Sustainable Patient Care: from Louisville, Kentucky to Tena, Ecuador

Posted on 12/13/11 No Comments
Excerpts from the Greater Louisville Medical Society, VOL. 59, NO. 7, December 2011
By: Raymond Orthober, MD and Brett Rossow, University of Louisville School of Medicine Timmy Student Leader

Group Photo - Louisville Tena Brigade May 2011

The Clinics

Each day our team would travel for upwards of two hours to clinic destinations, perched sometimes precariously, in buses, trucks or motorized jungle boats. Upon arrival in these small sub-100 population villages, the process became quite familiar. The buildings were constructed and arranged in concentric squares around the center of the village, which was always a soccer field. The village school was always the first perimeter of concrete buildings, with residences forming the outer perimeters. To the delight of the children in school that day, our teams would occupy their classrooms, giving them an unexpected break from classes.

The Sustainability 

To ensure that our group created a lasting impact on the communities served, this year and for the future, the U of L group teamed with Timmy Global Health, an Indianapolisbased, Ecuador-run organization that sends medical brigades every 60-120 days into identified medically underserved communities, thus ensuring continuity of care for these populations. This teaming also allows for bulk discounted purchasing of medications and supplies, as well as the opportunity for longitudinal clinical research endeavors for the U of L team.

The Cases

The populations that we served were exceedingly rural and agriculturally based. A typical patient worked long hours in the hot sun in the fields, bent over at the knees cutting crops with a machete. Chronic pain issues from overuse of joints were common and easily mitigated with ibuprofen and Tylenol. Complaints of “La Grippe,” or the flu, were commonly encountered and appeared not to be virally induced, but rather allergic complaints from the pollens and dusts stirred up
by the cutting of crops. These were easily treated with a drying agent. Chronic headaches uncovered dehydration – the average field worker was found to drink an average of only two glasses of water a day.

Most Poignant Case

Drug trafficking is an unfortunate reality in parts of the Amazon, the area of our visit being no exception. To deter detection, the traffickers will often protect the remote walking paths to their crops by stringing a trip wire across a path at knee level – anchored at one side by a tree and the other side attached to the trigger of a sawed-off shotgun trigger.
We evaluated the case of a 73-year-old woman who inadvertently triggered one of these booby traps. She self-ambulated into our clinic with wounds that were three days old. We counted 36 entry/exit wounds and our X-ray showed 24 retained buckshot pellets centered between mid-thigh and mid-calf. Incredibly, the wounds were not infected and there
was no neurovascular compromise. She was bandaged and allowed to recover on her own with a prescription for some
over-the-counter NSAIDs.

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