Liga International Medical Mission to El Fuerte, Sinaloa, Mexico
(for information about the organization, go to ligainternational.org)
In April 2009, I went on a medical mission with an organization called Liga International, to El Fuerte, Sinaloa Mexico. The whole experience was pretty incredible; it is hard to capture it all in words.
Why did I go on a “medical mission” to Mexico? I am not a medical professional, but my field of expertise is ‘medical sociology’ or as I prefer to say Sociology of Health and Medicine. My geographical focus has been Latin America, specifically Mexico. I also speak Spanish pretty fluently, and have studied medical Spanish and so I volunteered as an interpreter, which they need because a lot of the docs don’t speak Spanish.
Why Liga International? One of my MedSoc students told me about Liga at the beginning of the semester. Liga International is an organization of pilots, medical professionals (general, internal, eye, dental, pediatric, ortho, pharm, nurses, etc.), nurses, medical students, and other volunteers (i.e. Spanish interpreters) who run a monthly clinic in the remote mountainous rural farming towns of El Fuerte, San Blas and El Carrizo, located in the north of Sinaloa, Mexico. The first weekend of every month, about 15 to 20 small planes (such as the Baron Beechcraft, 4 seater, which I flew in; it is much like flying in a small sedan in terms of size) fly some 40-50 medical and support volunteers into northern Sinaloa to staff the clinics.
Me w/Julie (one of the pilots) and a volunteer Doctor with the plane
The experience was remarkable in that I had the opportunity to fly in a small aircraft to a remote part of Mexico, AND I had the chance to see first-hand a lot of the stuff- in regard to doctor-patient interaction in cross cultural settings, rural health, etc.) I read and teach about as an assist Prof of Sociology at a local Cal State University. Since I was a volunteer, it didn’t cost me a lot- just the price of my hotel room and food, as well as a fuel fee (about $200). (And air-sickness (read on!) and lack of sleep and probably exposure to some kind of flu bug all of which have since resolved.)
Below are some of my experiences and impressions….
The Liga organization/clinic works with local Mexican volunteers, including doctors and students. The students helped organize and run triage in the morning, and then ran the waiting room in the afternoon, distributing patients to the various clinics.
The Liga organization/clinic works with local Mexican volunteers, including doctors and students. The students helped organize and run triage in the morning, and then ran the waiting room in the afternoon, distributing patients to the various clinics.
Friday afternoon in El Fuerte. We arrived in El Fuerte by about 2:30pm. I was in a state of severe motion sickness. The trip was fine for the first 3 hour leg between John Wayne and Ciudad Obregon, where we went through customs and fueled up. On the trip from Obregon to Fuerte, Jack drove the plane (Julie and Jack are a husband-wife pilot team) and he did this little hotdog maneuver when we took off, plus there was turbulence landing, so I was pretty green in the face.
Me in a state of severe motion sickness
The pilots had the taxi drop my at my hotel, the El Fuerte ($50 night for room w/two bed tho’ I was on my own; very new and comfy for Mexico J ), and went on to their hotel, the El Torres, just down the street. I showered, and went for a walk to deal with the motion sickness. I checked out the local Mercado municipal, which was tiny and mostly shut down given the time of day, and then decided to head to the clinic to help set up as it was about 4pm.
The clinic is at the northern end of town, about a 10 minute walk to the central park and El Fuerte hotel. I arrived and met Winnie, the clinic coordinator. Winnie is an amazing woman- calm and centered despite being in demand from every direction from volunteers trying to find supplies, and set up for the Saturday clinic, and at the same time deal with the long line of patients already lined up to go through triage and get their “ficha” (appointment time).
The clinic
I Arrived at the clinic on Friday at 4, met Winnie and Lucy, and began to help organize supplies for the Pharmacy, OR, and exam rooms.
While I was helping put supplies away in the pharmacy on Friday afternoon, Dr. J arrived. Since a good number of patients had been through triage and were waiting around, Dr J and I went to work for a couple of hours. (Dr. J was the General Med doc and since he spoke very little Spanish I was assigned to him to translate.) I was anxious and stressed about my translating skills, as it had been a while since I had worked in a Spanish language medical setting, but Fri afternoon helped warm me up and I figured out which words I needed to look up/review.
Lucky me, the first patient we saw was a woman in her early 50’s who was suffering from hemorriods! It was great to translate for a few hours on Friday as it have me a good sense of what vocabulary I needed to review! (see below).
We worked for several hours that evening and then from 9-5 the following day, with only a brief 15 minute break to eat a small lunch at 1pm. I was shattered- to be speaking in two languages all day was extremely draining, plus after sitting all day in a chair in a freezing cold room (the clinic had wicked AC) my head and low back was killing me.
On both Fri and Sat eve after clinic, Dr. J and I walked back to town together and agreed to meet up in an hour for dinner. El Fuerte is a charming colonial town, and because of the tourism (it is located at the southern end of the Copper Canyon, near Los Mochis) it has numerous hotels and posadas that are lovely and reasonably priced, as well as restaurants and bars that offer good local cuisine (fishing and farming are the basis of the economy in N. Sinaloa). On Fri we had dinner at the Choza Hotel (really good food, but was too motion sick to really enjoy it) w/4 other Liga volunteers, two of whom were a father-son team; the kids was 13 and very smart and helpful, it was great to see a dad and son doing this kind of work together (they were on the religious side; they blessed dinner before we ate). On Sat eve, Dr. J and I met up w/another Liga pilot/Dr (yes, some of these amazing people are both pilots w/their own planes AND doctors) for a fabulous dinner at the Hidalgo Posada, which I could barely eat as I was STILL motion sick and simply too exhausted to eat or talk (but I did a fine job of drinking a margarita and sipping a straight shot of Patron!). Unfortunately, I did not sleep well either night, despite having a rather comfortable (for Mexico) bed; I was ill from eating too late and the motion sickness.
The patients that impacted me the most. As luck would have it the first patient we saw was a middle aged woman with hemorrhoids. Imagine having to translate that! Luckily I did know that word in Spanish ;)
Triage on Sat morning was my favorite part of the experience. I worked with Winnie from 8-9am, on Sat morning. The way triage works is that all the patients line up on Friday afternoon and Saturday morning, and fill out their medical form/record (some have been to the clinic previously) and tell us the reason they want to see the doctor today. Based on their complaint, they were designated an appointment time in the following clinics: General Medicine, Internal Medicine, Ortho, Pediatrics, Dentist and Eye.
Saturday morning Triage
Most of the people were elderly, women with children, and a few teenagers and young adults. Most are farmers from the outlying rural areas and their only access to medical care is through private clinic’s like Liga’s.
By the end of Sat we had treated 300 people in the clinic; There was also an operating room running that did 13 operations on Saturday, including several hernia, varicose vein, and cataract operations.
Patients that impacted me most:
- A woman in her early-to-mid thirties who worked as a tomato packer from 8 am to 12 midnight for six months out of the year (the other six months tomato work is out of season) came into the clinic with uncontrollable tremors. Dr. J diagnosed her as psychosomatic right away, after doing a few muscle and reflex tests on her. He was like “done” with her, saying he could do and recommend nothing. Next patient! I was so sad for her, wishing I could provide more information about mental health services, etc. but that was not part of the clinic.
-A 17 year old girl who fell off of a moving vehicle 1 year prior, damaging nerves in her right arm and a keloid scar on her lip (unfortunate case of really bad surgery/no PT on both counts). The girl does not speak. She does not go to school but sits home all day reading and watching tv (admittedly the school is far away, she lives in the campo/country). Literally, she is so shy that she is incapable of speaking to us so her mother accompanies her to the clinic and so she is there to hear Dr. Jay say that she (the mother) is protecting and coddling her daughter and the kid needs to be more independent and get an education!
- WE also saw many elderly men and women who had severe musculo-skeletal pain, headaches, backaches, etc. And no wonder as the nature of their work is literally backbreaking (farming, living in the country).
-The prevalence of diabetes/obesity, high blood pressure, dehydration, eye problems/cataracts was astounding. Also, the numerous hernias, varicose veins dental problems and childhood birth defects of all types.
-sense of time; asking the patients, “when did you begin to feel this ----- symptom was pointless. The concept of time was confusing- “it hit me a while ago” could mean a few hours, days, weeks or years. It was also difficult to get the elderly to focus on one particular issue/pain/problem. All of their aches and pains were connected and a long involved narrative was required to explain it all- something Dr. J did not have time for! He’d say to them, “ok, point to the ONE place on your body that hurts” to get them to focus! In some ways I felt like what was happening was a “cultural encounter” in which the indigenous/campesino could capture the benefit/mojo of western/American medicine….? Leads into dependency issues…..
-me pego – the illness/pain “hit me”
-profuse musculoskeletal complaints (because of hard work), headaches
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Health consequences for me! Fibromyalgia flare for 10 days plus!
Some of the frequently used words and phrases, several of which I had to look up!
-respira/inhala hondo – inhale deeply
-desmayos/desmayerse – to faint
-latidos; le late rapido/violentamente - heartbeats
-patear- to kick
-entumido- numbness
-aguda- Sharp/ dolor apagado – dull
-derrame – stroke
-vision borrosa – blurred visión
- escallofrios- chills
- erupcionesd de la piel
- materia fecal/orina
-rascar- to itch
-bultos- lumps
-Quistes- parasites
-mormullo- murmer
