Home delivery and other things that didn’t work so well

I am really truly back in El Salvador (see pictures below for verification).  You may be asking, “So how is it going?”

The short answer: “Very well, thanks”.  I’ve been back just long enough to get reacquainted with many of our patients and their charts from the past year.  With absolute objectivity, I do believe Salvadorans give some of the world’s best hugs.  Periodically patients’ eyes tear up and they say they’ve been praying for my health every single day this past year; the tone in their voice makes me believe them.

Indeed, one of my recent nights of insomnia was induced by sheer delight.  The two new nurses and I had shared a day at the clinic and had seen a full load of patients with  unbelievable ease.  During that happy, sleep-deprived night, all my heart could say was, “I have help!!”.  Two of us are now trying to do the work of three since one of the nurses had to go to the funeral of a close family member in the US, but hopefully by next week we’ll return to our new full team of providers.

But surely, you say, a doctor has more to do than receive hugs from patients* and fight sleepless joy.  Well, yes, as a matter of fact.  We draw hoards of diabetics (more so when public medical facilities run out of even the most basic medications) and a fair amount of an average day is spent checking our diminishing supply of diabetic meds and matching the existing drugs with the needs of the patients.  If it weren’t for the samples some of you have been sending down, we wouldn’t have this dilemma; we’d just have a lot more diabetics with poorly controlled blood sugars.   As it is, we live from medicine shipment to medicine shipment, hoping to keep Hemoglobin A1C’s within shouting range of normal.

One of the delights of my work is hearing about real life from patients.  A 50 year old woman told me last week that she was having mid chest pain.  That history, of course, calls for additional questioning.  The fact that the pain had been present fairly constantly for 25 years made me doubt an acute heart attack (even sturdy Salvadorans don’t survive myocardial damage for that long!).   She knew the exactly when the pain started because of the age of her youngest child.  Like many young mothers in these rural areas, she was looking for a way to help feed the family, and had walked an hour to gather mangos to sell at the market.  Something went awry in the process of putting the basket on her horse’s back, because the next thing she knew, she was pinned to the ground by a horse’s hoof,  with the full weight of the horse planted onto her milk-laden breasts.  “It was because my breasts were so engorged from not having breast-fed all that day while gathering mangos that I wasn’t killed”, she told me.

She was still protecting her bruised chest on the morning she set out to milk their cow on the hillside.  The cow had an aversion for my patient.  Being a wise country woman, she prepared for whatever bad mood the cow might have been in by shackling both front and back legs and putting a fence between the cow and her milking stool.  Unfortunately for my patient, the cow’s irritability exceeded all precautions.  In the midst of milking,  the tethered cow decided to take charge of the situation by flopping onto its side into the patient’s lap.  Maria could only grunt; her husband was working in the nearby pasture and was able to make the cow move off his wife only by tightly twisting the beast’s tail.

The stories are true.  My patient’s costochondritis reminds her of it regularly 25 years later.

*Hugs are truly part of our clinic mission statement!  Read it for yourself in Luke 4: 18, 19 in the Bible..

So, you may ask, are you doing OB now that  you’re back?.  Answer:  I try to avoid it.  If, however,  a pregnant mom shows up in my apartment, I am forced to do something (even if she is carrying 15 offspring!)  I forwent the ‘first do no harm’ part of the clause for the case shown below.  For those of you who haven’t made personal acquaintances with scorpions, in the following small photo are fifteen red-hot stings waiting to happen.

Economically, El Salvador typically parallels the US.  Last night I watched one of my former employees trying to fill her 9-month-old’s stomach with a toasted-corn-and-coffee drink mixture and cookies.    During my year-long absence, the clinic ran out of formula for her little one who had been born prematurely and now the mother was trying to wean the infant from milk as much as possible.  Formula costs over $20.00 a week at the grocery store and her husband earns $5.00 daily (when he has work), so she has been forced to look for other nutritional options.

Elections are coming up in El Salvador. We know:  the government is making a show of  working on our road.  During one of the recent elections, ¼ mile of the road leading from Santa Ana to our village was paved.  Last night there were 4 pieces of road machinery parked outside our village; the men sitting by the machines were all dressed for work in their bright yellow uniforms, but the machines were idle and the men reading their newspaper.     It seems so often our government has just enough funds to pay for the appearance of progress without quite managing to pay for progress itself; enough to provide uniforms–but not work–for the unemployed.

Rut, thanks to the same system, the fears of last year are relieved for the moment.  For last 40 years this road (connecting the 2 major cities of our country and running through our village) has been the subject of much political activity.  Indeed, several scams have ‘paved’ the road on the map but not in reality.  Last year millions of dollars were spent surveying and scooping, smoothing, packing, and developing drainage systems;   Only the final layer of cement remained to be poured on most of the road..  I felt wistful for the social disruption such a road would cause, forcing us to be a suburb of one of these large cities instead of our quiet country village.    But then, the money ran out, the company quit paying its workers, and the rainy season returned the road to its pre-paved state (“dust to dust” applies well on roads here).

A most joyous Christmas to you!

(Photo taken in my backyard last week; apologies to all snow birds!!!)

Jana Nisly


Marietta, with Karen (NP) and James (new clinic administrator) continue finding ways to better serve our patients.