Seneca Carrillo, MD is an ER physician at Chandler Regional Medical Center. Although she is a world traveler, this is her first medical mission. She was kind enough to share some of her frustrations: Futile. The word kept jumping into my head today as I saw patient after patient. I couldn't help but think it, even though I know its not true. I treat the patient for worms, something nearly ubiquitous in the water supply here, and realize as they take away their one dose of Albendazole, what did I really do? When this patient has no source of clean water, their worms will likely be back the next gulp of river water they take. I hand the next patient her papers for treatment of an STD. I include a dose of antibiotics for her husband. But without educating them both on how to prevent this, will she get it back in a matter of weeks? The woman with an infected foot ulcer who needs dressing changes daily, using a wet and then a dry one to pull off the dead tissue...but has no clean water to use to wet the bandage, no money to buy dressing changes, and has been wearing the same stained and tattered gauze for what looks like weeks. How does she heal without resources as simple as clean water?
This was hard for me today, to reconcile how to help these people with what we have at our disposal and what they have at theirs...which isn't much. But I came to realize, if we can target what we do know to the simple things, we can make a huge difference. 75% of the patients I saw today had dentures and they were in their twenties. If we can give the children toothbrushes and show them how to varnish and care for their teeth, this could be averted. Teaching our patients how to prepare clean water, avoiding contaminated water and doing the simple things to avoid the parasites and bacteria that are infesting their running water, we can aid in treating a multitude of illnesses. And lastly, utilizing the local doctor here to help refer the sickest of the sick to the specialists they need, like the 60 year old farmer who had a heart rate of 32 and kept passing out while working in the field. The pacemaker he probably needs could actually be a reality if someone knows about it locally and can get him to the central hospital run by the government to be seen by the cardiologist.
So futility led to a sense that we just have to target our resources and we can actually make a big difference. I just have to realize that lab tests, CT scans, and lots of referrals to dermatology and ENT, all the things I would usually do as an ER doctor back in the US, have no use here...its all about the simple things giving the most bang for the buck. There is a common saying with this Guatemala mission brigade crew, when you just have to work with what you got and make it functional, you do it the "MacGyver way".
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