Week two in Galapagos

Puerto Ayora

In these islands, time passes smoothly and quickly like a tepid, sweaty cerveza.  This week in summary:



Saturday Market, where we do
diabetes and hypertension
screening



In our clinic, we had a slight issue with our diabetes strips, which were putting a majority of patients in the pre-diabetic range.  It seems that the tests are running about 5-10% higher than previous clinic sessions, and than the hospital.  I wasn’t worried because we were looking at other health factors, such as weight, blood-pressure, heart-rate, risk-factors (such as previous heart-attack, family history), etc., and we’ve got some very unhealthy people here.  No matter if a person was pre-diabetic or high-normal, we were recommending diet changes, more exercise, etc.  In the U.S., we use a different test  (glycosylated hemoglobin) to diagnose diabetes and to help evaluate long term (i.e. over several months) control.  However, here we have diabetics on medication who don’t even own glucose monitors!  Once a week in our clinic might be their only opportunity to check their sugars. 

The problem, according to Emily, the director of ICE Galapagos, is that people might lose confidence in our medical acumen if our meters are not accurate.  I double-checked the relevant literature and asked a diabetes expert at Montefiore Hospital in the Bronx, Ann Levine, what she thought might be the problem.  She said that glucose meters are only required to be accurate within 15%, and can never be used to diagnose diabetes.  So, we’ve changed our marketing plan to explain things a little better to inform the patients, but we’re continuing with our clinic as before. 

Encouragingly, we’ve had 3-4 repeat patients in the short 2 weeks I’ve been here who have lowered their blood-sugars, their blood-pressure, and/or their weight, ostensibly only by following the nutrition and exercise advise that Emily and her team of volunteers have amassed and that we provide to the patients in what we hope are culturally-sensitive layman’s terms.  This is why I’m going into family medicine;  I want to keep people out of the hospital and enable them to improve their quality of life – when it works it is very rewarding.

Speaking of quality of life, we have had lots of referrals to the psychologist in our clinic.  There are apparently many problems with domestic violence and alcohol abuse here in Puerto Ayora, and very few resources available to combat these problems.   Our psychologist, a Brazilian volunteer, was recently sent home for 3 weeks because the government will not grant her a visa extension.   God forbid that a healthcare professional providing much needed care in an underserved area while spending her own money like any other tourist for lodging, food, tours, etc., is allowed to stay in the country without hassle.  The word down here for that kind of thoughtless red-tape is “ burrocracia” (with extra emphasis on “burro”).

In an earlier update, I mentioned a study I would be conducting to fulfill my medical-school requirements for graduation.  Because I knew my job here in Galapagos would be mainly health and nutrition education, I wanted to show that when people learn about health, their health improves.  Of course, the foundation I have been working for, ICE, is also interested in seeing the results of their efforts, and the volunteers and Emily have been collecting data over several years about health and health education.  It’s wonderful to have so much data, and I am going to try and dovetail my study into the existing research to maintain the continuity and integrity of all this great information.  For me, it means a passing grade, but for ICE and the people of the Galapagos, proving that education and prevention are improving peoples’ health could mean more government investment in this and similar programs.   

I am hopeful  that some of my colleagues in medical school at Albert Einstein in New York will be able to come to the Galapagos and continue this type of research and promotion of primary/preventive healthcare and to continue the study.  It would be wonderful to follow these patients for decades and help to keep them healthy!

You’ll be glad to hear that the baby with pneumonia is doing better.  Still in the hospital as of this writing, but maybe able to go home in the coming week.  At least the baby was able to receive antibiotics here, if not many of the other tests and monitoring that would have been available in Guayaquil.  I still fear that the child may suffer some sequelae, neurological, cardiac, pulmonary or otherwise, but that’s another story for another blog. 

On a purely personal note, Carolyn (my recently betrothed ) and I found out on St. Patty’s day that we matched for residencies at the University of Washington in Seattle!  She’s going into Pediatrics and I’ll be of course in Family Medicine.  We’re very excited and thankful to have such a wonderful opportunity.



takeoff




sunset at Tortuga bay



Otherwise, I have managed to squeeze in a little catamaran sailing, snorkeling (right after the tsunami scare; the visibility was horrible and everything we did see was covered with sand), more trips to tortuga bay, and if all goes well, I’m bound for some diving tomorrow at a place called Gordon Rocks, which is supposed to be a world-class dive site.  I’ll try and write less and include more pictures in future updates!  Take care.