Because of our extended lunch break yesterday, visiting gardens and greenhouses, we saw fewer patients than planned, 64 children and 53 adults. The physicians who are reading this are probably aghast that we would consider these numbers low. Mary’s comment of providing less than a Band-Aid sometimes feels uncomfortably true. However, one of the house calls we made today was on a man in his 40’s who had suffered a stroke two years ago. Although he had received acute care, the family had long ago run out of resources to continue seeing doctors or therapists or to buy medication for his high blood pressure. He lives with his wife and four children and has no loss of speech or cognition. After taking a history and finishing her exam, Mary gathered the patient, his wife and grown son and had a frank discussion about the likelihood of a second stroke unless his blood pressure was under better control. We left him with aspirin and an antihypertensive and a list of lower cost medications. At a minimum he will be able to continue the aspirin. Mary made a real difference for this man and his family in that they now understand what happened to him and why taking the medication is important. Before her visit all was a mystery.
I think we touch many people in small ways on these trips. This time, in response to an email sent out at my former practice, Northampton Area Pediatrics, and requests to friends, Mary and I took 75 pairs of reading and sunglasses with us. Any patient who said they had trouble with vision and who didn’t have cataracts or some other problem that reading glasses wouldn’t fix, was sent to a local volunteer who had a local paper and a pile of glasses arranged by strength. The patient would pick out some glasses and read or look at the letters, switching glasses until they found a pair that worked. The exclamations of amazement coming from the “lenses corner” could be heard even above the chatter of the waiting children. I gave out three pair to pre-teens who complained of trouble reading, and they were delighted. I’m so grateful to those of you who donated your unused glasses. It may have seemed a small thing, but it brought joy to the recipients. I have some wonderful photos of young and old trying on and showing off their new glasses, so when I get to a useable WIFI, I’ll upload them to Picasa.
After another cold night, improved by the extra blankets but definitely not cozy, we were all up and ready to go by 5:30 when the trucks and cats set up their choruses. Departure time wasn’t until 7:00am so I used the time to go through photos and work on Word documents for the Blog. We stopped for breakfast at Marcos’ house and were surprised to find a big bowl of, wait for it, Fruit Loops on the table. Obviously they were trying hard not to give us the same thing every day, but Fruit Loops?? There was a pitcher of hot milk to pour over them and we each had a big mug of Encaparina, a milkly wheat based cereal drink that is usually given to babies. It tastes like milky cream of wheat – delicious actually. Bette made sure to get a photo of Mary eating Fruit Loops to send to her boys as blackmail as they had been a forbidden food in the Rappazzo-Hall household.
Both Mary and I had some interesting patients today although interesting often translates into tragic when there are no resources to care for the patient. A very sad example was a 19 year old young woman I saw who was completely healthy until two years ago. Her parents carried her in and gently settled her in a chair and wrapped a blanket around her. She was very thin and pale and trembling with pain. Her father explained that she had been active and athletic when she began to develop pain in her legs. They saw several doctors but received no diagnosis until six months ago when it became clear that she had rheumatoid arthritis. She was treated briefly with prednisone, but the family couldn’t afford more visits or medication. Now, she has severe arthritis with involvement of all of her joints. Her hips and knees are frozen at 90 degrees, her hands are rigid, her jaw barely opens. In the US there are now biological that are changing the lives of patients with severe arthritis, but here in Guatemala, for a patient living in poverty, there is nothing. I brought Mary in and we ended up giving the girl Medrol. Mary will see if she can obtain Methotrexate for her on a compassionate basis, but there is already much damage to the joints.
Next I saw a 17 year old boy who came in with his father. He had been treated the year before for hypertension and “inflamed kidneys,” but had stopped visits and medication due to lack of money. He was having headaches and fever
And back pain, so he came in to be checked. His blood pressure was very high and he had tenderness over his kidneys and pain on urination. I again relied on Mary’s expertise and we discussed hypertension with the boy and his father – the reasons why he needed to stay on medication and continue follow up. He left with medications for his hypertension and infection and I hope he will continue both. The big problem here is that people who have chronic conditions, diabetes, hypertension, arthritis, who need medication for life, just can’t afford it. They buy it for as long as they are able, and then they stop. Food comes first, then shelter, clothing, and if there is anything left, maybe medicine.
Mid-afternoon, a comatose 17 year old girl was carried in by her frantic family members. The jumbled story was that she was prone to some sort of “spells,” and a natural healer came to the house regularly to give her injections of vitamins. She usually felt much better after these injections, and had received one the night before. This morning, she “slept in,” and this afternoon, they couldn’t wake her. She was completely unresponsive, even to deep pain, limp and floppy. She was breathing and had her protective reflexes and the family was, of course very reluctant to take her to the hospital. After some discussion, we agreed they could watch her for four hours and if she had not wakened they would take her to the hospital. I assume she woke up as we heard no more. I wish I know what was in that shot!
On a lighter note, there are a couple of very nice customs in Guatemala. The first is (and I apologize if I’m repeating myself,) the youngest son in the family is charged with greeting each guest personally. Each day when we come to Marcus’ home, the 8 year old son greets each of us with a handshake and “Buenos Días”, shyly but politely. The second is that even very young toddlers are taught to greet people by coming over and bowing their heads. Many times when a family entered the exam room, the mother would urge the two or three year old forward to bow a greeting to us. They stay bowed and silent until their greeting is acknowledged. It’s very sweet.
Two final stories and then I’m done: I saw two brothers, 8 and 9 years old. The history given by the mother was that they both had pain in their entire bodies all the time, weakness and fatigue, and yellow eyes since they were toddlers. It was there every day, at rest or while active. I examined them both carefully while they competed to see who could climb up and down from the exam table the fastest, who could slither off the table while I tried to listen to their hearts with the most finesse and who could jump the highest when I asked them to try. They were both a bit chubby and though I looked very hard, I couldn’t find a speck of yellow in their eyes. I had to tell their mother that despite their past history they looked healthy today, Great News!! She left a bit disappointed.
Finally, I saw two kids today who complained of headaches and “burning eyes” when they were reading at school or doing homework. They tried on various pairs of the donated reading glasses and picked their favorites. I have some great photos of them that I’ll post when I have WIFI.
That’s it for now. More tomorrow.
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