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June, 1999
Dear friends of DGH,
I am writing a short update on or work in Chiapas having just returned from a short visit there to help with the training of health promoters. Since the beginning of this year, DGH has been supporting two Mexican physicians who are working in the community health program of Hospital San Carlos.
They are presently working with three communities and about 40 health promoters. Some of the promoters received their basic courses from the hospital several years ago, but due to the conflict of 1994, the continuing difficult political situation and the hospital's economic situation, they have been unable to come to the hospital for further training and have not received regular follow-up. Some are very new and just starting the most basic courses.
I was able to help with teaching them in the hospital and visited all three communities. In one of the communities, I spent the afternoon with one of the community health doctors seeing patients with him and one of the promoters. This community is on "recovered" land, meaning it was taken over from a wealthy landowner during the uprising in 1994. Finally, after a long struggle, it belongs to the people living on it. It is very close a major tourist route, the highway that leads to Palenque from San Cristobal de las Casas and we were sitting talking to the patients in front of the house (a tiny wooden shack with a dirt floor) of one of the health promoters. Air-conditioned busses passing on the highway were so close to us that we could easily see the faces of the tourists riding in them. It was strange to see the two completely different faces of life in Chiapas at the same time.
One of the things that the community health doctors asked me is whether DGH might be able to provide more copies of Donde No Hay Doctor for the promoters. There are only a few copies (of the old edition) at the hospital and only some of the promoters from one community have copies in the communities. They would like to be able to provide copies for the newer promoters when they finish their basic course. I hope DGH will be able to help with this too.
I also had a chance to see a few patients in the hospital. One that impressed me most this time was a young woman who came because she was feeling weak and tired. She was very pale and turned out to have severe anemia (her hematocrit was 9%) and the cause was hookworm. It is a fairly common cause of severe anemia here where many people (especially women and children) often walk barefoot. (For those whose tropical medicine is rusty, hookworm infection is acquired by contact with larvae which live in the soil and penetrate the skin. It then travels to the lungs, trachea, esophagus and the stomach. On arriving in the intestine, it changes into an adult worm that can live for years and cause chronic blood loss.) The problem is that such patients need transfusions of several units of blood. The hospital depends on family members to donate but often only one person comes with the patient and sometimes that family member is him/herself too anemic to donate blood. The patient I saw could only get one unit of blood for that reason. It is often very hard to get patients to take iron pills for months and their symptoms improve only very slowly. One alternative that the doctors here sometimes use is injectable iron. Although this is rarely done in the US where there is a large and safe blood supply, it is a reasonable alternative in places where transfusions are not always possible since it allows replacement of iron stores much more rapidly. It is, however, expensive compared to other medications and the hospital cannot afford to buy it. Anyone who has any connections with the makers or distributors of parenteral iron, please let us know.
I am adding a couple of photos of the health promoters to the gallery of Chiapas pictures on the DGH web site. I think DGH is making a significant contribution to re-vitalizing the community health work of Hospital San Carlos and I hope anyone who can help with books or medications will let us know. Linnea Capps