Some Colombians do the Craziest Things

 

Today was my final day ashore seeing patients, and it turned out to be quite an adventure.  We rode the RHIB ashore 

again, and our Coxswain Petty Officer Hall handled that boat on full throttle the best I have seen yet.  We practically pulled up alongside the pier at full throttle and none of us suffered a drop.   

The influx of people traveling from the countryside was evident as we were greeted as we stepped off the bus by the largest crowd of patients yet.   At our 0730 physician huddle meeting with today’s Site Leader Dr. Cole, we were told that today would be full throttle for Adult Medicine with a goal for close to 1000 to be seen by days end.  Pediatrics would attempt to see 500 kids for total of 1500.  “Get to work!”, Cole said, “and remember, the more patients we treat, the more of an impact we have on the people here, so work expeditiously.”   

I snagged my trusty partner and translator Maria, and we hunkered down in a partitioned corner across from my roommate (and chainsmoker) Dr. Mike Barretti.  Mike is an incredibly smart guy, certified in Internal Medicine, means well, but has a bitterly sarcastic attitude sometimes.  He’s from Boston, and that says a lot.  He’s tough as nails.   For anything it provided a much needed respite for some laughs throughout the day when we needed it most.  He even had his travel size IPod player there playing some AC/DC as we worked.

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Each day I start out full of energy with the best intentions, full of coffee, and resolved to connect with each and every patient I see.  That lasts for awhile and then you hit a really tough patient that drains you, and in order to pick up the pace again you need a really special patient to bring you back.   That special patient this morning was a 84 year old woman full of life named Ines Cortez.  Inez didn’t look a day over 65 and had a smile and energy about her that brightened up that room really quickly.   Maria and I are so used to patients coming in and asking for (often demanding) pain medicine, vitamins, etc.  When we asked Ines “Cual es tu problema” (what is your problem) she responded that she didn’t have a problem.   She said she just wanted to talk to us, and didn’t want any medication like the others.   Maria and I exchanged smiles, and moved our chairs closer to find out more about this interesting woman.  Ines lives in the country, about 3 hrs away from Tumaco, and she told us about the Americans that had come to her farm to stay recently, and how they had gone on adventures, had fresh fruit, seafood, and lived off the land for months.  She told us all about her children and grandchildren and how some remain tending to the farm and some are working in Bogota and other cities throughout Bogota.   Halfway through our meeting with Ines, she stood up and came over to each of us and gave us a big hug and kiss on the cheek and said “Muchas Gracias por su ayuda y amor a Colombia.”  (Much Thanks for your help and love to Colombia).  That was so unexpected that it made my day.  I think it made Maria’s as well.  I told Maria in English that Ines is what in America we call an “Old Soul”, someone filled with wisdom and hope that comes into your life and affects you positively.  We bid Ines goodbye and emerged refreshed, with smiles a bit bigger, and ready to see a dozen more.

We hit lunchtime 1130 having seen 40 patients.  If we kept up the pace it could be 80 or 90 seen by the end of the day.  Lunchtime is always tough with sun beating down and eating the day’s selection of MRE preserved (dog)food.  It takes a lot of will at this point in the day to reengage, but this was the final push for Colombia and therefore after handing out some Reeses Pieces to the kids, Maria and I did a cheer and got back to work.    

Around 1:30pm I heard Mike exclaim from across the room “Hey Baldwin, have you ever heard of anyone having 17 children!  I have a patient here who has had 17 children!”  That’s the most I have ever heard of and I went over to talk with the woman.  She was middle-aged and relatively healthy looking.  “Wow!”, I thought as I tried to do the computations in my mind to figure out how this 46 year old had managed to do that.  Not but ten minutes later, a woman named Luz walked into my “office” and Maria began to question her.  “Dr. Baldwin!”, Maria said.  “This woman has had 20 kids!”  What was going on?   This woman was only 42 years old!   She was from the country as well.  What she said next was the sad part though.   Ten of the twenty had not survived, and two of the remaining were sick with leukemia and malaria.  I couldn’t help but shake my head, and say what??  This woman had my attention.  What she said next however, is what really threw me for a loop.  Luz’s chief complaint was gastritis, basically a mix between heartburn, stomach upset, and all the like.  She told Maria and I that she used Maalox to help treat the discomfort, but that the medicine was expensive and she could not afford it. Instead of Maalox, Luz  told us she resorted to drinking her own urine to help quell the gastritis pain she felt on a regular basis.   I turned to Maria with a puzzled and questioning look to make sure I had heard her correctly.  Maria nodded yes.   OMG.  We circled back and asked her the question again, and again this “home remedy” was the drug of choice.  We surrendered our questioning at that point, and I wrote Luz a script for double supply of Nexium for her gastritis so that she would at least not have to resort to the alternative for a while.  WOW.   Double Wow.   Haven’t ever seen or heard of that before, but as I write this I suppose that it would (although having uric acid itself) provide a buffer to the even more acidic stomach environment.   

Paula came in about an hour later, just as we were really losing steam again.   She was 18 years old, had an average build, was appropriately dressed, and appeared in relatively good health, other than being for the most part deaf in the left ear.   We treated her for the typical problems of headache, gastritis, and gave her multivitamins.  At the end of the visit she began to tell Maria the story about how she lost her hearing in the left ear.  When she was six or seven years old Paula said, she was near a city and saw on television of a cartoon character taking a rod and putting it through one ear and seeing it come out the other.  No she didn’t do that!  Yes, she did.  Paula proceeded and ran into and perforated her left eardrum and broke off the tip of the rod in her left auricular process.  I peered into her ear and saw the degree of scar tissue in there and felt horrible for this young girl.  I tried to be optimistic with her saying that is why God gave us two ears so that we can survive without one.  You are a survivor I told her, and she smiled.  

The patients kept coming in up until 4pm when the word came to shut down.  Maria, and I saw about 80 patients today.  Our final patient was a 12 year old boy named Andy (Andres).  He came over to me and pulled up his bright yellow shirt revealing a sternal scar where he had had his chest cracked as a child for a congenital heart defect.  They had fixed it and he wanted to show me and have me listen to his heart.  His heart beat strong and normal “Lub, dub, lub dub” and I 

asked him if he played sports.  Futbol (soccer) he told me.  Well you have an athlete’s heart full of courage I told him.  And for your body to grow strong and healthy you should take these vitamins every day, and eat well.  “Que sobre helado?”, the little Andres said (What about ice cream?).  “Tan poco”, I replied with a smile.  “Tan poco.” 

The ride back to the ship to the hospitality boat was long and slow as usual, but I didn’t mind.  I kept thinking about the nice 84 year old woman Ines and the way she lived her life amongst nature appreciating every second.   I wiggled my way up to the bow of the hospitality boat and stood at the apex for the hour long transit and enjoyed the sound of the cutting through the waves and the water splashing to the sides.  I didn’t mind my legs getting soaked by the spray.   It provided my muddy boots with a much needed cleaning.  

As we were hoisted up to the “Barco Blanco” (White Ship) as the Colombians called it the sun was setting and I snapped some photos to remember the moment.   After some good chicken for dinner, after the sun had set, my roommate LCDR Dave Bacon found me and told me they were doing a yoga class topside.  It was a temperate night, the stars were out, and I said, ah what the heck.  Yoga is great for core strength, flexibility, and simply when you want to zone out and enjoy some solitude and silence.  It’s even better when you are doing it outside on the flight deck of the USNS COMFORT 6 miles off the coast of Colombia.    

Day 7 ashore.  Total patients saw today- 85  Total by the team – 1500  Cultural lessons learned- many