Aug 17, 2013
Everyday this week has started before the sunrise… a nice time to travel, before the heat of the sun takes hold. I’ve enjoyed the early morning commute to 7am rounds at the Puerto Esondido General Hospital.
The Puerto Escondido General Hospital is a 30 bed hospital with one designated for gynecological patients, one for general surgery, and some private rooms for contact isolation patients; additionally, there is small pediatric unit.
The local medical coordinator of Child Family Health International connected me with Dra. Julia, a wonderful hospitalist, who went out of her way every day to ensure my experience was as rich and action-packed as it could be! Two days this week I spent observing surgeries: c-sections, a femur repair after a gun shot wound, cholecystectomy, appendectomy, and an amputation of a diabetic great toe.
Prevelant all throughtout Mexico and the United States, type 2 diabetes is the culprit behind many of the ailments of the patients hospitalized in the Puerto Escondido hospital. Kidney disease, loss of vision, and ulcers — all a result of the chronic microvascular injury of poorly controlled blood glucose levels.
One woman, 53 years old, had been hospitalized for 7 days (likely much longer than would be afforded in any US hospital) after presenting with uncontrolled diabetes and an unstagable diabetic ulcer on her right great toe. After debreedment and days of antibiotic therapy, follow up x-rays revealed the infection was not responding to treatment. The surgeon and care team gathered during rounds on Friday to explain her options to her: amputate her toe now, or wait and amputate her entire food or even more after the inevitable spread of infection into the bones. She agrees to the surgery today, muttering, “Si doctor, entiendo” — yes doctor, i understand.
The tears in her eyes make reflect her coprehension of the impending surgery; but, I do not believe she understands how she got into situation. What led her, and countless others like her, to limb-sparing amputations? Although I do not know her story, I presume it includes poor nutritional options coupled with gaps in healthcare access, resources, screenings, education, and follow up.
Since arriving in Mexico, my diet has been much higher in sugar than back at home. There are seldom low-sugar or complex carbohydrate options at the grocery or on menus. At Super Che, the major grocery store, I could not find one container of yogurt that did not have added sugar, no plain options, along the entire 30-foot stretch of refigerated yogurt options. Additionally, walking along the isle of sodas and juices, there are almost no diet options. Coca-Cola Light is the only sugar and calorie free drink that I could find. Sprite, Dr. Pepper, and countless Mexican brands line the isle; but none of them come in diet, light, or sugar-free. Then again, buying jelly, every option contained high-fructose corn syrup – diabetes in a jar.
There is an organization in Mexico, “La Federacion Mexicana de Diabetes” , that is geared towards supporting diabetes prevention and treatment. They support the education of people with diabetes and those at risk and the production and sale of healthy, low-sugar food options. The organization provides training for health care professionals, professional journals, and annual conferences.
Learning from the Locals - International Medicine 