Monday, January 12, 2009

Back In Action- Village of St. Matthews

A giant game of Uno was the last thing we did last night on the deck overlooking San Ignacio... it was the perfect end to the weekend.
We had to put our nursing caps back on today after a weekend of extreme adventure. We got a late start to the day and were a little set back by the rain.

We were quickly back in action...

Despite a high fever and severe strep throat, leave it to Ellie to still have a bright smile, work hard, and get the job done.
And leave it to Matt to charm the villagers into bringing back a pair of pet monkies.
Myself, both in the role of nurse and journalist...

In one of my interviews with one of village leaders named Noella I found out about a woman suffering from severe diabetes. Her diabetes had gotten so out of control that doctors were going to amputate her foot, before they could, she ran away from the hospital. Now, she is being non compliant with her medications and her chidren are sick. I told Noella that we needed to go see her now. Stepho, Sara, and I loaded up and made a home visit to their tiny little shack. When the woman removed the bandages on her foot we were amazed at the damage her severe diabetes had inflicted...

The woman whose name was Severa Cassola had a terrible ulcer on her foot. Her daughter Delsie had a fever over 102 degrees, was peeing infrequently, and had severe abdominal cramps.

When we tested the mother’s blood glucose levels, they were enormously elevated. Her levels were so high that the machine couldn’t even read tally the number, it just said HI. We were testing people in the upper 500’s so we know her levels were at least that. Getting to the hospital was an emergency for this woman. The diabetic ulcer on her foot was severe. We decided it was a stage 3 ulcer where pieces of tissue had become necrotic and even bugs were in the tissue.

How long must it take for a wound like that to heal, especially for someone in her condition? She has dirt floors that by the end of the rainy day were covered in about 2 inches of water, she has limited access to clean and sterile dressings, limited access to medications, and this woman still had 6 kids to take care of. We had to explain to the woman that she needed to go to the hospital immediately. If she didn’t get insulin in her immediately and get her foot treated she was at risk for dying. We had to tell her that she might die and that she could live with only one foot if needed. Her response, carried through a translator, made it clear she would rather die with both feet than live with one. She cried, saying she was scared and didn’t want to go. She was afraid the doctors would decide to amputate her foot again. We promised we would go with her to the hospital and help her get the medication she needed. Eventually, we helped her get ready and she let us transport her to the hospital.

Holding her daughters hand the entire ride to Belopan, you could tell both were scared.

The hospital in Belmopan is like an abandoned 1920’s hospital that suddenly came back to life… long hallways, lined with shutters, and old tile floors. We were able to get right into the emergency room. We were working amongst the nurses and doctors that actually worked there. It was amazing… working side by side with another professional from another culture, another nation, never having met one another before and still getting the job done.

What they have available at the hospital there is limited… very few gloves, very little antibiotic ointment (in fact they often put brown sugar into wounds to help granulation and healing take place), limited amounts of medications, and limited equipment. As a matter of fact, when the little girl who we had also admitted into the emergency room needed an ultrasound, they had no such machine. We had to go to a nearby clinic where we had to pony up the money to help pay for her procedure ourselves. That makes me sad because I know there are so many hospitals in our area back home that have wonderful equipment like ultrasounds that are frequently replaced just to get the newest and most update technology. I’d like to find a way to get the Belmopan Hospital an ultrasound. The hospital also has only one glucometer and no strips to use in it. That means that they have to do a blood test that takes about 3 hours to find blood glucose levels. The rest of her blood work would take up to 3 days to get back. It was hard for me to believe that in my backpack I had more specialized equipment than a hospital had. I’d like to see a small organization perhaps a rotary group, a Girl Scout troupe or another action group to take the role of supplying monthly glucose strips to the hospital. We are leaving a bunch of strips when we depart and a handful of additional monitors.

In the end, the doctors treated Severa with an immediate bolus of insulin, put in an IV, and brought her blood sugar levels back down to a level the machine we left them with could read and not be off the charts. It was also a level safe enough for her to return home on a new medication regiment. The little girl received a shot of pain reliever and fever reducer in her rear. When she didn’t want the shot, the doctor just grabbed her up and forced her to get the shot- something you’d probably never see in the states. Her ultrasound came back negative and her urine sample came up showing she had a raging UTI that had quite possibly early onset into her kidneys.

The whole thing was hard in particular for Steph O… hard having to leave the little girl and her mother in the hands of the hospital and dealing with the frustration of failing accessibility to resources. PZ, the great leader, teacher, and mentor of the group was the most solid rock for Steph O that day. It’s amazing to see how one teacher can become such an inspiration to 13 hungry minds and still stay emotionally recharged enough to take jungle medicine to a whole new level. You see something like today and you realize you just have to let go. There are doctors in Belize, there are nurses in Belize, and there are other people who care. Often times all we can do is make connections from people and the resources they need. Many times what we are offering is the gift of hope… the gift of knowing that someone cares, the gift of believing there may be a better tomorrow, the gift of knowledge in how to take responsibility an care of their own health.

One of our leaders here Adrian made a very profound statement last night. He said, we can only do so much to heal the body, but we can always reach in and touch another’s soul. Adrian read that during an exercise PZ had us all working on for our daily debrief. We all had to free write for about 15 minutes about our experience so far. Then we switched papers and went around reading them. It was inspiring, beautiful, and brought tears to many eyes.


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