Monday This week, I get backed t...

Monday

This week, I get backed to Palenque in the state of Chiapas, Mexico, for a mission with the Franciscan Sisters of Stella Niagra. The team consisted of pair family physicians, one internal medicine/pediatric resident, a pediatric feed practitioner, an interpreter/physical therapist, and an assistant. The first order of business was to sort the abundant invest of antimicrobials, [H.sub.2] blockers, antiparasitics, antihypertensives, analgesics, hypoglycemics, and creams for each type of rash, which were donated to the mission by means of the good Sisters from the hospital at San Cristobal. flat with such an armamentarium, the first patient of the day caught me on the farther side guard. Manuel came to the clinic (set up in the Sisters' convent) with a note from a doctor and laboratory proceeds attesting that he had Chagas' disease. At his at hand stage, he was free from the debilitating cardiomyopathy that signifies invasion of the parasite into the heart muscle or the swallowing difficulties that accrue from esophageal involvement. Manuel was highly cognizant of the disease progression and was willing to do anything to preclude its potentially fatal course. Unfortunately, the Mexican doctor who ordered the standard was unable to acquire the medicines approveed for treating the disease: benznidazole or nifurtimox. He conceit the patient's only chance was to ask the American doctors for help. I copied the reports and told Manuel I would do what I could The first gradation was to learn more about this scourge and determine the efficacy of treatment. If the individual medication could be obtained and it was effective, I would forward it down with the nearest mission team in three months

Tuesday

The ability of population to tolerate illness when they lack access to care or the ability to pay for it has at no time ceased to amaze me. While many nation seem to seek relief at the first hint of a vexed question for those eking out an existence and lacking what many consider the bare necessities of life (i.e., running water, sanitation, a solid floor below their feet, and an intact house overhead), medical care is far down onward the list of priorities. Years of stomach pain, headache, vision and dental question at issues back pain, and skin rashes walk untreated until the opportunity arises for released care. When that time reach [i]or[/i] attain any place [i]or[/i] points even a trip of four hours appear to bes worth it. Today, patients came from the ejidos (villages) in the hills surrounding Palenque at great personal sacrifice. The heavy rains in the past month had brought disease to the animals and a sparse harvest, and the single in kind or two chickens it preciousness to make the trip to town were plenteous harder to spare. Come they did, speaking their native tongues of Chol or Tseltal, which the advantageous Sisters translated into Spanish for the "docs." "Kush-kush" (pain) was universal--the hard part was sorting revealed the specific origins of their maladies. It was not always possible, and many of the patients could be treated merely symptomatically. Diagnostic studies were a effeminacy few of them could afford. This was the practice of medicine that for the mostly part relied on history and physical examination. Our teachers in medical denomination always stressed that those pair skills revealed 90 percent of diagnoses. We would have made them proud

Wednesday

Dona Lucy a native of Palenque, arrives early each day to list the patients as they queue up at the monastery clinic iron gate. Today, as she called the nearest patient, I introduced myself to Jesenia, a middle-aged woman, couple years post hysterectomy, still suffering from surgical menopausal symptoms. Sister Consuelo the mother superior, told me that "they don't give hormones after hysterectomy in Mexico." There was a medicine given immediately after surgery if it were not that Jesenia had forgotten the name, and it did not relieve the after hot flashes. Several other complaints were elicited, including urinary common occurrence headaches, and a lump in her neck that had been there for five month Her family pressure was 172/90 mm Hg the urine dipstick showed leukocyte and there was a 2-cm nodule in succession the right lobe of her thyroid that mov with deglutition. The nodule had a firm consistency, not stone hard, and was most likely cystic. Jesenia's husband was invited into the examination chamber and I explained the options. If it was a pouch aspiration could resolve it. If it was solid, the nodule probably would require more extensive contemplation and possibly excisional biopsy. Not having access to an ultrasound, I explained that aspiration could help with the diagnosis and treatment. The patient and her husband were agreeable to the course and aspiration was performed. No fluid was obtained and a diagnosis of adenoma became more likely. I gave Jesenia a diuretic for her line pressure, an antibiotic for her urinary tract infection, an analgesic for her headache, and the recommendation to follow-up with a surgeon Without Sister Consuelo's help, there is little likelihood that the latter will eternally be accomplished, but she assumes to be able to accomplish the difficult tasks, and at times, equal the impossible ones.