Report 2 

Our first day of clinic started a little late.  We were invited (urged) to attend the meeting of our host Rotary Club, Chapala Sunrise, that meets Thursday at 10:00 am.  What does that tell you?  Well, to me, that most members are retired here in Chapala and belong to another Rotary Club somewhere in USA or Canada with a few locals.  We asked for an earlier meeting but, no, the retirees needed the routine.  We were served breakfast in their meeting room at 8:30 and others joined in at 9:30, whom we greeted and invited them to see the hockey bags and the supplies that were just in the next room.  They were blown away with the amount of supplies and the fact that we had all volunteered our time and energy.  The meeting started at 10:00.  Peter Moreton, our president brought greetings from Festival City Rotary, exchanged banners and told about some of our club projects and thanked them for the invitation to bring the team.  Then, I told them about the team and the kind of work we would be doing and invited each and every one to come out and help at the clinics.  I forgot to invite them to come to Toronto for the convention but will do that at a later social event.  

Then, we were excused and loaded all the hockey bags into the back of the bus and off we went along with some of the translators to our first village, Ojo de Agua (meaning watery eyes).  I know, it does not make sense.  

Our clinic was in a small school and they had offered us one classroom as well as the courtyard.  Registration set up just inside the gate, and Triage not far away.  The fluoride team set up along the wall of the school, the nurses in the classroom, and Linda with the eye glasses had the best office of all, under a big tree in the corner of the school yard.  The doctor arrived later, took one look at the medical (nurses room) and said he would not work there.  We found him a spot in the kitchen and pharmacy was set up in an alley near the washrooms.  OK, not ideal but you have to work with what you have.  They offered us lots of tables and chairs, and the stations moved as needed to get out of the sun. We had good translators and we were soon in business.  

As we only worked basically half a day, we saw 94 people in need in this very poor village.  Dwayne and Valerie work with these people all the time and know most of them.

Fluoride clinic was busy because we were at the school.  The kids loved the streak of face paint that came from my sister Nora.  We put a big streak wherever they want it at the end of their treatment.  

Nursing had some interesting cases.  A 33 year old woman came saying she was 6 months pregnant with her 4th child, and 2 children with her.  They were all dirty, clothes and skin and said they had no soap and bathed in the lake.  Unfortunately we had missed putting the soap into the bus. They also had visible head lice and wanted treatment for worms and the lice.  We use a non toxic treatment for lice, basically a salad for the head.  The hair and scalp are soaked with any kind of cooking oil and the shower cap is put on to control the oil, and left for 3 hours to suffocate the lice.  The hair is then combed with a very fine lice comb to remove the dead (hopefully) lice.  The hair is washed with soap and shampoo a few times, rinsed and the final rinse has an ounce of vinegar to put in the water and then the hair is combed once again with the lice comb to remove the nits, the eggs that stick to the shafts of the hair.  All of the family have to be treated at once and then all of the bedding needs to be washed.  For this family, there is only one bed for mom and dad and the kids sleep on the dirt floor.  They have no kitchen.  An agency bought them a few chickens who are caged in a very small space, but she is able to sell a few eggs.  Mom was grabbing at the supplies as we were trying to explain the lice procedure, maybe thinking we would not give her what was needed.  This area is very hilly and the steps to the house were mostly missing.  Another agency installed a corrugated metal roof on their house a month ago so they lived through the rainy season with a leaky or non existent roof.  They bathe in the lake so we told them not to shampoo out the oily water and rinses into the lake.  They also drink the lake water sometimes so no wonder they all have worms.  

The mother, supposedly was 6 months pregnant.  But she did not look like it.  She had some visible abdominal scars and had a bit of abdominal fat over her jeans, but not that of a woman with a fourth pregnancy.  Two different pregnancy tests that we did were negative, yet she said she had felt movement and this felt like her other pregnancies. She had not seen a Dr. yet.  The nurses did not have any space to do an examination to feel for placement of the head and bum and we could not find our fetal heart monitor.  We sent her to the Doctor who also had the local female nurse specialist working with him with our concern to take a fetal heart.  They did not, even in the private space they had.  I do not think they even examined her.  Instead, they said they would do an ultrasound.  That would consist of Valerie, the missionary taking the whole day to get her to and from the ultrasound clinic and also paying for it.  Doing a fetal heart rate and examination for the size of the uterus is clinical and routine with a pregnant patient.  We did the urine dip which was normal, and reported to them.  As Canadian nurses, we were very disappointed in the care, and felt that we as nurses were not working well with the Dr.  He needs an interpreter all of the time to read the nurses notes and understand their concerns so we are not all starting from scratch.  

The fluoride clinics found that the children and everyone had very bad dental caries.  We also saw a number of children with red ear canals, probably from bathing in the lake.  We do not have any antibiotic drops and they would only get reinfected anyway.  

Wilma, our stroke rehab nurse fitted a number of people with canes to improve their mobility.  Linda fitted 31 people with reading glasses.  She had some folks who really wanted them, but the best prescription for lenses was window glass so had to tell them their eyes were fine and we did not have appropriate glasses.  We see a large number of people with Pterygiums on their eyes.  It is called

 ‘en carne’ here, carne meaning meat.  It is a meaty growth on the outside of the eye ball that starts from the outside and the inside of the eye and grows toward the cornea or window of the eye, through which we would see the coloured iris.  It is caused by exposure to wind, dust, dirt and smoke irritating the covering of the eye in the space that is last covered with the lids in a blink and first uncovered.  We give them sun glasses and a cap to help protect the eye.  If it keeps on growing, it covers the clear window and they cannot see.  It can be surgically removed but that would not happen to these people.  

Having clean water is a problem in these villages.  Bottled water is available but does not come from the factory or the source.  A tanker brings water from the factory and dumps it into a holding tank in the village which then taps it into bottles.  The problem lies in the transfers.  The hose from the tanker is dragged across the ground where the horses, dogs and animals defecate, and then slung over the top into the holding tank that is also not protected sometimes from bats and other critters, and the water is then contaminated and the jugs are filled from a spigot on the tank.  The 5 gallon jugs with water become green after a time.  Great, people are buying bad water.  We met Rotarians who also have a ministry here to supply water filters in the homes.  They use a clay filter which lasts about 5 years and costs about $50.00 all installed.  Unfortunately it does not remove heavy metals.  I told them about the Stratford Rotary Agua Box program that is only for disaster areas. 

This village of Ojo de Agua that is established right beside the lake, gets water from higher up the mountain.  It runs into a holding tank, which had a crack in it and all the water would leak out above about 18 inches.  Then the people would have to drink the lake water.  A Rotary Club installed a new water tank.  Thank you, Rotary!  Clean water and sanitation, health and hygiene, peace and conflict resolution, education and sustainable development are the primary interests of Rotarian projects.

We had dinner at the hotel and reviewed the changes we would make to our approach tomorrow.  Everyone was excited to have a first day of work under our belt.  First days are always difficult and the team came through with flying colours.  All the services repacked the hockey bags, removing some items and replacing others, like the omitted soap, ready for tomorrow.

Breakfast at 7 and we are on the bus to Mezcala, the largest village along the eastern end of the lake.  Our location is the municipal building and it’s very large 

covered sports area where we were last year.  We move tables and chairs to accommodate  every service.  Registration, Triage, eye glasses, fluoride and waiting room are outside under the cover and nursing is in one room.  We move book shelves  to make a private examination area on top of some desks and hang sheets over the mirrors to ensure privacy to encourage the Dr to do examinations and the nurses can as well.  We put the Dr in the open lobby but when he finally gets there, he wants the private area with the nurses, so Marian changes.  The pharmacy is in the kitchen.  We wanted eye glasses where we were last year but that was denied.  A Bombero (fire fighter) and a nurse who is the ambulance attendant come and we are not allowed in their room.  However, the fire fighter speaks some English and I invite both of them to come work with us, which they do and help at triage, both groups enjoying working together.  They work 24 hours on and 24 hours off.  Their ‘station’ consists of a desk, chairs and bunk beds, and the ambulance sits beside the building.  They would be very envious of the new Perth County Ambulance base!

Mary Lou has no translator and she does registration all by herself and does it well.  We had 150 people registered for treatment .  Fluoride clinic is very slow until school is let out next door and then we are flooded with kids, some playing on playground equipment beside us, but lots running around.  Some will come and have fluoride treatments but many make fun of them and interrupt the process.  Even with all of that, Jana and Carol managed about 100 fluoride treatments, and they are not recorded as patients.  They reported that the teeth the children in this community are in much better condition that in the village where we were yesterday, and this is relayed to Dwayne and Valerie.

Nursing had some really interesting situations.  A young woman her early 20’s came with main complaint of infertility.  All of that was discussed and then they find that she has huge urinary complaints and urinalysis reveals a major urinary tract infection, always a worry that it has migrated from the bladder to the kidneys.  She is very uncomfortable and the nurses send her to the Dr with this problem highlighted.  However, she apparently only tells the Dr about her fertility problem and we find out from Pharmacy that she was only ordered vitamins.  We look for her around the clinic and out on the street as we are worried about her medical problem.  Sadly, we do not find her.  

Wilma had fitted an older gentleman with a cane.  I looked out the window and saw he and his wife walking on the sidewalk and he was carrying the cane.  I went out and again showed him how to use the cane after asking him which side was sore (the cane is used in the opposite hand to the sore side).  I struck up a conversation in my broken Spanish, and found out they were married for 68 years and had children and grand children.  I did not know the name for great grandchildren.  He thanked us for coming and prayed for us right there on the  sidewalk.  Brought tears to my eyes.  Then they walked on, the gentleman using the cane with every step and she holding on to his other arm.  I got a great photo.  

A 15 year old comes with her mother with every complaint in the book.  Marian wondered if she might be pregnant so asked the mom to step away, and then quizzed the girl.  Yes, she had been with a 16 year old boy, but only once and a pregnancy test was negative.  Marian then gave her sex education and options.  The girl would not make eye contact and kept looking away and Marian explored  her emotional health.  The truth comes that she was very depressed and had tried to take her life last year when she was 14.  Resources for mental health are minimal and the translator who is the pastor wants her to turn it all over to God.  Marian explores that and other supports like youth groups and gatherings within the church community and has her commit to going to these and interacting with others even when she does not feel like it.  She will also be referred to DWayne and Valerie for follow up as well.  

A 38 year old woman with Abdominal pain brought a 4 month old baby also for treatment.  In sorting out the adult, times and sequences do not jive, and it is revealed the baby is her grandchild, whom she is raising because her daughter would not.  We always have baby formula and bottles but keep it hidden because if nursing mothers see it, they want to bottle feed as it is a status symbol, that you are not the poorest woman in the village.  As well, this lady was referred to DWayne and Valerie as the have some funding to supply formula as needed, week by week.  If a large can is given, it is quite likely to be sold.  

Marian had a lady with a drooping left side of her face.  Other neurological signs were negative, and the diagnosis of Bells Palsy was formulated.  The patient had had it 10 years before and it cleared on it’s own.  We do not have any steroids

but the patient was told that she was in good company if it did not clear as a former prime minister of Canada also has it.  Not sure how comforting that is but it gives her bragging rights.  

Connie at triage and Mallory the nurse are both concerned about a patient with an abdominal mass.  It was huge apparently in the epigastric area above her belly button and it was injected (aspirated?) a few years ago.  It was supposed to be done again but her brother got sick and she did not return.  Mallory and I took her to the ambulance room, had her lay on the desk and examined her.  It was a mobile, non fixated mass about 2 inches in diameter, non tender and not fixated to any structure.  As the capsule of this mass is still intact, it may get larger and she should return to her Dr.

Doogie, Dwayne Jr,  DWayne and Valerie’s 10 year old son is with us all the time because he is home schooled, mostly by dad.  He was with us when we had our first team meeting and asked some very pertinent questions about the process, quite amazing and intuitive for a 10 year old.   He was helping put together the toothbrushes, paste and soap for the people at triage but soon got bored with that.  He loves Mallory RN, young and vibrant, and he would sit with her as she examined the babies.  He will soon be a Doogie Howser MD, because he would listen and listen and then he wanted a pad of paper and a pen.  She thought he as just doodling, but he was writing down all of the symptoms and then piped up that was Mallory going to give any Tylenol for the pain and some massage for the muscles?  OK then, off to medical school with you! 

The nurses again became quite frustrated, that patients with very high blood sugars, in Canadian values of 25 to 35, 4 and 5 times the normal values were not treated for diabetes, rather given vitamins.  One of the patients came for eye glasses as well and her blood sugar was recorded as 35.  I took her to the Dr again along with the interpreter to ask about her diabetic treatment.  He said she just needed to take her medication and not drink coke or pepsi!  She was supposed to be taking Metformin 850 mg 3 times a day, but was not.  With a discussion, he agreed to add our Metformin 500 mg twice daily in addition and to see the Dr in the clinic in a week to get her blood sugar tested.  Another diabetic lady had a slightly lower blood sugar and he agreed to give her Metformin when she was not on any medication and a new diabetic.  This is all very difficult for us to understand when we do all of the teaching and emphasize the importance of taking the medication regularly as ordered, but none is ordered.  

Ashley, Kim’s 15 year old daughter is very diligent at lab services and she now does the finger pricks for blood sugar at triage so that decisions can be made edgier regarding their care.

Linda gave out 60 pair of reading glasses and she saw many patients with Pterygiums who received sun glasses and caps.  The Ambulance crew also received Sun Glasses as they did not hand should have them.  

In the early afternoon, we had 3 Rotarians come out to help, and that was wonderful to see.  As we were trying to relieve for lunches, the president, Bill Wilson, helped out at Eye glass clinic, Rod helped control the kids and fluoride and another who could translate became Marian’s translator.  I think they enjoyed the experience and they certainly appreciated the scope of the clinic.  

Paula and Shannon in pharmacy could only shake their head at some of the orders from the Dr.  like Tylenol one a day for 3 days.  It was busy at times and they are doing a wonderful job.  We (I) will need to canvas more pharmacies to buy more worm treatment.  

Local women are being paid to make lunches for us and they have been delicious.  Yesterday, they made soft tacos with either beef or pork, red beans, guacamole and sauce, some hot, some medium, which is also hot.  Today we had fried chicken and rice with a lettuce salad that most avoided.  

We purchased a 30 cup coffee maker so we could have coffee at the clinics.  We will then give it to the pastor for their gatherings, and he was so excited because now they boil water in small pots and add instant coffee.

We had a lot of dogs running around the clinic area.  The police car pulled up and all the dogs disappeared.  When the police were gone, the dogs came back.  Apparently the police shoot marauding dogs.

Right behind out clinic, there was a kind of market going on.  But no, it was a food bank.  They have 125 families on their list and they can get a bag or hamper every 2 weeks for 150 pesos, $10.00 Canadian.  There were 3 or 4 cabbages, a bag each of rice, beans, pasta and oatmeal, a bag of tomatoes, some packages of dried sauces, some potatoes, but also more than a dozen cans coke and pepsi and a huge bag of candy.  I did not see any fruit, not even the cheap oranges.  

We headed out, happy to have accomplished a lot.  I still think of the old man who prayed for us, and I for them.    Thank you for your interest and forward to anyone you think may enjoy reading this.