El Salvador Mission Trip 2012 - Part 7 - The Case of the Trip

Oscar was born with a myelomeningocele and is a paraplegic, having no movement and little sensation below his waist. 5 years ago he developed quite severe pressure ulcers on his buttocks. The skin broke down and the flesh degraded almost up to the bone. He was seen in a local hospital and they took skin from his thigh and grafted it onto the ulcerated regions of his buttocks. He healed up for a while. Unfortunately, post-operative care and therapy was lacking.

Dr. Boris and myself talking with Oscar and his mother after his debridement



Pressure sores and myelomeningocele

 Oscar was put back in his wheelchair with a single canvas sheet for a seat. He was not taught to transfer by lifting his weight up on his arms and pivoting. Instead he pushes and slides off his chair when transferring. This caused his ulcers to reopen. Additionally, he was not taught to lift his buttocks off his seat every few minutes, propping up on outstretched arms, to relieve pressure on his buttocks. He slept on a plywood plank.

This combination led to the ulcers opening up again.

Last year I saw him and his ulcers were minor. We tried to help him with supplies for an indwelling bladder catheter and adult diapers.

This year when we went down, I asked him to come see us. He did. There was a smell of rotting flesh coming from him, even though he sat in front of us pleasant enough. Fortunately, he came to the one clinic site that had some dental chairs installed in a side room. I extended one of them and lay him on his stomach to see his ulcers. I almost wept at their condition. Along with the help of our one RN, Terry Martin, and instruments the dentist gave us in addition to what we had, we gave him IV fluids and debrided the dead flesh off his ulcers. During residency training, I had spent one week with our resident wound care surgeon, Dr. Michael Caldwell. I had paid attention to what he showed me because I knew that one day I wanted to do medical mission work and would need the skills. This way the day. I debrided the dead tissue away the way I was taught to do. We packed the wounds with a wet to damp dressing and gave him antibiotics.

Our whole team was moved by Oscar's case. We scrounged around and found him a wheelchair cushion. We bought him a mattress and set up follow up with the local hospital where he had had his first surgery. We gave his mother enough antibiotics and wound care supplies and taught her how to change dressings.

This was one of those situations where it was difficult to keep my emotions at bay and do what I could. We continue to seek ways to help this young man who lives in a challenging situation. He only has a cell phone and no electricity to charge it, so it does not work all the time. He lives in a part of town where no postman will deliver mail.