solely based on my opinion. I call Dr. Tresler, a family physician from Texas. He agrees that her headaches are most likely an isolated problem and not linked to a more serious disease like preeclampsia. He recommends that she get some basic lab tests to be more certain. I write her a laboratory reference and ask her to return once she had the results.
The remainder of the day passes rather uneventfully. At 2.30, Calla and I head for Jaime´s house. He is a 6 year old boy with cerebral palsy. He lives about 30 minutes from the clinic in a sugar cane shack with a dirt floor. It is sad to see him and think about what his life could be like with adequate medical care. Instead, without speech therapy he can barely speak, without physical therapy he cannot walk, with occupational therapy he cannot even hold a pencil properly. Jaime applied to enter kindergarten last year but was denied access due to his disability. The clinic is rallying around this boy. The director of our NGO is formally petitioning the school to admit him. School starts in January, so our job is to to do all we can to get him physically ready. We spend time reading, drawing and walking. Jaime is a great kid. We will be updating the blog over the next few months with his progress.
From the Annals of Learning Spanish as a Second Language
When asking to pay for our coffee the other day I said: Yo quiero pegarle, which translates into: I want to hit you.
When I first started to see patients at the clinic and wanted to ask them about their bowel movements I said: ¿ Su bebe esta cagando normal?, which translates into: Is your baby sh#@€ing normal? Thank you to Calla for correcting this problem.
Wednesday, October 21, 2009
The day after Calla was stung, Bela decided to wash the clothes. It was a nice treat!
18 October 2009
I am recovering from the scorpion sting. Additionally, since being stung, I have learned quite a bit about scorpion toxins. It seems as though everyone in Estancia has been stung at least once, since they are very common creatures. My neighbors have all told me stories about various stings, with advice about prevention.
Here are a few things that I have learned, both from reading in textbooks and talking to people here:
Scorpions are hunters, and sting to get foot or when they feel threatened. They are creatures that like the dark, and so will hide under sheets, between mattresses and bedframes, in shoes, and in corners. Therefore, in order to prevent being stung, one should always shake out clothing, shoes, and sheets before using. People say that if a scorpion crawls on you, the way to avoid getting stung is to stay very still, because if you move the insect will feel threatened and attack.
Once the scorpion stings, it releases a toxin which has a half-life of twelve hours. That means that after about twenty four hours, a person still has about 25% of the toxin in their system. The toxin causes all sorts of effects, but the most striking is the numbness that occurs in the whole body, including the mouth.
Here is an excerpt from Harrison´s Principles of Internal Medicine (page 2604 of edition 16) about what happens when a person gets stung:
Patients present with restlessness, blurred vision, abnormal eye movements, profuse salivation, lacrimation, rhinorrhea, slurred speech, difficulty in handling secretions, diaphoresis, nausea, and vomiting. Muscle twitching, jerking, and shaking may be mistaken for a seizure. Complications include tachycardia, arrhythmias, hypertension, hyperthermia, rhabdomyolysis, and acidosis. Symptoms progress to maximum severity in about 5 hours and subside within a day or two, although pain and paresthesia can last for weeks.
--Harrison´s.
When a person gets stung by a scorpion, first aid includes applying cold compresses to the site. This helps prevent the toxin from being absorbed. Unfortunately, in Estancia, electricity is lacking, and, therefore, refrigeration is absent. People here are not able to use cold packs, as ice does not exist. Various people mentioned the importance of staying calm and not moving once stung to prevent the toxin traveling in the blood. One family also mentioned a traditional method for preventing the negative effects. You must find and kill the scorpion, open its body, and rub the insides on the site. The family explained that the toxin would then travel back into the body of the scorpion and out of the victim.
I am feeling much better now, as I was stung almost 48 hours ago. However, it was a horrible experience, and I think that I worried Bela quite a bit. The day after being stung, my heart was beating very fast, and Bela repeatedly took my pulse at about 100 beats per minute. I was strangely sweaty and drooly all day long, and every time I ate I bit my tongue or the insides of my cheeks, assumably from my mouth being numb. The silver lining of the story is that as we often see patients who are suffering the effects of scorpion stings, I will be better able to be empathetic about their symptoms now that I have experienced them for myself.
--Calla
I am recovering from the scorpion sting. Additionally, since being stung, I have learned quite a bit about scorpion toxins. It seems as though everyone in Estancia has been stung at least once, since they are very common creatures. My neighbors have all told me stories about various stings, with advice about prevention.
Here are a few things that I have learned, both from reading in textbooks and talking to people here:
Scorpions are hunters, and sting to get foot or when they feel threatened. They are creatures that like the dark, and so will hide under sheets, between mattresses and bedframes, in shoes, and in corners. Therefore, in order to prevent being stung, one should always shake out clothing, shoes, and sheets before using. People say that if a scorpion crawls on you, the way to avoid getting stung is to stay very still, because if you move the insect will feel threatened and attack.
Once the scorpion stings, it releases a toxin which has a half-life of twelve hours. That means that after about twenty four hours, a person still has about 25% of the toxin in their system. The toxin causes all sorts of effects, but the most striking is the numbness that occurs in the whole body, including the mouth.
Here is an excerpt from Harrison´s Principles of Internal Medicine (page 2604 of edition 16) about what happens when a person gets stung:
Patients present with restlessness, blurred vision, abnormal eye movements, profuse salivation, lacrimation, rhinorrhea, slurred speech, difficulty in handling secretions, diaphoresis, nausea, and vomiting. Muscle twitching, jerking, and shaking may be mistaken for a seizure. Complications include tachycardia, arrhythmias, hypertension, hyperthermia, rhabdomyolysis, and acidosis. Symptoms progress to maximum severity in about 5 hours and subside within a day or two, although pain and paresthesia can last for weeks.
--Harrison´s.
When a person gets stung by a scorpion, first aid includes applying cold compresses to the site. This helps prevent the toxin from being absorbed. Unfortunately, in Estancia, electricity is lacking, and, therefore, refrigeration is absent. People here are not able to use cold packs, as ice does not exist. Various people mentioned the importance of staying calm and not moving once stung to prevent the toxin traveling in the blood. One family also mentioned a traditional method for preventing the negative effects. You must find and kill the scorpion, open its body, and rub the insides on the site. The family explained that the toxin would then travel back into the body of the scorpion and out of the victim.
I am feeling much better now, as I was stung almost 48 hours ago. However, it was a horrible experience, and I think that I worried Bela quite a bit. The day after being stung, my heart was beating very fast, and Bela repeatedly took my pulse at about 100 beats per minute. I was strangely sweaty and drooly all day long, and every time I ate I bit my tongue or the insides of my cheeks, assumably from my mouth being numb. The silver lining of the story is that as we often see patients who are suffering the effects of scorpion stings, I will be better able to be empathetic about their symptoms now that I have experienced them for myself.
--Calla
Saturday, October 17, 2009
This is how we de-scorpion the room. Bela works, and Calla kind of helps. 
17 October 2009
Last night I was stung by a scorpion.
I woke up at around midnight because I felt a sharp sting on my leg, not dissimilar to a bee sting. Shortly thereafter, the leg went numb,and the numbness crept up my body to include my arm. I woke Bela up, but by that time my whole body, including my mouth and tongue, were like lead blocks that I couldn´t move.
Bela rolled me off of the bed and onto the floor, and Rebecca and Neal helped to search the room for the offending insect. He or she was never found.
The numbness wore off about four hours later, with a horrible pins and needles sensation in my extremities, and a feeling of vomity nausea in my tummy.
Luckily, however, I am fine today, with just a headache!! Bela and I have renewed our vow to shake out shoes-sheets-pillows-clothes before using any of them.
--Calla
Last night I was stung by a scorpion.
I woke up at around midnight because I felt a sharp sting on my leg, not dissimilar to a bee sting. Shortly thereafter, the leg went numb,and the numbness crept up my body to include my arm. I woke Bela up, but by that time my whole body, including my mouth and tongue, were like lead blocks that I couldn´t move.
Bela rolled me off of the bed and onto the floor, and Rebecca and Neal helped to search the room for the offending insect. He or she was never found.
The numbness wore off about four hours later, with a horrible pins and needles sensation in my extremities, and a feeling of vomity nausea in my tummy.
Luckily, however, I am fine today, with just a headache!! Bela and I have renewed our vow to shake out shoes-sheets-pillows-clothes before using any of them.
--Calla
14 October 2009
On Monday morning, Bela and I went up to the clinic early in the morning to wash some clothes before beginning to sweep and mop the clinic. Neal and Rebecca joined us up at the clinic shortly thereafter, and so short work was made of the morning tasks.
We sat down to a breakfast of fried plantains and coffee, but just as we were starting to eat, Ramiro pulled up in the Campesinos para el Desarrollo Humano pickup truck. A young woman was carried out of the truck and into the clinic by two men and put on one of the clinic beds. We talked with Ramiro briefly, and then the four of us (Ramiro used to work as a health promotor before becoming the director of the NGO) went in to see the patient.
She was a 19 year old girl, four months pregnant, with severe abdominal pain, vomiting, and fever. Her father and husband had thought that she had dengue fever, and so had waited for a few days before coming to the clinic. However, the night before coming in she had gotten much worse, and so had called Ramiro early in the morning. We examined the patient quickly, but decided that she might have appendicitis and would be better served in the hospital. Since Neal had just arrived, we decided that he should go to the hospital to see the process of getting a patient admitted. Bela decided that I should go as well, and that he would stay and see patients in the clinic with Etelvina.
The patient´s father and husband carried her back to the truck. Neal and I hopped in and traveled the forty five minutes to the hospital with the family. Once we arrived, the hospital guard brought us a wheelchair, and I went in to the talk with the nurses and doctor while Neal helped the family wheel the patient in. The doctor took one look at the patient and decided to see her immediately. He wheeled her to an examining room in the emergency department, talked with her and family, and then examined her. After the exam, he asked her not to eat or drink anything, told her that he was afraid she would need surgery, and sent her to get laboratory testing done. After she was admitted, Neal and I traveled back to the clinic.
We arrived at the clinic a little after noon, and ate quickly, because we had planned on presenting a workshop on tuberculosis at one of the neighborhood community meetings. Each month the neighborhoods have a meeting where families discuss community projects, community development, plan events, and occasionally have guests. Etelvina´s husband is the secretary for her community, called Colon, and so we were invited to give a talk there.
We arrived, and the meeting began with some community business. About halfway through the meeting it was our turn to present. We began with introductions and the objectives our talk, and then preceded to perform a sociodrama about a family whose mother had a prolonged talk. Etelvina played herself as the health promotor who helped the patient perform sputum samples, and visited the patient and husband later to make sure the husband performed the test and the patient received her therapy. After the sociodrama we presented the symptoms of tuberculosis using cards on which had attempted to draw examples. After our talk there were a lot of questions from the audience.
The next morning Etelvina told us that the community liked our sociodrama, and we are now making materials for a new workshop, on burn prevention and basic first aid for burns that do occur.
--Calla
On Monday morning, Bela and I went up to the clinic early in the morning to wash some clothes before beginning to sweep and mop the clinic. Neal and Rebecca joined us up at the clinic shortly thereafter, and so short work was made of the morning tasks.
We sat down to a breakfast of fried plantains and coffee, but just as we were starting to eat, Ramiro pulled up in the Campesinos para el Desarrollo Humano pickup truck. A young woman was carried out of the truck and into the clinic by two men and put on one of the clinic beds. We talked with Ramiro briefly, and then the four of us (Ramiro used to work as a health promotor before becoming the director of the NGO) went in to see the patient.
She was a 19 year old girl, four months pregnant, with severe abdominal pain, vomiting, and fever. Her father and husband had thought that she had dengue fever, and so had waited for a few days before coming to the clinic. However, the night before coming in she had gotten much worse, and so had called Ramiro early in the morning. We examined the patient quickly, but decided that she might have appendicitis and would be better served in the hospital. Since Neal had just arrived, we decided that he should go to the hospital to see the process of getting a patient admitted. Bela decided that I should go as well, and that he would stay and see patients in the clinic with Etelvina.
The patient´s father and husband carried her back to the truck. Neal and I hopped in and traveled the forty five minutes to the hospital with the family. Once we arrived, the hospital guard brought us a wheelchair, and I went in to the talk with the nurses and doctor while Neal helped the family wheel the patient in. The doctor took one look at the patient and decided to see her immediately. He wheeled her to an examining room in the emergency department, talked with her and family, and then examined her. After the exam, he asked her not to eat or drink anything, told her that he was afraid she would need surgery, and sent her to get laboratory testing done. After she was admitted, Neal and I traveled back to the clinic.
We arrived at the clinic a little after noon, and ate quickly, because we had planned on presenting a workshop on tuberculosis at one of the neighborhood community meetings. Each month the neighborhoods have a meeting where families discuss community projects, community development, plan events, and occasionally have guests. Etelvina´s husband is the secretary for her community, called Colon, and so we were invited to give a talk there.
We arrived, and the meeting began with some community business. About halfway through the meeting it was our turn to present. We began with introductions and the objectives our talk, and then preceded to perform a sociodrama about a family whose mother had a prolonged talk. Etelvina played herself as the health promotor who helped the patient perform sputum samples, and visited the patient and husband later to make sure the husband performed the test and the patient received her therapy. After the sociodrama we presented the symptoms of tuberculosis using cards on which had attempted to draw examples. After our talk there were a lot of questions from the audience.
The next morning Etelvina told us that the community liked our sociodrama, and we are now making materials for a new workshop, on burn prevention and basic first aid for burns that do occur.
--Calla
Sunday, October 11, 2009
A Typical House in Estancia
8 de Octubre 2009
There are now two new volunteers in Estancia with us. Neal, a fourth year medical student at Tufts, will work with Etelvina and us in the clinic, and Rebecca, his girlfriend, will work on community projects.
Yesterday Etelvina, Neal, Bela and I saw patients in the clinic in the morning. It was an interesting mix of patients for me. A couple of children came in with colds, a woman came in with diarrhea, and a woman came in for a Pap smear. Additionally I saw a woman with headaches and a child with impetigo. I was tidying up the exam room to go eat lunch when Israel, the health promotor in training, came in to talk to me.
Abraham in the community health promotor of the NGO for which we are volunteering. He is in charge of health promotion in 9 communities, and travels every day on foot visiting patients who are sick or children who are malnourished. He was visiting some families in a nearby community in the morning and heard about a very sick patient, a 40 year old man who had been ill for about a year. He went to visit the house, and decided that the man needed more medical attention. He contacted the clinic, and asked Israel to have someone come and visit the man.
Fortuitously, Israel had a meeting in the county seat, Cacaopera, a town a forty minute walk and twenty minute bus ride away. After talking to Abraham and then to Ramiro, the director of the NGO, it was decided that he would take the organization´s pickup truck to drop me off at the top of the hill below which lives the patient. I quickly packed up my stethoscope, opthalmoscope, thermometer, and blood pressure cuff and hopped in the car to go to the patient´s house.
Because it has rained so much lately, parts of the road were difficult to pass in the pickup, and took us awhile to get up to the main highway that leads to Cacaopera. Once on the highway, we drove for awhile before encountering Abraham, the health promotor, who was waiting on the side of the road. We parked the pickup and Israel continued on to Cacaopera, and Abraham and I started the descent to the patient´s house. We took a windy dirt path that led us through a forest and a cornfield on the slope of a hill above a rushing river. Interestly, we passed by the house of the woman whose Pap smear I had performed in the morning, so I stopped to say a quick hello to her before continuing on.
We finally arrived at the house, a cane shack off to the side of a bigger cane shack, where the patient´s family lives. Because he had been sick for so long, the family had decided to have him live apart, so that he would not infect his small children with whatever illness he was suffering from. We stopped and said hello to his wife and daughter, and then continued on to visit the man.
He was a forty year old man who had first become sick in December of last year. He began to lose weight, and started to feel weak, so he was taken to the hospital. He left after one day before tests were performed, because he was afraid of dying in the hospital. He came back home, and then began coughing.
He coughed for months, and continued to lose weight. However, by the end of May, he began to feel better. He started to work again, sewing hammocks, and began to regain his strength. However, by the beginning of August, when the corn harvest is in full swing, he began to cough again. He lost his appetite, and lost weight. Furthermore, he was having fevers that began to happen more and more frequently. Every once in awhile, when he coughed up flem, there was blood in it.
Abraham and I talked to the man for a long time, and then I examined him. Both Abraham and I feared that he might have tuberculosis. His symptoms were troubling, and he looked thin and weak. He coughed up a thick flem frequently when talking with us. We told him of our fear.
The Ministry of Health in El Salvador has a tuberculosis control program. As many people in the area were exposed to tuberculosis during the war, and all children receive the BCG vaccine against tuberculosis, the Ministry uses sputum samples of symptomatic patients to diagnose the illness. The test is complicated—patients must perform three separate samples and deliver them to the health department clinic, which for many patients is over an hour away. Luckily, however, the test and treatment are free.
The man was surprised to hear that we thought he had a disease that could be treated. He had assumed that he was dying from an illness for which there is no cure. He decided that he would like to be tested for tuberculosis, and if positive treated. His biggest goal is to move back into his family´s house, but he did not want to harm his children.
I spent the walk back up the hill hoping that the man would be easily cured, knowing that an easy cure for a disease like tuberculosis is not a reality. Treatment is long and difficult, as patients must take many pills over the course of six to nine months. It is difficult to coordinate in a place like the United States. In a place like here, just the thought is overwhelming. However, there are people like Abraham working hard to treat and prevent illness in the community, and so there is hope that the man will one day return to live with his family.
--Calla
There are now two new volunteers in Estancia with us. Neal, a fourth year medical student at Tufts, will work with Etelvina and us in the clinic, and Rebecca, his girlfriend, will work on community projects.
Yesterday Etelvina, Neal, Bela and I saw patients in the clinic in the morning. It was an interesting mix of patients for me. A couple of children came in with colds, a woman came in with diarrhea, and a woman came in for a Pap smear. Additionally I saw a woman with headaches and a child with impetigo. I was tidying up the exam room to go eat lunch when Israel, the health promotor in training, came in to talk to me.
Abraham in the community health promotor of the NGO for which we are volunteering. He is in charge of health promotion in 9 communities, and travels every day on foot visiting patients who are sick or children who are malnourished. He was visiting some families in a nearby community in the morning and heard about a very sick patient, a 40 year old man who had been ill for about a year. He went to visit the house, and decided that the man needed more medical attention. He contacted the clinic, and asked Israel to have someone come and visit the man.
Fortuitously, Israel had a meeting in the county seat, Cacaopera, a town a forty minute walk and twenty minute bus ride away. After talking to Abraham and then to Ramiro, the director of the NGO, it was decided that he would take the organization´s pickup truck to drop me off at the top of the hill below which lives the patient. I quickly packed up my stethoscope, opthalmoscope, thermometer, and blood pressure cuff and hopped in the car to go to the patient´s house.
Because it has rained so much lately, parts of the road were difficult to pass in the pickup, and took us awhile to get up to the main highway that leads to Cacaopera. Once on the highway, we drove for awhile before encountering Abraham, the health promotor, who was waiting on the side of the road. We parked the pickup and Israel continued on to Cacaopera, and Abraham and I started the descent to the patient´s house. We took a windy dirt path that led us through a forest and a cornfield on the slope of a hill above a rushing river. Interestly, we passed by the house of the woman whose Pap smear I had performed in the morning, so I stopped to say a quick hello to her before continuing on.
We finally arrived at the house, a cane shack off to the side of a bigger cane shack, where the patient´s family lives. Because he had been sick for so long, the family had decided to have him live apart, so that he would not infect his small children with whatever illness he was suffering from. We stopped and said hello to his wife and daughter, and then continued on to visit the man.
He was a forty year old man who had first become sick in December of last year. He began to lose weight, and started to feel weak, so he was taken to the hospital. He left after one day before tests were performed, because he was afraid of dying in the hospital. He came back home, and then began coughing.
He coughed for months, and continued to lose weight. However, by the end of May, he began to feel better. He started to work again, sewing hammocks, and began to regain his strength. However, by the beginning of August, when the corn harvest is in full swing, he began to cough again. He lost his appetite, and lost weight. Furthermore, he was having fevers that began to happen more and more frequently. Every once in awhile, when he coughed up flem, there was blood in it.
Abraham and I talked to the man for a long time, and then I examined him. Both Abraham and I feared that he might have tuberculosis. His symptoms were troubling, and he looked thin and weak. He coughed up a thick flem frequently when talking with us. We told him of our fear.
The Ministry of Health in El Salvador has a tuberculosis control program. As many people in the area were exposed to tuberculosis during the war, and all children receive the BCG vaccine against tuberculosis, the Ministry uses sputum samples of symptomatic patients to diagnose the illness. The test is complicated—patients must perform three separate samples and deliver them to the health department clinic, which for many patients is over an hour away. Luckily, however, the test and treatment are free.
The man was surprised to hear that we thought he had a disease that could be treated. He had assumed that he was dying from an illness for which there is no cure. He decided that he would like to be tested for tuberculosis, and if positive treated. His biggest goal is to move back into his family´s house, but he did not want to harm his children.
I spent the walk back up the hill hoping that the man would be easily cured, knowing that an easy cure for a disease like tuberculosis is not a reality. Treatment is long and difficult, as patients must take many pills over the course of six to nine months. It is difficult to coordinate in a place like the United States. In a place like here, just the thought is overwhelming. However, there are people like Abraham working hard to treat and prevent illness in the community, and so there is hope that the man will one day return to live with his family.
--Calla
Saturday, October 3, 2009
Calla and Etelvina, the health promotor
Calla, Rebecca, the new volunteer, Vicenta, who does massage therapy, and Etelvina
Calla, Etelvina, and Israel, the new health promotor
Clinica CAIPES
Calla, Etelvina, and Israel, the new health promotor
Clinica CAIPES
29 September 2009
I have adapted to the work day routine of the Clinica CAIPES. There is a general schedule, however the quantity of patients ebbs and flows with the rain, as the rain brings more mosquito born illness, and people stay shut up in their houses, allowing illnesses to pass more easily as well.
We wake up in the morning between five thirty and six, with the sun. We have not needed to use an alarm to wake up since arriving. After waking up, each of takes a quick shower. I smear on sunscreen and insect repellent before walking up to the clinic. The walk to the clinic is short, only about five minutes long. Once there, we open the clinic and kitchen doors, and stack the chairs. We mop and sweep the entire clinic, which consists of a small entry way, two rooms in which to see general patients, a small surgery room, and a ¨women´s room¨ with a table designed for gynecologic exams. Additionally there is the pharmacy room and the bodega, where extra medicines are stored. Sweeping and mopping takes about a half an hour, after which we wipe down the exam tables and wash the dishes from the night before. After completing these morning tasks we heat water for coffee and make breakfast.
At eight we start seeing patients. Each patient gets registered in the electronic medical record. Each patient has a paper chart, where daily notes are written, but the electronic system tracks age, weight, some demographic parameters, diagnoses, medicines, and references written. We see patients alongside the health promotor. We first take a history, then take vital signs like pulse, temperature, and blood pressure, and then do a physical exam. We talk about our ideas with the patient, and then step out of the room to make a concrete plan. Making the plan usually involves a discussion, reading more in the textbooks at the clinic, or calling local or international physicians. Once a plan is made, and if we are prescribing medicine, we get the bulk bottles out of the pharmacy and pack the correct number in a baggie, and then write or draw instructions on a sheet of paper inside the bag. If we are prescribing a liquid medicine, like an antibiotic, for a child, we mix the medicine and calculate the dose before handing the patient´s parent the medicine.
We see patients all morning, and usually take a quick lunch break at around one in the afternoon. On most days there are more patients waiting to be seen in the afternoon, and we generally finish seeing the patients by four thirty. After seeing the patients, their information must be entered into the computer and their records filed away. At that point we tidy up for the day, close and lock the clinic and head back home.
Generally in the evenings we hang out with the children who live next door, or sometimes visit other people in the community. It gets dark by six thirty, so at that point we head up to the clinic again to heat up the leftovers on the gas stove from lunch for a quick dinner. We are generally in bed by eight, and will sometimes read by the light of a flashlight before going to sleep.
Special Event for People of the Third Age (Tercera Edad)
After Bela and I arrived, the clinic held an event for anyone in the community over age 65. People were invited via word of mouth and by home visits from the community health promoters.
On the day of the event, a Peace Corps volunteer from a neighboring community, three hours away, arrived and gave a charla about natural ways to relieve arthritic pain. She did a wonderful job. Her charla was interactive, and everyone in attendance participated in stretching exercises. After her charla, we moved to the lawn in the back of the clinic for music and dancing! The local band, four men who have played music together since they were young, played traditional songs. We danced and sang. The clinic chef, Niña Francisca, made sweet plantains and chocolate atol, a drink made of corn meal, for everyone. It was great fun and a great way to meet people in the community.
I have adapted to the work day routine of the Clinica CAIPES. There is a general schedule, however the quantity of patients ebbs and flows with the rain, as the rain brings more mosquito born illness, and people stay shut up in their houses, allowing illnesses to pass more easily as well.
We wake up in the morning between five thirty and six, with the sun. We have not needed to use an alarm to wake up since arriving. After waking up, each of takes a quick shower. I smear on sunscreen and insect repellent before walking up to the clinic. The walk to the clinic is short, only about five minutes long. Once there, we open the clinic and kitchen doors, and stack the chairs. We mop and sweep the entire clinic, which consists of a small entry way, two rooms in which to see general patients, a small surgery room, and a ¨women´s room¨ with a table designed for gynecologic exams. Additionally there is the pharmacy room and the bodega, where extra medicines are stored. Sweeping and mopping takes about a half an hour, after which we wipe down the exam tables and wash the dishes from the night before. After completing these morning tasks we heat water for coffee and make breakfast.
At eight we start seeing patients. Each patient gets registered in the electronic medical record. Each patient has a paper chart, where daily notes are written, but the electronic system tracks age, weight, some demographic parameters, diagnoses, medicines, and references written. We see patients alongside the health promotor. We first take a history, then take vital signs like pulse, temperature, and blood pressure, and then do a physical exam. We talk about our ideas with the patient, and then step out of the room to make a concrete plan. Making the plan usually involves a discussion, reading more in the textbooks at the clinic, or calling local or international physicians. Once a plan is made, and if we are prescribing medicine, we get the bulk bottles out of the pharmacy and pack the correct number in a baggie, and then write or draw instructions on a sheet of paper inside the bag. If we are prescribing a liquid medicine, like an antibiotic, for a child, we mix the medicine and calculate the dose before handing the patient´s parent the medicine.
We see patients all morning, and usually take a quick lunch break at around one in the afternoon. On most days there are more patients waiting to be seen in the afternoon, and we generally finish seeing the patients by four thirty. After seeing the patients, their information must be entered into the computer and their records filed away. At that point we tidy up for the day, close and lock the clinic and head back home.
Generally in the evenings we hang out with the children who live next door, or sometimes visit other people in the community. It gets dark by six thirty, so at that point we head up to the clinic again to heat up the leftovers on the gas stove from lunch for a quick dinner. We are generally in bed by eight, and will sometimes read by the light of a flashlight before going to sleep.
Special Event for People of the Third Age (Tercera Edad)
After Bela and I arrived, the clinic held an event for anyone in the community over age 65. People were invited via word of mouth and by home visits from the community health promoters.
On the day of the event, a Peace Corps volunteer from a neighboring community, three hours away, arrived and gave a charla about natural ways to relieve arthritic pain. She did a wonderful job. Her charla was interactive, and everyone in attendance participated in stretching exercises. After her charla, we moved to the lawn in the back of the clinic for music and dancing! The local band, four men who have played music together since they were young, played traditional songs. We danced and sang. The clinic chef, Niña Francisca, made sweet plantains and chocolate atol, a drink made of corn meal, for everyone. It was great fun and a great way to meet people in the community.
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