Another week of daily jornadas has passed. We are seeing plenty of dermatologic, musculoskeletal, gastrointestinal, and other random concerns. It is interesting to see the differences between towns - in one we saw mostly pregnant women and kids with lice and/or scabies. In another town, it was vague complaints of aches and pains. Others had more acute problems - machete injuries, etc. I saw one man who had joint swelling, pain, and fever for one year. He's 19. In the US, we'd tap the knee effusion, run serum tests to check inflammatory markers, infectious causes, and would probably land on some sort of solid diagnosis (JIA, other rheumatologic condition?). Here, we thought if it were bacterial, he'd be more ill by now, but without much else to do, treated him with antibiotics and referred him to the National hospital.
Coloring books have kept the kids interested while waiting (or staring at us).
The medicine is at times frustrating, and affirming that I want to do family medicine where I can make long lasting relationships with patients and treat the whole person. Here, we listen to stories of families just making enough to live by (with tortillas and beans for each meal), and know that they suffer musculoskeletal pains not only because of the work (which is undoubtedly strenuous), but also because of the psychosocial circumstances. A great thing that we are able to provide is someone to listen, and reassurance.
I've had my share of "focus on this" stories, which drag on and on, going back to the dawn of the patient's life (or their parents') to explain the problem. I am not saying it is easy to listen patiently when a story takes a tangent from a tangent, but it gives insight into the lives and values of the people we are meeting.
On patient on Friday kept coming up with new concerns as I reassured her that it was normal to have occasional back pain, or that those pains she was feeling were a common occurrence with menses, etc.at one point, she asked me if her tubal ligation was going to give her cancer. Not sure I heard her correctly, I went over it a few times, but apparently someone (and you can guess from what theological background...) told her that preventing pregnancy can cause cancer. We spent some time talking about family planning and the lack of a relationship to cancer, and that she made the right decision for her family.
This was also at a clinic where there were amazing, frank public health posters. Breastfeed your babies, family planning is good, protect yourself from Dengue, don't have unprotected sex. In many places, these discussions are not had enough, so it was great to see the information out in the open (pictures of posters below - warning for graphic one of cervical cancer).
Also in the photos, you can see our accommodations for our overnight stay in Guadalupe, and a nice lunching spot we had by the river.
