Jan. 9, 2009 - Day 6
The drive to la Meza takes about two hours, but in spite of the length, I enjoyed myself. I was able to listen to peaceful music while admiring the deep blue sky, eclipsed occasionally by towering mountains and fluffy clouds.
La Meza is a small and dusty village, which I quickly discovered to house spectacular views of the surrounding mountain ranges. After setting up clinic at the local church, we immediately set off to triage the first group of patients waiting for our services. I took blood pressures and pulses, gently moving two fingers down the ridge of the thumb to mark my spot and adding sustained pressure to the side of the patient's wrist as I had been taught.
I remember just a few days ago when I was struggling to find a pulse on a middle-aged man with a thick, leathery layer of skin over his wrists. I remember my frustration at feeling only silence rather than the pounding beneath my fingertips, when it was so easy to find it on my own wrist, and my feelings of ineptitude as I tried to work quickly to minimize any discomfort for the patient. Dr. Mendoza had patiently taken me aside to show me his full-proof "pulse-finding method", stressing the amount of pressure I needed to exert on the patient's wrist. Although seemingly foreign just a few days ago, these triage skills now felt natural and comfortable. I was even given the chance to diagnose one of the patients. Though it was a relatively simple case of rheumatoid arthritis, I was still able to suggest ibuprofen as the drug of choice and fill out the patient's prescription - quite an honor for an aspiring doctor.
One of the patients we met today was an 83-year old woman who I accompanied throughout the clinic and with whom I actually held a conversation. She was in wonderful health for her age - no history of high blood pressure, no diabetes - just the beginnings of arthritis and the stiffening of a few joints on her fingers, but nothing to warrant alarm. I learned she had lived in town all her life and that housework now comprised the better part of her days. Her wrinkled face creased into a smile as she chattered about her family, and I could tell by the concern shown her by her fellow residents, that she was a well-respected force in her village.
Class in the only school house in la Meza ended around 11 today, and soon, huge, eager crowds of school children dressed in their uniforms gathered by the church to peek in at the commotion inside. To their delight, I offered them handfuls and handfuls of fruit candy, stressing that they share with others. Unfortunately, the boys would not share with the girls or vice versa, so it was up to me to mediate these disputes by a fair distribution process. I can still see their bright-eyed faces and hear their excited cries, and I can't help but smile when I remember their joy; it's a fond memory I hope to keep for a long while.
A group of young girls were especially memorable. The eldest, with her younger sister and their neighbor in tow, came up to greet me. After learning my name, the three pulled me along by the hand, and led me to their peers outside - all the while keeping up a chorus of "se llama xiaoxiao" ~ "her name is xiaoxiao" as they introduced me to their group of friends. From then on, I was prone to hearing strings of "xiaoxiao, xiaoxiao, xiaoxiao" by an enthusiastic group of followers as I walked around clinic, much to my amusement.
As clinic day came to a close, we enjoyed some local food made fresh by appreciative townspeople, after which, Dr. Mendoza explained we had one last patient to see - a man with a case so rare and extensive that none of us had ever seen anything like it before and may never see again.
While embarking on the short walk to visit our patient, Dr. Mendoza explained to us the seriousness of the patient's condition and prepared us for the visual image we would soon witness. Because the door of the house was only a foot or so wide, our group shuffled one by one to enter the cramped home and struggled to make room for each other.
It took a good while before my eyes adjusted to the dimly lit room, a harsh contrast to the sunlight outside. As I took in the room around me - containing two small but neatly made up beds, a few pieces of furniture along with some picture frames on the wall - I inhaled the overwhelming odor of urine and sweat that seemed to permeate the room and add to its dank and musty qualities. Finally, I could make out the man's right foot, which he rested on the dirt floor. It was unmistakable and strangely inhuman - huge and swollen with grotesque, reddened ulcer sores leaking pus on the side of his skin. The entire leg was swollen to at least twice the size of the other and appeared to consist of hardened patches of leathery-looking skin.
We learned that the man has a mycetoma, a chronic, inflammatory and subcutaneous granuloma caused by some fungus or bacteria that enters the skin via a traumatic event - in his case, a large cut he received almost 20 years ago while working in the fields. Also called a pie de madura, this condition most often affects the foot and develops into multiple nodules. His is one of three total cases in this region, and Dr. Mendoza had promised to check back on our patient a few months ago to further assess his condition. While his mycetoma had remained nearly stagnant for years, it now caused the man considerable pain and had recently started oozing pus, spreading patches of hardened, bulging skin in multiple regions up his leg. Unfortunately, the only treatment at this point involves amputation and replacement with a prosthetic limb.
Our group watched in amazement as Dr. Mendoza applied antibiotics to the affected region and tried to convince our patient to accept surgery. He explained that if the man does not go through with treatment now, future intervention would require amputation up to the knee, an invasive procedure that would leave him disabled for the rest of his life.
The situation was difficult for all of us to watch. The man still has to provide for his family, and continues to engage in work involving strenuous physical labor on a daily basis. It is no surprise he wants to hold out on amputation for as long as possible so that he can continue to work. Unable to force any action on the man, Dr. Mendoza could only provide his medical expertise and the promise of a future visit. After the man's wife thanked us for our visit, we left the house in silence, saddened by the seriousness of the man's condition and by our inability to do anything about it.