Clinic Day 1: San Juanito
Jan. 6, 2009 - Day 3
I woke up early this morning for a morning run with a few other girls. The temperature was surprisingly chilly as the sun peeked out near the horizon, which made for an invigorating run. We circled the plaza - then decided to wander down some of the side streets. At one point, we found our path blocked by a large group of intimidating dogs that seemed to capitalize on our apprehension by barking ferociously. The early morning activity of the plaza - the busy street sweepers, the elderly couples on their morning strolls, the stores and street vendors beginning to open for the day as the light glinted off the tops of towering trees, and the hazy mountain ranges in the far-off distance - made for a lovely backdrop against the pounding of each step on the dusty, pebble-lined streets.
It took a good few hours driving on rocky terrain the entire way to arrive at San Juanito, a tiny village situated amidst rolling hills. We stumbled out of the van into a swirl of hot dust to set up clinic at the local church, a well-kept, canary yellow-hued building that clearly constituted the heart and life of the village. A long line of eager patients had already gathered to see us. I would be starting off the day registering patients, which I took as the perfect opportunity to improve upon my waning Spanish-speaking skills.
Together comprising an entire spectrum of ages, each patient grabbed a numbered card and waited anxiously in the hot sun, while I, with my clipboard and pen in hand, attempted to ask each a series of questions - from their name and age to current medications and chief complaints. This seemingly simple task was in actuality quite a challenge. Not only did I need to ask my questions in a way that made logical sense to the patient - and in Spanish for that matter, but also, I had to be able to process his or her quick-paced and occasionally mumbled replies in a meaningful way, which sometimes required looking up a word or two in my dictionary and the use of multiple creative hand gestures on both our parts.
Claudia, Dr. Mendoza's niece, spoke no English but was nonetheless, always willing to help. At first, I kept asking "¿Tiene algunas alergias o problemas con medicinas?" ~ "Do you have any allergies or problems with medicine?", a question that made sense to me, but only yielded looks of confusion in the patients I asked. Instead, Claudia recommended I ask "¿Le hace daño algún medicamento?" ~ "Does any medication cause harm to you?", which immediately prompted a look of comprehension and most importantly, an actual response.
Throughout my interactions, I was constantly reminded of what Dr. Mendoza had stressed on our first night in Matamoros about the importance of communication. He explained that because we would be working in rural villages where healthcare access is limited and medication in short supply, the majority of the patients we encounter would be rather ignorant of medical terminology or health concerns, making clarity critically important. Accurate diagnosis and proper treatment stem from a thorough assessment of the patient's particular situation, which ultimately depends on effective and thorough communication between patient and caregiver.
But I found that no matter how terrible my Spanish likely sounded and however many verb tenses I likely mis-conjugated, treating each patient with a smile went a long way. I was amazed by their patience towards my repeated clarification questions - a true testament that a smile and a willingness to listen can break down any language barrier.
During the short interludes between patients, I visited often with a few of the families sitting nearby the church and offered small pieces of candy to the children. Each lit up with a shy smile at the sight of the sweets, and I soon found myself stared at by numerous curious faces through the windows and doorway.
I also had the opportunity to witness Dr. Mendoza's masterful diagnosis of multiple patients, many of whom had gastritis complicated by a diet consisting largely of spicy salsas and flour tortillas. Antacids can treat this condition temporarily, but Dr. Mendoza explained that what looks to be a simple case of gastritis can quickly take a turn for the worse and may result in severe reflux disease or cancer if left untreated. A change in eating habits is necessary to prevent, or at least slow the onset of these consequences.
I met a woman who arrived with her two young sons - her face covered in a layer of rough, leathery skin likely a result of spending years under the harsh sun without skin protection. She presented with heel pain and deep "manchas" (marks) on her feet and abdomen, a symptom indicative of a deep parasitic infection. After another careful examination of her heel area, Dr. Mendoza quickly assessed the source of her heel pain - the result of bone growth on the side of her calcaneous bone, worsened by friction from walking.
During diagnosis, I could not help but notice that the woman's sandals were covered in a layer of grime, and her toes were caked with dried mud - understandably so from the dust outside. It is no wonder that infections like hers are so prevalent in many of these rural areas. Moisture, humidity and dirty conditions complicated by a lack of fresh and clean sources of water become breeding grounds for these diseases. I wish there was some way to do more to attack the source of these issues rather than just attempting to treat their effects.
But despite these feelings of helplessness, I was thoroughly touched by how grateful these patients were for the little I could do for them. Some shook my hands, others embraced me - each looked up to me with such deep kindness and respect that I felt almost embarrassed to accept it. I had merely offered my empathy.
Later today, our group took a collective walk around Jaumave. Everything is so colorful here - houses are pinks and purples, greens and blues, and trees are decorated with wrap-around strings of colored plastic. The townspeople are not rich but their happiness and their love for each other is so evident. There is a real sense of community and cohesiveness here that is scarce found elsewhere. I think there is a lot to learn.