This morning I saw a very cute, very old (89 yrs old) tiny Shuar indigenous woman in the clinic. She walked slowly with a long walking stick, and I suspect she could barely see because she needed to take my hand to guide her into the exam room. (Plus, she was wearing 2 different earrings, which I doubt was a purposeful fashion statement.) This lady lives all by herself. She had a couple of ailments, mainly related to arthritis -- people work incredibly hard here, and painful joints are very common. I gave her a couple of prescriptions to help her feel better. Later when I went by the clinic pharmacy to ask about something, I found out the old woman had paid for her medications with 2 baskets that she had woven. The kind clinic staff had agreed to sell the baskets for $2 each to recuperate the cost of the medication. Needless to say, I promptly bought both of them.
Another day, I saw a middle aged woman as a patient who struck me as a little strange almost at once. She had various complaints, one of which was a history of anemia that she said had never been treated. I saw in the electronic record that she had been seen for anemia in the clinic a while back. It took me quite some time to sort out all of her various complaints. We were able to get a quick estimate of her blood counts (a spun hematocrit, for those of you who "speak medical"), and sure enough she was a bit anemic. The most common cause of anemia is iron deficiency, followed by vitamin B deficiency -- since I didn't have any way of determining what she needed, I prescribed her both iron and B vitamins, and recommended that she take both of them every day for 3 months. Then she should come back and we could check if her anemia was better. She seemed really happy with that plan. When I went by the pharmacy later, nurse Amanda (who has been here for 15 years and knows everybody), told me that this lady bought a grand total of 4 iron pills. No wonder her anemia never gets better... Amanda also told me that this lady actually sells jars of snake oil out of her tote bag (a piece of a cut up snake in a jar of oil), and tries to get the patients to buy her snake oil (literally!) instead of buying their medicine from the pharmacy. Even the kindly priest in charge of the mission has tried to chase her out of here. Amanda also told me that this lady sometimes borrows young indigenous Shuar kids and takes them to the bus station to pass off as her own, to help generate sympathy and help her beg for money. It takes all kinds, I guess.
One other really interesting and eye-opening case was a guy who was bit by a snake in his right arm about 5 months ago. If you are easily grossed out, you might not want to read further. This man was working out in the fields, and was bitten by a venomous snake. He went to the local hospital 45 minutes away, where they shipped him to the bigger city hospital in Loja, about 2.5 hours away. As best I could gather (there is really no way to get my hands on written medical records), the bite was infected and he stayed at the hospital for weeks on IV antibiotics. They then shipped him to an even bigger hospital in a bigger city called Cuenca, about 2.5 hours further on from Loja. There they did surgery to get rid of the infected tissue, and to do skin grafts over the open wounds. He is still doing wound care treatments. He came to see me because he cannot straighten out the fingers on his right hand at all -- he can close the fingers (grip), but he can't open them. He has such a big divot out of his arm that I suspect the muscles that straighten out the fingers are mostly gone. We are going to try get an MRI of his arm (which feels like a Hail Mary, as I have absolutely no idea how we are doing to get such a thing as an MRI from here) to see what is left. It's a cautionary tale, for sure, and has given us an even healthier respect for staying away from snakes.
Who knows what tomorrow will bring -- that is true of family medicine in general, but particularly out here in the far reaches of South America.
