Thursday, July 2, 2009

Project HOPE Volunteers Help Yasmina and Other Salvadoran Girls

Three years ago, Yasmina, a 14-year-old Salvadoran girl, had received a penicillin shot to treat tonsillitis. The penicillin worked, but the very next day she displayed symptoms of “drop-foot”—she could no longer flex her foot upward to walk or run normally. The condition hadn’t improved in the intervening three years, and now her lower leg and foot were significantly atrophied and she walked with a limp.

Yasmina was now at a new Continuing Promise temporary worksite that had just opened today at the elementary school in rural Pasaquina, El Salvador. Project HOPE volunteer nurse practitioner Faye Pyles, one of two care providers in the pediatrics ward, thought she knew what Yasmina was suffering from. She referred her to the Navy physical therapist in the 4th grade science room down the hall. The physical therapist worked with her for almost 20 minutes, and seconded the diagnosis Faye had suspected—the tech who had given her the shot, either through poor training or negligence, had brushed her sciatic nerve in the process.

Even in the States, nerve damage is untreatable.

We put her in an ankle brace to keep her from a severe sprain and give some support to the leg the way her foot would if she were walking normally. She had just been referred to the pediatric neurologist, a Navy doc, when I was called away to translate another case—a woman with plantar fasciitis to whom the physical therapists were trying to explain how to use shoe inserts and do some stretching exercises to help the pain.

Meanwhile, Ann Russell, HOPE’s volunteer nurse midwife who is heading the OB/GYN ward on the ground, was having an interesting day of her own. She was seeing a lot of unwed young women, say, under 20, with severe dysmenorrhea. Back home, the most common treatment for irregular or very difficult periods is actually hormonal birth control—the scrip just says “hormone therapy” instead of “contraception.”

Continuing Promise doesn’t stock contraceptives, but even if it did, these young women probably wouldn’t take them. There is a huge cultural stigma against an unwed woman being on any form of contraception here. In fact, when Ann asked her patients the routine question of whether or not they were sexually active, they were uniformly taken aback that she thought such a thing might be possible.

She spent most of the day, then, educating these girls, and convinced them that, if they found some “hormonal therapy” medication, they wouldn’t have to miss school for an entire week every month, wouldn’t have to miss work, miss life…and that they could remain sexually inactive at the same time.

Faye and Ann were at the elementary school with Project HOPE senior medical officer, Dr. Ken Iserson, and a whole handful of HOPE volunteer triage nurses—Amy Bream, Meg Candage, and Marley Gevanthor—who upon arrival dove right into the crowd of patients awaiting screening. Even the HOPE Ops Officer, Tracey Kunkel, found herself employed in the pharmacy, working on totaling the hundreds of prescriptions HOPE, the Navy, and the other NGO’s onboard have given out so far in El Salvador.

I caught up with the Navy pediatric neurologist just before our helo flight back to the ship this evening. He had seen Yasmina just before he had to pack up for the day. If she were in his own practice, he said, he would have an orthotic device made to fit her foot, one that would place the joint at a safe angle and offer support in the way a normal foot would.

This is exactly what he did for Yasmina. He worked with the Salvadoran Ministry of Health on the site, and they have her mother’s telephone number, and vice versa. She is scheduled for an initial fitting for the device at La Union hospital on July 6th.

Thanks for reading-Jacob

1 comment:

  1. Nice article, hope to see you back at your parent's later this year.