into the communities

I spent one of my last weeks in February in a series of small communities on the edge of the Sierra mountains and over an hour off the paved road ways. To get there the health promoters I had gone to support and I hung on to the back of pick-up trucks as we spun around the curves and through the dust of yet another part of Chiapas that has only had electricity for three years. As there is a deprivation of medical attention, we set up shop in three small towns and worked for about 6 days. At my insistence, the health promoters set up consult rooms in their homes or in mud-brick houses with an examination bed and a desk. They stayed with me to take blood pressures and I talked to them about the patients’ medical conditions.

It was really a pleasure to support the health promoters by showing the communities that they are working with a doctor and to see them taking such good notes on my questions and on the differential diagnoses I had discussed with them. In all of the communities, families cooked for us and gave us a place to sleep. The real adventures of the day revolved around the 1-2 hour long hikes, hitchhikes, and walks to the nearest city’s phone to call Ines.

Also, there were a few house calls we made into the mountains. Often, to my surprise, patients would come in with ultrasound results and medicines from other doctors. The people of those communities have a lot of faith in the Guatemalan doctors. One theory on why that is is that the Guatemalan doctors prescribe more medicines and injections than even the Chiapan doctors. Many patients want injections and vitamins. They trust injections more than pills in fact and it is very hard to get them to change. I saw many people with chronic back problems, unsolved colitis symptoms, and rashes that come and go since the hurricane. The rashes I hypothesized were due to the dirty water they are filling their buckets to bathe with. The colitis had already been treated with a buffet of medicines for everything parasites to bacteria so the best I could do was to tell them to avoid the troubling foods. The back pains and aching feet are a more difficult problem. These people do more physical labor than most of us with poorer conditions and the only real solution is a package of painkillers and a long cruise vacation, neither of which I could sufficiently offer.

The whole trip was very educational and I will most likely go back to support the health promoters in march.