Word of Mouth is the Best Advertisement
Pedro is a 58 year old gentleman who came to our clinic in Arroyos y Esteros and consulted with our doctor, Patricio Ramos, regarding some left shoulder pain. Patricio started him on an anti-inflammatory medication and asked him to come back in a week. The following week Patricio was not able to come with us, so I saw Pedro in follow-up. Pedro speaks only guaranie so our nurse, Delia, served as interpreter for us. He said that he did not get any better on the medication. He could not raise his arm higher than 90 degrees due to pain and reportedly he had been like this for more than a year. I asked him to keep taking the medication because it may take longer to get a response. Later, I talked with Patricio about him and we agreed that he needed an injection of steroids.
Introductory Note: MAESTRA is a health clinic project from Friendship Mission, one of the Global Mission partners in Paraguay.
Pedro is a 58 year old gentleman who came to our clinic in Arroyos y Esteros and consulted with our doctor, Patricio Ramos, regarding some left shoulder pain. Patricio started him on an anti-inflammatory medication and asked him to come back in a week. The following week Patricio was not able to come with us, so I saw Pedro in follow-up. Pedro speaks only guaranie so our nurse, Delia, served as interpreter for us. He said that he did not get any better on the medication. He could not raise his arm higher than 90 degrees due to pain and reportedly he had been like this for more than a year. I asked him to keep taking the medication because it may take longer to get a response. Later, I talked with Patricio about him and we agreed that he needed an injection of steroids.
The following week we stopped at a pharmacy on the way to Arroyos y Esteros and Patricio purchased 2 doses of dexamethasone, a potent steroid. At the clinic we examined Pedro together and Patricio told me to go ahead and do the injection. The steroid is routinely mixed with 1 or 2 cc’s of lidocaine which helps the steroid spread to a greater area than if it is used alone. This also serves as an indicator that the injection was placed properly if the patient reports a relief of pain soon after the injection. After I injected Pedro’s shoulder I asked him to go ahead and try moving his arm.
Pedro was amazed. He was pain free and could move his arm any way he wanted. He left the room and showed everyone in the waiting room what he could do. He stayed for the duration of our clinic and continued to show off his renewed ability.
The next week Patricio saw Pedro in follow up. Patricio came to me and said that he needs another injection. I said that it was too soon and we should give it more time. But Patricio insisted, saying that there was still a little bit of inflammation and we needed to get rid of it. So I said okay. Then Patricio asked me if I could show him how to do it. It turns out that this family practice doctor with 8 years of experience in rural Paraguay did not know how to perform this procedure. So I talked Patricio through the procedure showing him how to palpate the bony anatomy and determine the proper site for injection in addition to proper sterilization of the skin.
How do we measure the effects of this simple treatment? On the one hand we have a respected gentleman of the community talking about a successful treatment, and on the other we have a doctor who knows how to give relief to patients who do not get better with the only treatment that he had been using up to this point.
I did a study of all of our charts that we have in order to better understand and also to document what we are doing. We have about a thousand active charts. When a new patient comes for the first time a “social chart” is completed. This includes type of employment, income, number of people in the family, number of people living in the household, and etcetera. I learned from the study that 78% of our patients live below the poverty line. 44% live in extreme poverty. In Paraguay “poverty” and “extreme poverty” are based on the price of a bag of groceries and the number of people that live in the household. It was interesting that the category that contained the most “x’s” as a result of tallying each individual chart was that of a household of one or two individuals with an income of less than 500,000 guaranies(about $125.00) a month. These are the elderly who spent a lifetime working and earning a living but were not a part of any type of retirement system. The note under “observations” was usually something like “Rely on money from children (or food from neighbors).”
It appears that project MAESTRA has matured to the point that it can continue to sustain and even grow by itself. Because it provides services to poor people there is no way that it can earn whatever money is needed to pay the doctors, nurses, personnel and other costs.
Shalom y bendiciones,
Paul Jacquay
Paul Jacquay serves as a long term volunteer at Mision de Amistad (Friendship Mission) in Paraguay. Paul works as health consultant for the medical department and is a nurse trainer at the Mision de Amistad School of Nursing.