Busy month. Clinic saw 448 patients. Multiple consults. A couple hospitalizations.
Many patients receive excellent care for chronic diseases in our clinic, such as diabetes and hypertension, but there are other illnesses for which we can provide only modest care. Foremost among them is Chagas disease, which I mentioned in a previous post below.
Two of our patients succumbed to the disease this month, dying from heart failure despite our best efforts to manage their condition, and another woman miscarried most likely due to complications from Chagas.
Chagas, like many diseases in the developing world, is a preventable disease. Though steps have been taken towards its prevention, with nets and insecticides, it remains an endemic, neglected disease without cure or even effective treatment. In South America, it is responsible for more deaths than malaria and many do not know that they have been infected until it is too late.
In public health, there is a metric known as the DALY, or the disability-adjusted life year. It is calculated by adding the "years of life lost" (YYL) and the "years lived with disability" (YLD) both other figures that measure premature mortality in a population. All this amounts to is essentially a fancy way of measuring how many healthy years of a person's life are lost due to disability or disease. Bolivia, the poorest country in South America, leads the world in DALY for Chagas, something that all too clear to us at CMHP, as by some estimates nearly 70% of the surrounding population that we treat is infected. Chagas disease has been recognized as a neglected disease by many global health organizations, and some have said that it is the most neglected of the neglected diseases.
Many of these infections occur because of poor infrastructure. The bug that spreads the disease (the vector) is called the vinchuca, or the more ominous sounding blood-sucking assassin bug, or the more innocuous sounding kissing bug in English. These bugs hide in the leaves of the motacú, which are used to construct many of the roofs here, and come out while the inhabitants are sleeping. They crawl onto the faces of the inhabitants to suck their blood and in doing so infect the sleeping person. This is the reason for their namesakes in English.
Recently I had the privilege of presenting a class on first aid, with the help of Dr. Macneil, an ER doctora volunteering down here, to the new group of community health leaders that are being trained here in clinic every Saturday. As the primary health resource for many of the surrounding villages, I thought basic first aid skills would be useful to them. The course covered how to treat shock, wounds, choking, drowning, and ended with a practice session in CPR. The following week splinting and emergency transport was covered. There was a short, very difficult pop quiz afterwards, which I sort of feel bad about because a couple people had trouble just reading it (that said, Bolivia's literacy rate on the books is pretty good). Afterwards, we briefly read a section of the following poem, with the idea that the best medicine is in prevention. I've included it below in its entirety as my way of celebrating getting into medical school, and because it speaks to the fact that the root cause for many of the diseases we treat are symptoms of larger social problems, such as poverty and inequality.
"A worker's speech to a doctor" by Bertolt Brecht
We know what makes us ill.
When we’re ill word says
You’re the one to make us well
For ten years, so we hear
You learned how to heal in elegant schools
Built at the people’s expense
And to get your knowledge
Dispensed a fortune
That means you can make us well.
Can you make us well?
When we visit you
Our clothes are ripped and torn
And you listen all over our naked body.
As to the cause of our illness
A glance at our rags would be more
Revealing. One and the same cause wears out
Our bodies and our clothes.
The pain in our shoulder comes
You say, from the damp; and this is also the cause
Of the patch on the apartment wall.
So tell us then:
Where does the damp come from?
Too much work and too little food
Make us weak and scrawny.
Your prescription says:
Put on more weight.
You might as well tell a fish
Go climb a tree
How much time can you give us?
We see: one carpet in your flat costs
The fees you take from
Five thousand consultations
You’ll no doubt protest
Your innocence. The damp patch
On the wall of our apartments
Tells the same story.
(thank you Amo)
Contributions to Chagas research here:
http://www.treatchagas.org/
Mother's day in Bolivia featuring skits about domestic abuse, patriotic songs to the mother's of the nation, and this awesome dance with one of the volunteers from the clinic:
