Sustainable Patient Care: from Louisville, Kentucky to Tena, EcuadorExcerpts from the Greater Louisville Medical Society, VOL. 59, NO. 7, December 2011 By:Â Raymond Orthober, MD and Brett Rossow, University of Louisville School of Medicine Timmy Student Leader
Each day our team would travel for upwards of two hours to clinicÂ destinations, perched sometimes precariously, in buses, trucks orÂ motorized jungle boats. Upon arrival in these small sub-100 populationÂ villages, the process became quite familiar. The buildings were constructed and arranged in concentric squares around the center of theÂ village, which was always a soccer field. The village school was alwaysÂ the first perimeter of concrete buildings, with residences forming theÂ outer perimeters. To the delightÂ of the children in school that day,Â our teams would occupy theirÂ classrooms, giving them an unexpected break from classes.
To ensure that our groupÂ created a lasting impact on theÂ communities served, this year andÂ for the future, theÂ U of L group teamed with TimmyÂ Global Health, an Indianapolisbased, Ecuador-run organizationÂ that sends medical brigades everyÂ 60-120 days into identified medically underserved communities, thusÂ ensuring continuity of care for these populations. This teaming alsoÂ allows for bulk discounted purchasing of medications and supplies, asÂ well as the opportunity for longitudinal clinical research endeavors forÂ the U of L team.
The populations that we served were exceedingly rural and agriculturally based. A typical patient worked long hours in the hot sun inÂ the fields, bent over at the knees cutting crops with a machete. ChronicÂ pain issues from overuse of joints were common and easily mitigatedÂ with ibuprofen andÂ Tylenol. ComplaintsÂ of â€œLa Grippe,â€ orÂ the flu, wereÂ commonly encountered and appearedÂ not to be virallyÂ induced, but rather allergic complaintsÂ from the pollensÂ and dusts stirred up
by the cutting of crops. These were easily treated with a drying agent.Â Chronic headaches uncovered dehydration â€“ the average field workerÂ 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,Â 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 â€“ anchoredÂ at one side by a tree and the other side attached toÂ the trigger of a sawed-off shotgun trigger.
We evaluated the case of a 73-year-old womanÂ who inadvertently triggered one of these booby traps.Â She self-ambulated into our clinic with wounds thatÂ were three days old. We counted 36 entry/exitÂ wounds and our X-ray showed 24 retained buckshotÂ pellets centered between mid-thigh and mid-calf.Â 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