Working in a makeshift primary care clinic, such as those we set up, may be one of the rawest ways I can think of for a person to learn about the challenges people face in their daily lives. We had arrived in Santo Thomas, a small village of adobe houses scattered over an extended ridge and plateau overlooking the Honduran border into El Salvador and beyond. Leaving before sunrise, we spent the last 90 minutes standing in the back of a large truck as it maneuvered rocky roads. At least 150 people had already been forming a set of lines in front of where we knew our clinic would be. The line was growing by the minute, and we eventually saw more than 220 people on this day.
Setting up the pharmacy in a partitioned area was first priority for myself and others who had this assignment for the first half of the day. Our medical interpreter and one of the fluent physicians were beginning to organize a triage system. Pregnant women, malnourished infants, sick children, those with bloody diarrhea, respiratory infections, skin infections and others were being prioritized.
| “At least 150 people had already been forming a set of lines in front of where we knew our clinic would be. The line was growing by the minute, and we eventually saw more than 220 people on this day.” |
Four of the physicians and two fourth-year medical students were already seeing their first patients. Often they arrived as a unit, a young mother and some of her children. Impetigo and scabies [contagious skin infections] seemed to be endemic; at least 20 children presented with each, some with both. Malnourished bellies full of roundworms and hookworms were also common. A decent fraction of the women and children were clearly anemic.
Throughout the day, some of the saddest moments unraveled. A woman had brought in her paralyzed four month-old infant suffering from untreated Hydrocephalus [build up of fluid in the cranium that leads to destruction of the brain]. Another paralyzed one year-old child was suffering from the after-effects of what was probably a preventable case of meningitis. A nine year-old girl had a granulomatous sore [firm tissue formed as a reaction to chronic inflammation], speculated as potential leprosy. We treated two children with bilateral cleft lips and cleft palates for respiratory infections. An 18 year-old man had an abscessing infection to the bone tissue of a maimed club foot, the second club foot seen that day; both of which would have been corrected at a young age in the US. Two patients were diagnosed with insulin-dependent diabetes and told about the negative long-term outcomes they faced considering their access to the care they needed. We tried to make arrangements for all their referrals, transport and offsetting the cost of needed tertiary care. Since we worked with grassroots organizations, they might actually get the care they need.
— Luke Rawlings, Honduras, November 1999
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