I've never seen an outbreak of bugs that have no name.
"They are everywhere," we are told by a well-armed policeman. "They are crawling all over the woman with the new baby."
|Debbie with Bianca and family. Photos courtesy of Jeff Fredrick, MS, CPO.|
"We can go to Barranquilla and buy some bug spray," I automatically respond.
"Not a good idea," Ligia Applegate of Humanitarian Universal Connexion joins in from the makeshift pharmacy. "It might hurt the new baby!"
Oops! Bad enough idea even in the States--spraying a whole house full of bug juice with a critter still in a crib--and it's worse here. Safety restrictions on chemicals are immune to North American warnings. Chemical companies are not above shipping whatever they can sell--even if the FDA will not allow the product to be used around our own kids.
Greg Fox, a rehab specialist, and I follow four policemen through the refugee camp. It's a good time of year to travel to Colombia: hot, but windy. Unfortunately, the wind does more than cool. "Fecal snow" is one term for it. A powder of dried, raw sewage is picked up and blown through the camp. It's the same smell given off by treatment plants in the United States. There is one just beyond the runway we departed from two days ago. But back home, it is only a smell--no particle ingestion!
|Colombian soldiers on a bug-fighting mission.|
Keeping bugs off a baby--is that anything like saving cats out of trees? Five combat-ready policemen evidently think so. They discuss the problem as seriously as if planning an assault on a guerilla stronghold. They seem genuinely concerned about the plight of the woman and the baby. It's the true heart of Colombia, which is seldom reflected in worldwide media reports of the violence here.
Great Day for Rehab Care
Deb Plescia, CPO, is eight for eight: five lower-extremity and three upper-extremity prosthetic fittings with clinically excellent results. A day of such spectacular deliveries is rare even stateside, especially since there were no diagnostic fittings, no laboratory, and few tools. The reasons are simple: good preliminary focus, clear documentation, excellent fabrication technique, and no time compression during the actual fitting/delivery process. The results: a great day for a good prosthetist and her patients.
The success rates of the physical therapists and orthotists are the same. Three adaptive wheelchairs, rejects thoughtfully transported by Delta without extra compensation, are painstakingly adjusted by Catherine Knickerbocker, PT. Three severely involved patients whose positions without chairs were a harbinger of worse things to come may dodge a decubitus bullet. Mike Hanna, PT, also works patiently until the children are fit as professionally and safely as if the chairs were specifically ordered for them.
Providing Help Realistically
|The face of a refugee.|
We stop to discuss our needs for the next trip. Too often it is a question of how close you can get to what is needed. Sometimes, "appropriate technology" is a misnomer that can mean "less technical." It represents a cap, a limit defined not by functional level or need, but by availability and economics (sometimes even geography)--the least humanitarian and most crude of the determinants that drive the rehabilitation process.
It makes sense to provide the appropriate device when one can. If there is a need, and a less-than-perfect substitute exists, maybe we should ask the patients to decide. Decisions for a person's well-being in developing countries are often made by expatriates who have everything. It's easy to be philosophic when your child gets the best care and your own stomach is full. Occasionally we need to be reminded there are two sides to the appropriate technology issue! To serve effectively, sometimes we must serve the need, not the ideal.
Can Do--No Matter What!
Bianca, who lost her leg in April 2002 in an assassination attempt on the then president-elect of Colombia, Alvaro Uribe Vélez, comes to the clinic to walk for the first time in two years. The 17-year-old has lost weight and matured into a beautiful young woman, just since our last trip.
"You look great," I tell her.
"I've accepted my difficulties--I feel better now about everything," she responds, as though recognizing her earlier obsessive focus on the tragedy had affected her looks.
"See, I'm okay!" she says with a big smile as Deb Plescia carefully fits her new AK prosthesis. Those are pretty brave words for a 17-year-old. I don't know who's smiling more as she walks away on the new prosthesis--her or Debbie Plescia. Debbie's attitude as well as Mike's and Catherine's remind me of the old World War II adage, "can do," with a twist: "Can do, no matter what!" It reflects a depth of professionalism that is unaffected by inconvenience. Whether it's in the most beautifully furnished office on Physician Road in Anytown, USA, or a mud hut with filthy floors in Colombia, it doesn't matter. Their attitude and output would remain the same. I couldn't be more proud of them. Problems don't matter; output and results do. It shows on the amputees' faces as they walk by to leave the clinic, and in the expressions of the mothers pushing their catastrophically challenged children in new wheelchairs, instead of carrying them.
|Current and appropriate enough technology.|
The next day, we're back at the the primary medical clinic in Barranquilla.
We don't find any orthotic and prosthetic needs, just scabies, worms, malnutrition, and a few untreated wounds from war and traffic accidents.
Sometimes humor coexists with tragedy.
"I feel bad about it," I overhear Debbie Plescia confess from the pharmacy.
"What?" I ask provocatively.
"I gave a prescription to the wrong patient," she confesses solemnly. "He nodded his head when I asked if he was the man the prescription was written for."
"Is it serious?" I ask, growing more concerned.
"He took a stool softener that was meant for a constipated child," Debbie responds, still solemn.
We laugh as we imagine the results, until Dr. Lisa Kohler interrupts with news that a ten-year-old she saw last clinic for routine problems has died of pneumonia.
I can't help wondering, if we hadn't delayed so long in returning, perhaps we could have saved the little girl? I doubt if a stool softener will hurt the man who misrepresented himself and took it, but it might cost him some inconvenience for a while. In the end, maybe it will do him some good!
Corruption, Violence: People Suffer
Sometimes I feel the same way about this whole country. It, too, seems to have taken a wrong drug or two. In the end, the violence of the old drug cartels, the cruel kidnapping by guerrillas, and the retaliation of the paramilitary would benefit from a similar error that might soften their rhetoric and agendas. Who knows? In the meantime, sadly, the people continue to suffer. There's nothing new about this in the historical sense. It's always the people who pay for corruption and violence. It's what scares me so much about our own country. The corners we cut and our growing disrespect for law and order could be seeds of the anarchy, chaos, and violent competition that cost people so much in Colombia.
The trip ends with over 500 medical and 80 O&P and physical therapy patients served, including one man who perhaps has learned a valuable lesson. Maybe sitting around a little more over the next day or two will give him pause to consider the importance of representing himself more honestly?
Jeff Fredrick, MS, CPO, BOCP, is director of Hangers Rehabilitation for Development (Hanger RFD) and branch manager at Hanger Prosthetics & Orthotics, Tallahassee, Florida.