Archive for September, 2007
For the last 13 years, the Zapatista movement of the indigenous people of Chiapas has attained global recognition as a preeminent people’s movement for open and representative government, basic human rights and respect for the Earth and all its people. While many know the story, few have experienced first-hand their daily struggle to survive in extreme poverty all the while maintaining their fight for land, respect, food, and the freedom to live by their culture.
Shipra and I were invited by Dr. Juan Manuel, a local physician we have close contact with, and Mere, a “promator” (community health worker), to travel to a Zapatista community in the hills of Chiapas. This, in short, is what we did:
- Meet Juan Manuel and Mere in front of Hospital San Carlos at 8am.
- Travel by “collectivo” (shared van) from Altamirano through valleys and cloud forest to Ocosingo
- Traverse bustling market, carniceria, and shops in Ocosingo
- Eat tamales and atole (milk and corn drink) for breakfast
- Leave Ocosingo by “combi” (covered truck), and speak at length with Juan Manuel about Mexican history and history of the Zapatista movement
- Pass military checkpoint, no hassle
- Arrive at Municipio Autónoma Olga Isabel, a large Zapatista enclave
- Met many Tzetzal “coordinadoras”, indigenous women from many pueblos in the area who lead and organize around the movement. They lead the Zapatista “communidades en resistencia” (communities in resistance). They speak Tzetzal, an indigenous dialect, and little Spanish, making introductions difficult.
- With Mere, ride “combi” up bumpy dirt road to trail head and hike uphill through jungle and pine forests. Dodge a black snake. Stunning valley views.
- Arrive at Campanawiitz, a small indigenous village of several wood, tin-roofed, dirt-floored huts.
- Mere and Solomon, local promator, administer vaccinations in Solomon’s home as Shipra and I entertain the children with hand puppets and silly faces. Children and adults curious of us. Farm animals abound – chicks, dogs, a pig. Small black and white TV, decorations with tricolores (Mexico’s red, white, and green) and with health education posters made by Solomon. Solomon’s wife cooks lunch in adjacent hut, the air thick with the fire’s smoke.
- Lunch with Mere and Solomon of homemade corn tortillas, rice and black beans.
- Shipra and I examine Solomon’s sister pregnant at 38 weeks (baby’s heart sounds perfect, head down) and father suffering from osteoarthritis, we think.
- Hike back to dirt road along a ridge with valley views, through corn and bean fields and several cows grazing.
- Ride combi filled with lumber back to Olga Isabel where we speak with several Swiss human rights workers invited there to witness the Zapatista struggle as observers. We watch a DVD on the Zapatista movement. It begins to rain.
- Take short combi ride through the night to Chilón, a nearby town, where we sleep at the gorgeous home of Nely, a “partera” (midwife) and friend of Juan Manuel.
- Eat heuvos rancheros and Juan Manuel sees a patient as Shipra and I explore the fantastic hilltop views of Chilón.
- Return to Olga Isabel. Juan Manuel sees patients at Clínica Autónoma Municipal, Shipra helps the women bake bread, I chat with the men and shoot basketball. It is a warm, sunny day.
- Two more combi rides: one from Olga Isabel to Ocosingo (2 military stops this time, no issues) and then from Ocosingo to Altamirano and home.
- Happily home and grateful for the incredible experience, we eat, shower (after 2 days), and go to sleep.
As hard as it is to tear my thoughts away from the fantastic cultural journey I’m on, I think I owe it to myself to discuss the reason I am/we are here: to provide medical care to the people of Altamirano, Chiapas.
The pathology and variety of disease seen out here in rural Mexico is not as surprising as is the ability to practice modern, mainstream medicine, of course with limitations, in a place where one’d expect very very little of anything. I am grateful to the Sisters of Hospital San Carlos and those generous folk, physician or otherwise, who’ve come before me and helped bring this, and my experience in it, into reality. I marvel at diagnosing and treating relatively common ailments at least as I’ve been working in the pediatric ward here: bronquiolitis, neumonia, trauma, abscesos y celulitis, recien nacidos eutroficos y hipotroficos (full term and premie newborn babies). In a place where I expected close to nothing, I’ve found so much. Mexico is a land of plenty and of wealth, but of various sorts you might not anticipate.
My first patient was Jose Maria, a charming 3½ year-old boy. He had been admitted 5 days prior to my arrival with a hugely swollen, red and painful right pinna, the conch shell-shaped, floppy outer portion of the ear. He had been seen at an outside clinic and received antibiotics to no avail. What could have certainly been a simple outer ear or skin infection had developed into a serious infection of his ear cartilage – perichondritis (pericondritis en Espanol – See, Spanish no es tan dificil!). This condition can be very challenging to treat given the nature of the tissue itself: cartilage has very little blood flowing through it, and blood carries, among other precious things, antibiotics. If you’ve ever had your ear or nose pierced, you’d notice how while it may hurt like all heck, it bleeds very little (Big ol’ nerve endings, teeny lil’ blood vessels). That said, perichondritis requires up to 2 weeks of intravenous antibiotic, one that can eradicate, among other more common skin bacteria, a nasty little bugger called Pseudomonas, a common organism in this condition. Jose was started on an anti-Pseudomonal medication – Ceftazidime – plus another called Gentamicin for its synergistic effects with other antibiotics. Here, in a rural Mexican hospital, Jose was receiving exactly the treatment regimen he’d be receiving in any American hospital. Fascinating.
As with many things here, though, aside from maybe thunderstorms and black beans and rice, resources are limited. As one might expect, powerful, specialized antibiotics such as Ceftazidime are in short supply. Thus, after 7 days of treatment, Jose Maria consumed into his tiny vessels the entire hospital supply of the ear-saving serum. We continued the other antibiotic and since he made such great clinical improvement throughout his stay, we let him go home early to enjoy his family and his new and improved ear.
Jose Maria on the mend
Jose’s improvement and cheery mood leant for a more treasured and therapeutic plan: the bond of doctor and patient. Jose is a sweet, smiling young boy as you can see. I lucked out as I got to him as he was feeling better so I reaped the dividends of another’s poking and prodding. We joked, played, shared coloring time and he and his family were kind enough to sit for these pictures.
Ready for home
Originally uploaded by daprovocateur
Funny, aside from a few technological gaps in his care, of important but not of critical value, I could imagine the same scenario playing out in the States.
This is my first journal entry and first blog post from Chiapas, Mexico. Today is September 4, 2007. These thoughts were written en route from Los Angeles to Mexico City, the first leg of my journey but were realized today when we arrived in Altamirano, site of Hospital San Carlos and our home for the next 2 weeks. More to come. Enjoy!
You’ve seen her image before: a dark round face. a stout but solid frame. Her body cocooned by colors of all kinds: a patchwork of red and gold stripes, bright green and blue hues, beads and other shiny accents. You may recognize her from the cover of a magazine, maybe National Geographic, or your favorite cable travel channel, but never would you ever expect her to enter your world, to see her and her many children in tow strolling your sidewalk or perusing the aisle of your local grocery. Never in a million years.
Now, flip the image.
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