Wow--today was certainly action-packed! After another breakfast of toasted bread and chocolate milk, Ana and I literally set out to conquer the world. Our morning started out on the wrong foot, however. Yesterday, we bought Maribel Dulce five oranges and a pineapple as a thank you gift. This morning, we awoke to find that she had cut up four of the oranges in halves for us to eat with breakfast. Turns out that she had one orange last night (which, according to her, was extremely good), but then discovered that it hurt her teeth tremendously to chew the pulp.
So much for our thank you gift...
In any case, this morning, we were told to help out with home visits in the morning since the whole medical team from Brown was going to be there. Ana and I got there early and spent time chatting with Diego about Dorka and her family. Soon enough, Michael, Heather, and Cindy arrived in short order. We filled a bag with all sorts of medicines and set off to visit the people living in a remote village called Los Pajones. We hiked for about 15 minutes before coming to our first destination.
Our first home visit was quite sad--a 72-year old woman who looked at least 20 years older than her stated age. She had a history of high blood pressure, stroke, and diabetes, and, according to the niece, she had been feeling extremely lousy for a long time. When we saw her, she was in prominent atrial fibrillation, and there were crackles in both lungs. We were told by Diego that the woman was dying, and that everyone was fairly certain that she was on her way out. And with 4+ pitting edema in her legs, and overly-distended bladder, and signs of congestive heart failure, she couldn't have been that comfortable at all.
So what did we do? Other than tinker with her blood pressure meds, start her on a beta-blocker to control her heart rate, and discuss the feasibility of starting her on a diuretic--we did absolutely nothing. I'm really starting to get the sense that symptomatic control is the best one can hope for out here...
The next house visit was not much better. We took care of a couple who had some minor ailments: controlled hypertension and back pain. Their father, however, was also not in good shape. When we saw him, he was lying on a thin matress on a pile of old blankets. His body was fixed in a contracted position, and it was physically impossible to break him away from this fetal position, even to examine him. And it was heart breaking to do so. He had evidence of a pronounced facial droop and asymmetrical muscle strenth. But by far the most disturbing sight were his pressure wounds. Bound to his bed for many months, he was starting to get nasty bed sores on his bony prominences. And there were many of those sores on his body. Michael and I tried getting a blood pressure, but could only manage to get a systolic number due to the fact that he wouldn't relax his arm enough for us to check it properly. We noted, as we were busy moving him around, that the man smelled absolutely horrible. Indeed, we realized that this was because he had been sitting in his own feces and urine for quite some time. The couple taking care of him knew how important it is to change positions frequently, but both of them were too busy with handling their own issues for them to give him very much attention.
We were able to see a few more cases that morning, including a man with aortic stenosis, a woman with possible tuberculosis, and a man with asthma. But overall, I felt these home visits went far more smoothly than the ones we had done previously. Heather is essentially our attending now, and she has adapted incredibly well to her new role as a leader and chief caregiver.
I should mention that these home visits are primarily for patients who live in areas so remote that it is extremely difficult for them to access the clinic. As such, it would usually take us the whole morning to see 5-6 patients, since the houses were so far apart from one another. Walking through the woods and mountainous terrain made me very appreciative of just how strong one has to be to live here.
After our home visits, Ana and I scampered off to Santiago to try and get some toys for Dina and Ramon's children. This turned out to be a far more labor-intensive experience than anticipated. Diego was able to give us a lift into the city in the early afternoon. Ana and I had about two hours to take a cab back to our apartment, eat, go toy shopping at the market, and find our way back to the Gua Gua stop for the last ride up to the mountains. We made it, just in time...only to endure a very long ride up the mountain with a fairly reckless driver (though it seems that reckless is the norm over here). Finally we arrived in the mountains...ten minutes before basketball practice was supposed to begin. Feeling disoriented and quite car sick from the ride, I managed to stumble behind Ana as we trekked up the hill to deliver goods to Dina and Ramon, and then back down again to play some basketball with the girls.
Thankfully, the day had a happy ending. We may not have saved the world, but we did manage to get back to Maribel Dulce's house in one piece...
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