Clinic Day 3: First day in San Cristobal

Posted on: 02/27/2019

Today is clinic day 3 for the Delk Team! We traveled to San Cristobal Acasaguastlan and set up a new clinic. Statistics from yesterday’s clinic, our last day in Sanarate, continued to increase from the day before. A total of 548 patients were seen: 217 in general, 97 pediatrics, 40 gynecology, 81 dental, and 60 VIA/cryotherapy. Laboratory ran 153 tests, 22 ultrasounds were performed, and 135 teeth were extracted. A total of 55 patients were referred for surgery and/or specialty care. We were very lucky to have two local optometrists volunteer their time to see multiple patients over the two days in Sanarate. Now that we have moved to another village, we were sad to see them go but continue to be so thankful for the vast number of patients they were able to provide with eye exams, eye drops, and glasses.


Today Mike, one of our interpreters, led our morning devotional, focusing on the theme strength. He shared a beautiful story from a past Faith In Practice village trip in which he felt that he and a patient were truly touched by God. She had late-stage cervical cancer due to untreated infections caused by an unfaithful husband. She was extremely weak and required extensive fluid drainage from her abdomen while in clinic. Due to events earlier in the day and his involvement with the patient, he felt a very strong connection to her. He noticed her daughter and husband were minimally attentive to her needs and stepped in. Up until that moment he had never prayed in Spanish, but this is what Michael felt she needed. She was begging God to take her pain away and to heal her. She was very afraid of death, something that would unfortunately but likely be soon for her as her disease had progressed too far for us to provide treatment. He helped for as long as he could. She was too weak to walk so she was placed in a taxi to be taken home to be comfortable. Before she left she asked Mike to never forget her. After sharing this very personal story with the rest of the team, it is apparent that Mike has not forgotten Irmelina and never will. We prayed for strength and courage in the face of similar difficult moments in our remaining clinic days.


As we are halfway through our clinic operation, we continue to see hundreds of patients with many medical complaints but we also have to overcome dwindling supplies of medications and other equipment. In the pharmacy, pharmacists Bethany Delk (also co-team leader), Pam Renard, Michelle Plum, and Ally Stilwell, strategize and collaborate with providers to provide the best medications for patients. Oftentimes supply of one medication will start to run low and efforts are made to switch to alternative agents for eligible patients in order to preserve supply. Many factors are considered such as whether or not patients will have access to something similar in a few months when the supply we give them runs out. In one rare case, a patient who is hemodialysis-dependent presented to clinic with prescriptions that she was unable to obtain because the medications were too expensive. We didn’t stock any of the medications in the clinic pharmacy, so an Faith In Practice worker went out and bought what we felt would be the most impactful for her quality of life, which was a particular blood pressure medication. While we aren’t able to provide in every instance where we don’t have a medication for a patient, we try to find a way to help them in some capacity. If not for the tremendous teamwork between the Faith In Practice village director and coordinator, providers, and pharmacists, intervention through Faith In Practice would not be successful.


Although medication may seem like a logical treatment for illness much of the time, it is not always the best option for the patient. NP Linda Zimmbelman shared a story with us about a young women she saw today. She was in her 30’s and had a six-year-old daughter, but her husband had recently left her. She was very overwhelmed and anxious about the financial strains of being a single mother. She definitely showed signs of depression and anxiety, but Linda thought, well, I could give her antidepressants but then what will she do when she runs out? The patient agreed that maybe this wasn’t the best treatment option. Instead, Linda continued to talk to her and took the extra time to share phone applications and techniques that she could use when she feels stressed and anxious. This could help her to calm down. Linda told her, “you are strong, and I know you can do this.” We thought this story was touching because Linda took her treatment a step further in order to provide a sustainable solution for the patient, rather than the easier route which would have been give her 90 days of medications and move onto the next patient waiting. The patient was truly grateful for her help and time and was very excited about utilizing her new relaxation techniques.


This morning the pediatric clinic was quite busy. One of the pediatricians commented that of his first ten patients, only one was a well-child visit! A four-month old named Maria was born with “a little tail” (see photo in gallery captioned “Maria”). The mother stated that it sometimes drains clear fluid, but does not cause her pain. This type of presentation can be associated with inability to roll-over (as an infant), inability to bare weight on his/her legs, urinary incontinence, etc. if lesions extend into the spine.  Due to her young age, we are unable to assess if the deformity is causing or will cause any functional issues as she grows. She will be referred for minor surgery in order to obtain imaging to determine if spinal involvement exists– which would more likely cause these functional challenges. If needed, she will continue on to have the deformity corrected. During this visit, Maria continued to smile and laugh, brightening both Frank (pediatrician), Mike (interpreter), and my day.

Another six-year-old child was carried in by his mother. His legs and feet bowing backward (often a manifestation of cerebral palsy called scissoring), his head tipped toward his back, and arms flailing. His mother explained that he was actually born “normal,” but then had meningitis at 3 months of age and has not been the same since. He has about two seizures every day and three every night. She stated she has trouble feeding him and he often sleeps all day and is awake all night. This mother should truly be commended for her ability to care for this boy at home. Pediatrician Frank began to tear up as he examined him, particularly when he saw that every tooth in his mouth was black and rotting, a severe infection and malnutrition risk. He repeated kisses the top of his head and told the mother, “que dios la bendiga – which means God bless you." We would not be able to pull the teeth here in our clinic due to the number of teeth requiring attention, but also do to his inability to remain still. This type of procedure would require general anesthesia in a hospital setting. However, his mother lit up when she was told they would be referred to see a neurologist in the coming weeks or months – something they have never had the opportunity to do in the past. They will also likely be able to arrange for proper dental treatment at that time.


On a brighter note, a lovely surgical success story was shared with us after Carriedelle (NP) and Teresa (interpreter) saw a patient who had knee surgery several years ago through Faith In Practice. She presented to general clinic with minor knee pain that could be treated with common pain medications such as ibuprofen and acetaminophen. The patient stated her knee is so much better after the intervention provided by Faith In Practice and she kept repeating “Thanks to God I had surgery and my knee pain is much better” to team members. This patient represented a rare case where we get to see patients after they have received their intervention and it was such a joy to see the impact that Faith In Practice had on this patient (see photo in gallery captioned, "Thanks to God...").


We are about to join for dinner and reflect on the day. We look forward to attending our last day of clinic tomorrow! We hope to make it the best day yet. Thanks for reading!