,When we arrived, we set up the clinic and then ate our packed lunches as the patients started arriving. There were no huge surprises. We did see a 3 year old with profound microcephaly, cerebral palsy, and a refractory seizure disorder who is blind and weighs less than 15 pounds. His mother walked into clinic carrying him slung in a cloth down her back like the Maya carry infants. He appeared well cared for. We did not have any phenobarbital with us to refill his prescription and since there is no bus service out of the village (or any nearby village within an hour's walk), we were concerned that we needed to find another way to get his medication. We were able to arrange for his father to catch a ride out of the village that next morning with the government maintenance crew so that they could get his medication in town. We were also able to give his mother some help with stretching exercises to try and prevent significant contractures.
One of the medical students entertained the children with photos he took of them.
We ate dinner sitting on a wooden floor of a Maya hut, dipping hot corn tortillas in "caldron" (a Maya chicken soup). As the sun set, the villagers came to hear our presentation on nutrition and exercise. Back pain is a huge problem in the villages (as it would be for us if we had to clear our fields with a machete, grind our corn for every meal, wash our clothes on a stone in the river and then sleep in a hammock). The boys seemed more engaged with our presentation but the girls and the women were mainly spectators. It is very difficult to engage the Maya women, even when taking a history in clinic, and they were definitely not convinced that they should do stretching exercises or any movement to alleviate their back pain!
The next morning we drove to another village about an hour away, Otoxha. On the way, the Land Cruiser got a flat tire but fortunately we had two vehicles with us (the first overnight trip we had ever taken two!) and we were able to transfer all of our clinic supplies, medications and charts to the second vehicle. We sent two people ahead to set things up, left Mr. Rudy to change the tire with one of the medical students and the rest of us walked the remaining mile into the village. We saw about 30 patients that day and made one home visit before packing up for the long drive back.
We spoke with the government appointed community health worker in Otoxha as well about our ability to offer physical therapy if needed. The community health workers have very little training and she too was very resistant to the idea of any physical therapy or exercise training as therapy. So much of what we try to do in medicine is only as effective as the patient believes it will be. The overnight trip left us realizing we are quite a ways from understanding the Mayas' belief system and culture - something that we have to understand if we are going to be able to use physical therapy modalities in their medical treatments.
Arriving home in the evening, I was happy to see that Bill and the boys had kept up with the dishes as well as had the floors swept. However, while I was gone we had acquired another housemate. One of Will's friends is without a home right now and asked to temporarily stay with us. We have had others live with us before, just never in such a small house with only one bathroom. We do have an extra mattress and often feed at least 3 extra people at mealtimes now so I think I am doing better with it than I would have done when we first moved here!
Angela
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