Today, we washed our patients’ feet.
We headed north on the coastal road towards Putu. It was the last area that Dr. Berger and the CESFAM had asked us to check, and Paulina had made contact with a local health worker who could assist us in finding the refugee concentrations to assess their medical needs. The Putu posta was small but intact, and Barbara our contact met us there for the ride into the countryside. When I say “into the countryside,” I mean REALLY into the countryside. Most of what we drove through were forests, and most of the road was dirt or gravel. The trees were beautiful, with silvery-green eucalyptus and dark-green pines contrasting in the changing light. However, there was a lot of ground to cover, and how anyone keeps track of refugee movements here is a mystery to me. But Barbara seemed to know where she was going, and indeed, we came across a series of small communities in the little glens and valleys. Each was accommodating families or friends from the coastal areas devastated by the tsunami, or local people whose adobe homes had collapsed in the earthquake. We treated minor injuries, mostly lower extremity wounds, which we cleaned and dressed. We also collected information for the local health service so that they could return for chronic or routine care, and moved on.
After several hours of this, we followed a road down to a winding, sandy-bottomed river in a valley. The river was crossed by a cable bridge straight out of an Indiana Jones movie. Needless to say, it seemed like the perfect place to stop for a brief snack, and the inevitable walk across the scenic bridge. (Paulina, Barbara, and Camilla elected to remain with the truck.) When we reached the other side of the river, we could see a small farmhouse up the hill through the eucalyptus trees. A man in a red shirt and straw hat came out and waved at us. We waved back, and turned back towards the bridge. He started running down the hill, not appearing angry, but seeming to very much want to talk to us. We waited, and he reached us, out of breath and with a small boy in tow. Needless to say, there was a certain language barrier, but Will was able to piece together something regarding a woman, and the word “roto” (“broken”). We explained that we were medics (“somos medicos norteamericanos”) and headed back across the bridge for our translators. The man insisted on following us, the boy clinging to his back. He seemed adamant that we not get away without coming to see the woman. Once we got back to the truck, the story unfolded. His family’s house had collapsed and his wife had injured her foot in the earthquake. The skin was intact, but the foot was very painful and she could not walk on it. They and their three children were staying in the wooden farmhouse, which belonged to their friends. Could we please come and help his wife? He had no way to get her to a doctor, and other than helicopter deliveries of food beginning two days previously, they had had no contact with the outside world since the earthquake.
Well, this seemed like the sort of thing we might be able to help with. Paulina and I walked back across the bridge to the house, while the husband and his son rode with the rest of the team in the truck several miles downriver to a place where a vehicle could cross. On foot, Paulina and I reached the house first. We found our patient, Rosa, outside cooking bread, with her other two sons, the eldest (twelve-year-old Enrique) keeping an eye out for three-year-old Diego. Rosa was delighted to see us, and in obvious pain as she hopped around on her left foot, but she asked us to please wait so that the bread didn’t burn. She tipped a dozen round loaves out of a Dutch oven while balancing on one foot, and then hopped inside. We followed.
The house was solidly built of wooden planks and timbers. Rosa sat on one chair and rested her leg on another while I examined her foot. Clinically, she had a Jones fracture, a break in her proximal fifth metatarsal. She needed an Xray, crutches, and a next-day referral to an orthopedist. I was pretty confident that none of those things were going to be available. By now, the rest of the team had arrived. So now what? Well, we needed to immobilize the fracture, and Rosa needed to be non-weight-bearing on that foot, if the fracture was going to heal. But, everything we did had to be reversible and manageable by our patient and her family, so that if something went wrong, they could undo it and take care of it themselves (since even the Chilean public health service doesn’t routinely make house calls across cable footbridges). So, we couldn’t cast her foot. We would have to splint it — but again, it had to be a splint that would last for weeks, not days; could be taken off if she began to develop a pressure ulcer or other problem; and could be put back on by the patient without undue difficulty. Our available tools were cardboard splint material, padding, and a whole lot of duct tape. We got to work.
Clay had proven his ability to make crutches time and again in Haiti, so he was on crutch detail. Zach was our splinting specialist, so he and Jake began work on the world’s finest (and maybe first) custom-made lower extremity foot-and-ankle splint. Will took pictures, played with the kids, and talked to the husband. Paulina and Camilla translated. And I, at Zach’s suggestion, washed Rosa’s foot. It made sense; a clean extremity would be much less prone to pressure sores or other problems while inside a splint. And since I was not doing anything else that was particularly useful, it seemed like a good act of service. So, I got out a chlorhexidine gluconate surgical scrub sponge, asked Enrique for a towel, and did my best to be useful. Frankly Rosa seemed as awestruck by the fact that a norteamericano was scrubbing her toes, as by the fact that there was a medical team in her borrowed dining room. We explained to her that she was our hundredth customer, and that therefore she got a free pedicure. The kids, in particular, found this hilarious.
We visited and worked until we were all finished, and got to know a little more about Rosa and her family. They had been in their adobe house during the earthquake, and in their haste to escape with the children, Rosa had twisted her ankle. Her ankle had swollen and then subsided, but her foot hurt every time she put any pressure on it or even wiggled her toes. No one in the family had ever seen Americans before we came to their house. And when we secured the splint and checked out the crutch, Rosa could walk again after a fashion, her foot no longer hurt, and she and her family thought we were the best thing since oven-baked-bread. We felt pretty good about the world as we left, waving goodbye to the kids as we bumped our way down the road. If we had treated no other patients at this point, we would have felt as though we had met the day’s minimum standards as far as being of service.
Needless to say, we then found plenty of additional patients. The various small communities we went through had a variety of patients with injuries that needed attention, but had not been able to reach a larger clinic or hospital. We made various arrangements tailored to each patient. In one community, an elderly woman had probably sprained both her ankles, but needed Xrays to rule out fractures, and had no transportation to get her to the hospital. A man in the community had a truck, but claimed that he didn’t have the five liters of gasoline that he needed to get the woman to and back from the hospital. We gave a five-liter jug of gas to the woman, and were confident that things would work themselves out somehow. We cleaned puncture wounds, lacerations, abrasions; we wrapped and taped ankles and toes and heels. Feet just seemed to be the theme of the day. Paulina documented every patient for the health department, and we made quick medical assessment notes for the field hospital. Finally we headed back to Putu, where Barbara knew of one more woman who had been injured and needed medical assistance. Needless to say, she was reported to have injured her foot.
Our last patient therefore was Gloria, who turned out not to have so much of a foot wound as a traumatic lower leg wound with an aggressively spreading cellulitis. A TV set had fallen on her left shin during the earthquake, and she had been seen by one of the paramedics at the local posta, who had prescribed her tramadol and amoxicillin without much effect. I was frankly concerned by the wound, which was hot, draining, and an angry red, with induration and swelling of the foot as well. She needed an Xray, and she would clearly benefit from IV antibiotics. So, Camilla called Captain Berger for me, and I briefed him on the patient’s condition. He suggested that if we could transport Gloria to the community hospital in Constitucion, he would call the hospital to inform them of our arrival; and, after completion of Xrays at the community hospital, Dr. Berger would accept the patient as a transfer to the field hospital for whatever additional treatment was needed. We dressed the wound and instructed Gloria on how to pack an overnight hospital bag, with Camilla’s assistance (and reassurance). Gloria was very scared, but insisted that she could walk out to our truck; after watching her hobble a few feet, we halted her, and simply picked her up in a four-hand seat lift, and carried her to the truck. We headed back into Constitucion, dropped off Barbara and Paulina to make report to the ministry of public health, and continued on to the community hospital. Gloria could not thank us enough for our help, all the way and into the hospital. The physician in charge was already expecting us, thanks to Dr. Berger, so we presented our patient and said our goodbyes to Gloria. The rest of the team then dropped me at the field hospital to make the day’s report to Dr. Berger, and headed back to the parish house.
Dr. Berger and I visited for a bit after discussing the day’s activities. He’s usually stationed in the Atacama desert, in the far northern region of Chile, and his wife is also a physician in the Chilean Air Force. He thanked me again for Team Rubicon’s medical assessment, and invited our team to the hospital for coffee tomorrow morning. I accepted without hesitation, as I knew my fellow team members had been jonesing for some real java since our expedition began, and I headed back to the parish house on foot. The sky was remarkably clear, and I could see the Southern Cross hanging above me, like an illustration from my Boy Scout handbook when I was still in high school. I never would have ruled out being in Chile, but I certainly could not have predicted these circumstances. It was a pleasant moment of solitude in a busy day, but I was also looking forward to a real meal, and I knew Will was cooking, so I quickened my step back to the plaza and the parish house. The gates were locked, but I scaled them easily, and was “home” for the night.
Dinner was a festive affair, thanks to the fact that Will had tracked down a clove of garlic and a chunk of frozen hamburger in our wandering today. We had mixed pasta with meat and garlic sauce, and drank a toast in honor of our absent comrades and our new family in Chile. It was at this point that Zach made the very insightful observation that our work today was very much about washing the feet of our brothers and sisters, and about bridging the gap not only in terms of emergency response to natural disasters, but bridging the gap between who and where we are, and the people we want to become. That seemed very much appropriate. Clay, who is not particularly religious, also reflected on the fact that he had thought of a verse of scripture a number of times during this mission — “Be still, and know that I am God.” He wanted to know where it was in the Bible, but none of us knew exactly where it was, so I looked it up, and laughed out loud when I found it in context, in the 46th Psalm. I read the whole psalm aloud to the team, which I was able to do because my phone had internet access at the time; I don’t have it now, so I will have to ask you to look the verse up yourself. But we all found a certain resonance in the psalmist’s reassurance that though the mountains might tremble, and the waves of the ocean might rage against the land, we are invited to be comforted and unafraid.
Our assessment as we broke up for the evening was that we have done what we came here to do on behalf of our Chilean brothers and sisters. We will close down our mission here tomorrow, and start making our way back to our own homes and families. We will take with us memories of a land that is beautiful and fruitful, a people who are innovative and resilient even in the face of unprecedented natural disaster, and friendships which we hope will last a lifetime. We are very grateful, every one of us, for the opportunity to be of service, and for the support that has made all of this possible. In particular, we would like to thank our families, who have stood behind us in this mission despite the financial cost, personal frustrations, and extra responsibilities placed on them while we are away. We look forward to coming home, and if we have done any good in Chile, it is because of your sacrifice and support. Thank you!