Of chickens and phenobarbital

Fall 2002 Dear friends, Hello! Several of you have reminded me that quite a bit of time can slip by between these letters. My apologies. Be assured that infrequent correspondence has much more to do with duties and distractions than with disinterest. You remain so very important to me and to our work and I love hearing from you.

Clinic Updates: Several months ago I had a week of retreat time when I could reflect on our work and purpose. I saw that, in fighting personal fatigue over the past several years, I had neglected regularly teaching our staff. And that a staff that is not challenged can become a staff that is bored. My staff, being exceptional [my bias!], had done fairly well with the lack of “in-services” but it seemed urgent to start educating more deliberately again. I asked for each of my staff’s learning goals and was thrilled to see how closely these goals corresponded with my aims for them. So far we have started studying basic algebra in order to calculate medicine doses. At the same time that they are figuring out how to do 9-x=7, they are tying surgical sutures on a suture board and learning to write the Spanish equivalent of “rales and rhonchi in the right lower lung field”.

Tidbits of recent Salvadoran life: A 18 year old man with a history of repeatedly banging his head open while seizing came in smiling ruefully: “Doc, those meds you gave me must really be strong!” I concurred but wondered why he was reporting this now. He smiled again. As usual he was taking his meds on his front porch (his single-roomed dirt-floored house is used mainly for sleeping; the open front porch serves as lunchroom and sitting room for family and farm creatures alike). One of his Phenobarbital tablets dropped onto the ground. A chicken wandering through saw a meal in the making and snatched the pill before Eduardo could rescue it. This chicken gulped, walked a few steps, and promptly fell over into a profound sleep. There it lay for 5 days, breathing deeply but soundly asleep. On the fifth day it awoke, (yawned, I assume) squawked, and continued its scratching and pecking existence without any further comments or complications. Yesterday a mother in the practice explained her own bit of bad luck. Patients still swarm off the 6 a.m. bus in their competition for the first positions in line. These last weeks have been busy at the clinic so people understand that unless they bustle while leaving the bus they may not be seen the same day. Yesterday Elida planned with 4-year-old Javier that he would squeeze through the crowd and dash to get numbers for him and his 3-month old brother. The bus belched to a halt, Javier maneuvered through the crowd and took off in a great sprint. He was leading the pack and was about to get his number when he dropped to the ground. The adult patients stormed past him and still Javier squatted, completely absorbed. “Oh, Mami, look! It’s so cold and hungry!” An abandoned kitten had stolen Javier’s attention, interrupted the number-obtaining process, and delayed the family by hours. Thankfully, the mother understood the pathos involving hungry and helpless creatures of any species and entered into her son’s tenderness rather than scolding him for causing extra hours of dead time at the clinic. The almost- annual medical strikes are again in process. (Teachers and attorneys working for the government also strike, but that is another story.) Physicians working in government hospitals strike in an attempt to negotiate salaries, shutting down hospital services for weeks to months at a time. The typical government response is to fire these docs and hire someone else to replace them. At some distant time negotiations then occur, an adjustment is made in salaries, and the fired crew is hired on again. It seems like a bit of a game from my perspective, but the game isn’t too much fun for the multitudes of patients whose surgeries are delayed indefinitely or who are losing their routine medical care. This week an insulin-dependent diabetic ask me to switch her to oral meds because of the strike. I am unable to stock insulin and pharmacy prices are prohibitive. We had no options so the patient and I agreed to try and see what happens. We continue learning about local beliefs and their impact on our community. We were recently eating supper at a friend’s house when she started telling about the siguanaba’s mischief. This phantom is known of in much of Central America; our local character is a woman with masses of tangled, light-colored hair plastered over her face and with pendulous breasts. She most recently appeared several months ago to a 8-year-old neighbor boy who was fetching water for his grandmother. The most dreadful part of the encounter was the Scare that entered him. These Scares can kill—and here the conversation deviated to report the Scare that entered her when she was bitten by a rattlesnake as a teenager. Then, as now, the remedy for a Scare was to immediately beat the victim until he/she starts screaming lest the Scare causes them to swell up and die; it took 14 lashes from a rope to expulse the Scare from the rattlesnake-bitten girl. Though 8-year-old Miguelito was protected through the beating from swelling up and dying after seeing the phantom, he remained pale and quiet for an entire month afterward (could the remedy for the Scare and the neighborhood terror have anything to do with that?) To my friend the siguanaba was as real as the pasteles we were eating and considerably less palatable. I was told yesterday of a government program where children can trade in toy weapons for a tee-shirt. Now, that is good news in our country!! I will sign off as I sometimes sign off to my family: so nice talking with you and now it’s your turn. God’s very best to you! Yours, Jana