Though today was our third day in Humacao overall, it was my first day in Humacao since I arrived this week and spent yesterday in Ponce. As we drove in to Humacao, I did not know what to expect. I had heard that the town where we would be spending our day, Punta Santiago, took a devastating blow from Hurricane Maria, as it is located directly on the coast. As we approached, I saw both lasting signs of Maria’s footprint, including abandoned storefronts, as well as signs of rebirth, resilience, and strength: a tree with words painted in Spanish saying “I’m still standing” and beautiful murals of Puerto Rican flags.
Today we divided into three groups. One stayed at the newly renovated community center for a primary care clinic, while the two others, working alongside P.E.C.E.S and Coalición de Coaliciones employees, made house visits throughout the community. My group began our day by revisiting patients from the previous day who were in need of surgical consultation. As Bonnie mentioned in yesterday’s post, we returned to see our patient with lymphedema. Though we unfortunately did not have a surgical option to offer that would resolve his problems, we could provide additional wound care supplies. In speaking with him and his wife, we learned that the most difficult aspect of his care is getting compression devices to stay around his legs, given that all succumb to gravity as the day progresses. When Dr. Haack reached into her bag and pulled out full-leg compression stockings that clip to a waist belt to avoid slippage, both the patient and his wife were ecstatic. What was a simple medical device to us was in actuality a life changing gift to them. The patient felt that with this he would be better equipped to control his swelling, allowing him a limited degree of ambulation throughout the day, which he had been lacking previously. He then repeatedly insisted that we all receive his phone number so that we have a place to stay the next time we come to Puerto Rico. As we left his house, I was disheartened that there was no surgical miracle that could ameliorate his problem; however, his gratitude in response to our simple supply donation proved that maintaining the status quo and preventing a disease from progressing can also have great value in a patient’s life.
Our second house visit included incision and drainage of a sebaceous cyst. The patient was in his 60’s and had suffered a debilitating stroke years ago. His 90 year-old mother was his primary caregiver, welcoming us with outstretched arms into their home. Thankfully, the procedure was straightforward and uneventful. As we were educating the mother on how to care for the patient’s wounds, we heard a knock on the door. An emergency medicine physician and nurse were also conducting house visits. The physician was born and raised in Punta Santiago. She weathered the storm here with her family and feels a strong connection to the community that raised and nurtured her. Now, as a young physician, she makes house visits for patients who are elderly, disabled, or without transportation. All of this is strictly volunteer; she does this on top of her daily eight hour shifts at the local hospital. Her commitment and generosity towards her community epitomized the people we have met thus far in Puerto Rico—continually going above and beyond to aid their fellow human beings as they strive to achieve health equity, not simply equality.
A report from a community member gave a slight alteration in our afternoon plans. We were told there was a wheelchair bound gentleman who was without food and water so his home immediately became our next stop. He has had little contact with the healthcare system and was initially reluctant to let us into his home; however, over the course of 45 minutes that we spent with him, he gradually opened up. Tears welled in his eyes as he shared that he was shot five years ago because he was mistaken for his brother who had stolen from the assailant. Since then, his life had been mired by depression, barely getting by with food and water, immobility, and loneliness. He lived alone in a home that was severely hurricane damaged, with repairs moving like molasses whenever he had spare money to put towards them. He slept on a mattress without any sheets on concrete floors with no air conditioning. By far, the greatest impact of our visit was connecting him with social workers who could help him long term in regards to food security, adequate housing, and access to necessary medications. However, I did not feel that we had made a sizeable medical impact. We gave him food, water, and personal care items in addition to checking his vital signs. Nevertheless, I learned that mental healthcare can have a much greater impact. This patient showed me the importance of being present and listening to one’s life story; simply being heard was impactful to this gentleman. As he shared with us his many ups and downs, we were cutting and attaching two twin fitted sheets into one fitted sheet to cover his bare, full-size mattress.
As an aspiring surgeon, never did I think that the most fulfilling part of my day would be listening to a gentleman’s life story while anastomosing two fitted sheets within an un-airconditioned home in Puerto Rico, alongside fellow medical students and an attending surgeon. This shows the importance of applying one’s skill set, coupled with respecting and acknowledging others’ humanity in order to make an impact in others’ lives—no matter how unexpected or unconventional that impact may be.
-- Emily DeMaio, MS3