Day 2 – El Salvador Mission Trip 2011 - Dawn and Insect Stories

Day 2 - January 31, 2011

The next morning, we all got up and after a cold shower, were ready to set off for our first field location, Guadalupe. Outside, we could see the beautiful sunrise...



And horses grazing on the field on the campus.


The girls came down from their dormitories with stories of having found a scorpion on the floor...


They also had a huge (about 5 inches long) grasshopper hanging out on their shower curtain.


These guys were all over the place.

Day 2 - El Salvador Mission Trip 2011 - trip to Candalaria

February 1, 2011 - Trip to Candalaria

The next day we were ready to get back to work. Today we were scheduled to go even further, to Candelaria to the location of a second church. On the way there, we saw this cool-looking igunana that was about a couple of feet long.

I saw about 42 patients at Candelia, including 2 cases of a rare skin disorder, epidermolysis bullosa. The first patient, shown in the pictures below was only 29 years old but looked more like 60.

The pictures below show the bullae on her hands and the scars from ruptured bullae and sloughed off skin on her back.









Even if she lived in the States, I doubt we could have done a lot for her.

There was also a lot of bad teeth in El Salvador, probably because of no fluoride in the water.

Here's a funny picture of a little boy that does not want the doc to look in his ears.

Seeing a lot of rashes,



white spots on skin

and fungal infections.

Here's our dentist looking happy, tired and ready to work.

It was a busy day of seeing patients.

By the time we got back to base, we were all pretty tired.

Day 3 – El Salvador Mission trip 2011 – trip to Ayutuxtepeque

Day 3 ; February 2, 2011

On Day 3, we went to the location of the future Dream Center – a project planned by Castillo del Rey. At the moment though, the church has been meeting in a tent for a few years.

On the way to this location, we stopped to the a field of lava rocks. We took some samples as souvenir.


I saw about 41 patients here.


The kids are the most fun to see.


The kids are just the cutest and instead of working, we were tempted to just play.

Day 4 – El Salvador Mission trip 2011 - Lago Coatepeque

Yay! We don’t have to drive anywhere today because we will seeing patients here at the campus. We set up medical camp in the gym. From about 4:30 am, patients had lined up outside waiting to be seen. Some came on wheelchairs whose wheels were almost falling off. People here walk long distances over hilly terrain (it is after all, a volcanic terrain). We saw a lot of foot problems.



This lady’s feet had dried and formed large cracks like this one.


Others had diabetic sores on their legs.

This young lady had the classic physical exam findings and symptoms of Grave's disease. We had seen her last year too and she was not so far along. Unfortunately, she could not get in to see anyone to care for her. This time, we just bought her the medicine.

Day 4 – El Salvador Mission Trip 2011 - Lago Coatepeque A cauliflower mole

We saw one 57 year old woman with a large cauliflower mole on her face and removed it for her.


We did this by first cutting the mole out.


Then sewing up the skin.




She didn’t feel a thing because we used local anesthesia. Such simple procedures are forbiddingly expensive and so people live with these skin defects in resignation.

Day 4 – El Salvador Mission Trip 2011 - Lago Coatepeque - treating dehydration

A 17 year old volunteer came into the gym where we were seeing patients. He had nausea, headaches and did not feel right. After checking him out he seemed quite dehydrated. I was able to place an IV and give him some fluids. This turned him around. Heat exhaustion is an ever present threat to those working in hot climates, especially those who came from chilly Wisconsin.

Day 4 – El Salvador Mission Trip 2011 - Lago Coatepeque Paronychia

We saw a 70 year old man who had injured his finger a couple of months ago cutting wood. He thought that maybe a splinter got in and had become infected. His finger looked like this.

This is a paronychial abscess.

You could see the bulge in the skin with yellow pus beneath it and increasing redness and swelling.


I numbed up the finger up, cut the abscess open and drained the pus out. He felt much better. After dressing the wound, I sent him home with some antibiotics.

Day 4 – El Salvador Mission Trip 2011 - Lago Coatepeque End of the Day

I saw about 50 patients that day.

All told, between 6 doctors, we saw about 1000 patients over these 4 days.

After a long but rewarding day, we got to jump in the lake… I mean we got to swim in the crater lake. It is about 1400 feet deep in the center, being a crater lake.

That evening, we were served a traditional El Salvadorian food – pupusa. I loved it.

As a special treat, some of us (those who were willing to have it) got coconut water from the coconut palms that grew on campus.

Here is me with the local doctor there, Dr. Boris.

That evening, our local partners put on a show of El Salvadorian dance for us.

During this program, our hosts said lots of nice things about us. It made me worse to think that here we are who give up 5 days of our comfortable lives in the States while they live in need, and they thank us!

I hope to come back every year and I am going to get involved with the hospital project (see the post nearby).

Day 5 - El Salvador Mission Trip - Going Home

The next morning was our last day in El Salvador. We had a good breakfast, packed our stuff up and prepared to leave. Before that, we took a few photographs. These show the medical team and then only the doctors and the dentist.

I also took one with William, one of the students on campus who helped us. He is preparing to enter the ministry.

I had a great time during the trip. Unlike last year, this year I boarded the plane to come to El Salvador sick. I had been working in Urgent Care the week prior and had contracted an upper respiratory illness. During the whole trip, I was sneezing and coughing and felt tired. Nevertheless, my discomfort was nothing compared to the need all around me.

I did arrive home with no voice, so my posts will have to serve as my report until I get my voice back.

Camp Angel 2011 Winter Camp

It's been busy! However, the Camp Angel 2011 Winter camp was on the docket and as always, it was a pleasure to go.

The Camp took place from January 21 to 23, 2011 at Camp Manito-wish YMCA -- a delightful campus (http://www.manito-wish.org/) . There were about 30 boys and girls, ages 8 to 12. A lot of the usual crew of counselors showed up, with some new faces and some that have had to move on (busy with school). Lolly Rose, the founder of Angel on My Shoulder was there, as energetic and charismatic as always. She is a great example of how one can turn a personal tragedy into a blessing for so many (read her story and more about Angel On My Shoulder at http://angelonmyshoulder.org/.

Other volunteers were there too: Dick (whose family has been touched by cancer) and Amy, his fiance, Mike, Donna, Kerri and Jeff and Dr. Bill Hocking. We also had a 4th year medical student, Nathan Zachariah would might come help as a camp doctor.

The campers had a lot of fun, even though the temperature was below zero for part of the camp. It was -13 F (-25 C) this morning. A volunteer brought her beautiful dogs and offered dog sleigh rides to the kids. There was finger painting, face painting and rock painting. Of course, there was also horse sleigh rides, sledding, ice fishing and a talent show.

Other than the bitter cold, we all had a great time. See you all in summer.

'Twas 3 days before Christmas...

Christmas is a time for joy...but not always. I was on call for pediatrics when my pager went off at 5:30 am in the morning. When I called back the nurse informed me that a kindergartner had passed away. I went in to declare her dead. She had fought cancer and lost. Her mother held her body in her arms and wept. Her father and grandparents stood around the bed. There are no words for times like this. I have had this family in my prayers during this holiday season.

Just a few days ago I had gotten notification that a patient of mine had died in hospice. I remembered the phone call from his aged wife a month ago asking me if I would prescribe home health because she could not no longer move him into a tub or onto a commode by herself. By herself! I remembered encouraging her to bring him in. He would not come. When he finally did, he died 2 days later. Once again, losing a life partner of many decades at a time like this must be crushing. When hollywood shows love, it shows beautiful young people, hands and eyes locked together. However, I see love in this elder woman trying to help her husband onto a commode or into a tub. He has nothing more to give her. She will get nothing in return. She does it just because she loves him. They have shared life, home, bed and children for decades.

My prayers go out to these families and other like them in need, sickness or alone.

Let it snow!

Aaah! I finally have a weekend off when I am not working the ER, not staffing wards, not in Urgent Care or the newborn nursery. Actually, I was supposed to go to City on a Hill for the monthly free clinic, but the roads were too hazardous to make the three and half hour journey there and back. So I get to spend the weekend at home (could update the blog too :-) ).

Since we have no place to go, let it snow, let it snow, let it snow....er... okay now, enough, please stop!

Been waiting too long?

It was around Halloween time. The clinic was very busy and a few unexpectedly complex cases had set me behind (can you sense me making excuses yet?). I must have been running about an hour behind schedule.

I walked into the exam room of my next scheduled patient and saw this! I came out as quickly as I could and got my medical assistant to come and look too. We all burst out laughing.

What do you think? Been waiting too long?

Practicing in Resource-Poor settings

At City on a Hill's monthly free clinic, one gets to practice medicine a little differently than at my usual place of work. For one thing, we do not have access to the same resources (labs, imaging, sub-specialties) that one has in a larger clinic, multi-specialty venue or hospital. And yet, patients may have problems that could benefit from this. I saw a woman with an obvious goiter. Interestingly, her mother had the same thing. They had lived their entire lives in the U.S. in a city. She had mixed symptoms of both hyper and hypothyroidism. Management is proving to be challenging. I chatted with an endocrinologist friend who is from India. He suggested some physical exam techniques and history I could obtain to help manage her without further expensive imaging. I benefited from his experience managing patients in a resource-poor setting.

BRCA1

I love taking care of entire familes. It gives me the opportunity to know the pertinent medical history of not just the patient, but his or her relatives too. It introduces me to the support system (or failure thereof), the psychosocial environment and allows me to effect changes that benefit everyone in the home (like in diet, smoking habits and such). Sometimes though, while the opportunities to care for the whole family are beneficial, they are not joyful.

I have one such somewhat disjointed family in my practice. I take care of 3 generations of women -- a grandmother, her young daughter and that daughter's toddler. recently, grandmother -- a somewhat young lady in her mid-40s found a lump in her breast. We got the biopsy and it was positive for cancer. Because of her age, we checked her for the dreaded BRCA1 mutation. She was positive. This means that her daughter and grand-daughter are at increased risk too. Deleterious mutations in the BRCA1 gene may confer as much as an 87% risk of breast cancer and a 44% risk of ovarian cancer by age 70 in women (Lancet 343: 692-695, 1994). This also confers a 20% risk of a second breast cancer within 5 years of the first and a 10-fold increase in the risk of subsequent ovarian cancer. Her daughter and grand-daughter have a one-in-two chance of having this mutation

This is crushing news for these 3 generations of women. Recommendations go even as far as prophylactic bilateral mastectomies (removal of both breast completely to prevent developing breast cancer. The younger women will need yearly mammogram and/or breast MRIs from age 25 upwards.