The last few days have been unusual here in terms of the weather and many are blaming it (half heartedly) on Donald Trump.  It has been very cool with local people wearing winter coats, overcast and varying degrees of moisture.  Last night (Friday) we had a heavy rain.  They have two seasons here, wet and dry.  The rainy season ended in mid October and November is supposed to be one of their nicest months for climate. 
One more comment about Donald Trump.  There was a sign on an empty lot along the main road advertising “Future home of Trump Towers and Spa.”  The sign is now down, probably figuring he has other things to do.  Everyone here is shaking their heads and are concerned for the future.
Our 5th clinic was on Friday Nov 11th, and we missed the Royal Canadian Legion Branch Remembrance Day Service.  We were invited but had clinic responsibilities. All of us wore poppies, but the significance was lost on the local population.  But it was important to us. 
We packed up and left at 8 am as we had expected a lot of patients.  We were situated in a community centre where there were rooms and a large open air but covered concrete area.  The best was that there was a lock on an entrance gate so we could control how many came in at a time.  They sat on benches and were then registered and moved to another bench for Triage and then moved to the side of an entrance to the building.  Pharmacy set up in an office near the exit door and they were happy to find a shelving unit for our meagre supply of medications as we have yet to see the confiscated medications from Customs.  The Eye team, Physio and Lab shared a space that had some beauty chairs and sinks, and they also had to share a translator, not ideal or productive for everyone, but in usual fashion, they managed, making the best of the situation.  Two nursing stations and one doctor shared a smallish open area in the foyer of this building, crowded in and noisy, but in true form, they made it work.  Another room had the nursing supplies, a nursing station and a Doctor’s, while the last room had the PAP smear and examining table and a Doctor’s office.  We were soon up and running.
A group of young people came in and I thought they were translators, as I never know who is coming and how many will show up.  No, they were students from University in Guadalajara here in Mezcala to look at tourism possibilities.  But one agreed to come back and translate which she did.  Good job because as usual, we did not have enough translators.  
We saw 240 people from 130 families, but only 15 from San Pedro, the poorer indigenous community where we were yesterday and could not see everyone.  The authorities had wanted to have us in Mezcala yesterday and bus everyone from San Pedro.  We held ground and said we would go to them, and it was a good job we did.
Kim and Christy had a great flow going in Triage, interrupted when their translator disappeared.  The patients then went to chairs outside the building and Gord transferred them to the services.  We had an 18 year old with 3 children!  But we had more older people today.  We had a 10 year old boy, rather chubby, who was diabetic and on insulin, and his blood sugar was high.  He came with his grandmother and aunt as his mom was working.  Everyone on the team tried to help him.  He tested his sugars once a day, but did not record them, so a trend could never be established and his regime changed accordingly.  We all talked to him about his control and also how hard it was to be a diabetic when just a child.  I think he likes his sweets from the reaction of his grandmother.  He just seemed withdrawn from his unfortunate situation.  
A 38 year old woman had a history of diabetes in her family and when we tested her, her sugar was 24.7, we found a new diabetic patient and she was given medication and diabetic teaching.  We had a 20 year old woman who was on dialysis, but she could not afford her medications.  We made sure she had many months supply and she was a happy woman, and returned to kiss Marian, her nurse.  A 9 year old orphan boy living with his aunts, was fairly healthy, but he got a pair of croc shoes and was thrilled.  
We saw more older people today and everyone had body pain ‘all over’.  I am not surprised because all work is done by hand, and even old people have to work and do their part.  Pharmacy is out of adult Tylenol, and we cannot give them Ibuprofen because we do not know what their kidney function is like.  All of our Tylenol was confiscated by customs and still sits in Guadalajara.  We had purchased more here but now we have none.  It is heart breaking not to be able to relieve suffering.  
The Physio tag team of Marilyn and Stuart were kept busy all day treating the seniors with knee, shoulder and back pain, and Stuart got to manipulate a foot, a skill he had learned at home treating Marilyn.  The nurses saw an 18 month old who walked only on the toes and the balls of his feet but without a volunteer to usher people from service to service, they fell through the cracks and did not get to physio.  Too bad, too because Marilyn could have really helped them, as she had brought a very small child’s walker. These people are short in stature and our canes are too tall. On the street, Stuart bought a rusty hand saw with a poor handle for 50 pesos ($3.70) to saw off the wooden canes to make them ergonomically correct.  A man came in with a 3 prong cane made from a tree limb, but the prongs were held in his hand.  It actually worked pretty well, but he still had to lean on his grand daughter.  He traded his cane for a walker and walked independently, happy as could be.  Stuart brought the traded cane home to Canada, a great reminder of the work accomplished.  We needed more walkers and called our Rotary/Tepehua clinic hosts to bring some we had seen at the clinic.  No, they belonged to the clinic, but they would try to get some from the Bomberos that had been sent in a container from here.  They never did come but we documented the contact information on the folks who needed them.  Hopefully……..
The eye glasses team of Linda and Bob Reid fitted 60 pairs of eye glasses and gave out 150 hats and sunglasses.  A local Optometrist came and set up shop outside, testing everyone who wanted for distance vision prescriptions.  He will make the glasses and return with them tomorrow.  The glasses cost 350 pesos, ($25.00), a discount for our team.  It did not seem to matter what the strength of the glasses, they were all $25.00.  So why did I have to pay $450.00 a few months ago?  Our 10 year old diabetic boy needed glasses and we will pay for those.  It was interesting to watch the practitioner putting the big special glasses on people and then slipping in lenses to get the best strength reading.  But none of the going back and forth to see what was clearer, just depending on being able to read the lower lines on the chart.   They documented in a book the names, contact information and the prescriptions needed.
Charlene had requested diabetic glucometers and test strips from the reps at the hospital, and she had enough to leave behind.  She taught Dr Santiago’s assistant how to do the whole procedure, from doing the finger prick to recording the reading, and gave them our reading scale which is different from the USA and hence, Mexico.   
Lunch was provided by the local municipality and came about 2 pm.  When the officials came to the clinic yesterday they were so happy we were coming to serve, they also wanted to provide transportation, which I declined as it had already been arranged.  I did however thank them for the offer of lunch and they said they were pleased to do it.  You have to let people take some ownership. 
At the end of a long day we had seen 240 people from 130 families.  Dr Ramon, our Rotarian Orthodontist from London had to act as a translator today as we did not have enough, a usual situation.  With his easy personality and good humour he did a great job, also recording those who needed dental work.  The sad truth is that these people would never get to the free dental clinic in Tepehua.  It is also unfortunate that we were discouraged from bringing the Fluoride so we did not have a station set up to do the oral health teaching.  And because we did not have local Rotary volunteers, our team members were otherwise engaged.  
We had a chance to shower when we got back to the apartment hotel, not everyone had hot or even warm water, just when you need it as it is certainly cool and raining today.  Dinner was catered in, making it easy.  We finished the evening with a card game of GOLF (thank you Dennis and Barbara).  On another night a large group played a card game of ‘spoons’ which was lively and hilarious with adults acting like kids.  Bed always feels so good.  What a great team.  Christy B finally has in her hands on the rest of the money we sent to Rotary to pay the bills, and she is a trooper.  Everything here is a cash transaction, and tips are the wage scale, something learned, not explained by our hosts.  Christy keeps it all straight as we need receipts for everything for the CRA back home.  
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In Rotarian and humanitarian service,