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’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.
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.