Archive for October, 2006

Clinic thoughts, Chiapas  

Posted in Liveblogging from Chiapas at 12:25 am by Anje Van Berckelaer

8/29/06 I am getting tired of eggs for breakfast and have gotten a box of bran flakes in town. My teammates make (gentle) fun of me. Consulta externa. Giardia, otitis media, gingivitis, allergic rhinitis, probable fibroids. On the inpatient service, a 33-year-old man with a heart the size of a large cantaloupe. PMI visible where you would normally look for the spleen. Another woman with multiple liver masses.

8/30/06 In clinic, lots of abdominal pain, fibroids, neurocysticercosis, prenatal care. What to do with a positive brucella antibody from an outside lab? Who ordered it? The woman is well, without complaints.

9/2/06 Post-call. I’ve learned a new word: keraunographic markings. The characteristic pattern lightning leaves on skin. A seventeen-year-old girl was struck by lightning. I’ve never dealt with this before. Quick consultation with the books: the girl’s story matches nearly word for word. Loss of consciousness, transient swelling of the legs. Her hair is burned where she was struck. Terrified. Her seventy-year-old grandmother, who weighs marginally more than a healthy nine-year-old American child, is speechless, and I am grateful she was not struck herself. I don’t think she would have survived.

Later that night, an 18-year-old girl I’m convinced has congenital hypothyroidism comes in, hugely distended. A plain film reveals loops of colon 12 centimeters in diameter. At 11:30 pm, I call the surgeon, an insomniac who had finally fallen asleep, and feel guilty for waking him. I’m wondering: ascaris? Volvulus? Adhesions? The next day, he operates, and it’s a megacolon of unknown etiology. I marvel at the care her father gives her. She cannot communicate, first walked at the age of 13, and only on her good days. He holds her, carries her, whispers encouragement. He sleeps at her bedside, on the floor, like many family members at Hosp. San Carlos.

9/6/06 We fell, one by one, to the “venganza de Moctezuma.” The case of traveller’s diarrhea that hit Mark made its rounds through half the team. We blamed fruit, water, our own underchallenged immune systems. A few doses of Cipro later, we were back on our feet.

The two weeks passed quickly. From the distant vantage point of our supremely overweight nation, it’s hard to believe that people can be so malnourished, that their illnesses can be so ignored.

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