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
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