La Brigada

Today was our first day of medical brigades, and according to Dr. Sevilla, it was the healthiest community that we will encounter during this week. This is mostly d/t the fact that they are only a 45 minute drive to the closest “city.” Many of the communities that we will be visiting are much more secluded with an even decreased access to health care in comparison.

Driving up the mountain, one of the most poignant pictures is of the garbage dump covered in scavengers, both human and vulture picking through the discards of the larger towns below in hopes of finding valuables. The smell of course assaults you, but I feel that the continual presence of this is a much more memorable image. Although, many have tried to move the “basurero” away from the small town, much of the efforts have been met with pure apathy.

In the town, fortunately, many of the other public health efforts have been successful. The majority of the residents of the town have chimneys instead of stoves so that the smoke of their cooking fires billows outside rather than into their homes and their lungs. The improvement in the health of these families has been substantial as they have seen a dramatic decrease in morbidities such as asthma and COPD. Additionally, there has been a significant decrease in the carbon monoxide poisoning seen.

One patient I had sticks to my mind tonight. She was an 80-year-old woman who came in due to a cough that she had had for years and pain in her bones (“dolor de los huesos.”) With her simply attempting to walk in, it was obvious that something was very wrong. Her protuberant belly preceded her as she was guided toward our small little station in the loud classroom. The cough she had had for years, but what bothered her most was the pain in her bones. As much as I attempted to redirect her toward her cough she had for years or her history of ovarian cancer, my attempts were futile as she continually insisted that the other brigade had checked her out and she was “fine.” Soon enough, as much as I attempted to speak to her and offer some sort of treatment for her bone pain in hopes of delving deeper into the root of her problems (recurrent ovarian cancer? Carcinomatous TB?), she left. Even now, I am left with the question of what could I have done differently and how has the discontinuity of care between the multiple brigade groups entering this community has affected the long-term outcome of her health. It is completely unclear to me why they decided that she was "fine," and what sort of tools they used. Did they ultrasound her belly? Did they perform a PPD? Sometimes, you feel like there is only so much you can do.... and it makes you feel a little small.