Honduras Journal 6

During this visit, we were able to work in the new neurology and psychiatry suite; this was just built out. It is 3 rooms, one for the nurse (Luci), one for the psychiatrist (Dr. Laura Mendoza, excellent young, idealistic psychiatrist) and one for neurology (Dr. Jose Estrada or Dr. Sofia Dubon, both young and idealistic doctors).

 

We also had several people filming for a short “Honduras Video” that we are putting together (mostly for promotional purposes). It was a very busy day, many patients waiting when we heard a blood-­?curdling scream from outside our neurology rooms. We ran out, to find a young man (20 y.o. or so) covered in blood in SEVERE, SEVERE pain. They run a 24/7 ER in our medical clinic, albeit without much equipment. However, some medical care, or ER care, is better than none. The docs and nurses who staff our ER are incredibly devoted and skillful. They do a lot with very little.

 

SO, the director of the entire clinic, Daisy, was cutting the young man’s pants off, in order to clean one of the gunshot wounds. We found some IV Valium, and a skilled nurse managed to get an IV into him. I had one Vicodin (hydrocodone) on me, and I gave him ½ only (I did not want to induce respiratory depression with Vicodin and Valium, and he received 10mg IV Valium, a hefty dose). He calmed down. He had 2 major wounds: one bullet sticking into a leg bone, another passed thru his wrist. His hand was flexed (I assume the median nerve was injured or severed). In the U.S., in most areas, a hand trauma surgeon would possibly repair the damage.

This would involve a complicated 6 to 9-hour operation. Not going to happen in Honduras, so he will most likely be left without use of his hand, and in moderate or severe chronic pain.

 

SO, now what to do: we needed to get him to Tegucigalpa, a long, harrowing journey, but they could not afford a private ambulance. I said I would pay (in Honduras it would be $55), but then the one “public” ambulance in town showed up. You need permission from the mayor to use it, but he gave his permission, so off the young man went.

His younger sister was crying inconsolably, obviously severely traumatized. She will suffer from PTSD. SO, what happened in the shooting? Turns out, this made the nightly news. The young man’s stepfather was yelling at him: so, his older brother came to his defense, as did his mom. His mom had suffered abuse from the stepfather (common in Honduras, unfortunately). The stepfather went and retrieved a gun and shot mom, plus the 2 brothers. He spared the younger sister. We don’t know what happened to any of the other 3; the older brother was shot in the stomach, and on TV looked pallid, so he may have died. Police were searching for the stepfather.

 

I had been seeing a young man during this crisis that has an unusual peripheral neuropathy. He may have CMT (Charcot Marie Tooth neuropathy, a hereditary form of peripheral nerve illness). There is no treatment, but at least we can (maybe) tell him what he has. We will have to make a clinical diagnosis, as obtaining tests are unlikely.

 

During the last several trips I had been surveying patients regarding demographics; these are as follows:

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