Peru Health Outreach Project

Meet Carlos*

What started with a complaint of lower back pain (a common problem the labor driven communities of the Sacred Valley face) turned into a medical crisis that highlighted the vulnerability of the human condition when isolated from resources many of us take for granted. This 26 year-old father of two explained that he had lower back pain that radiated to his legs, a pain he believed might have triggered the many syncopal episodes he has been experiencing for the past few years. Upon further questioning, he noted that he had ‘palpitaciones’ and radiating pain from his chest to his left arm prior to these episodes. Further probing revealed that he had swelling in his extremities and noticed a change in color in his fingers as well. It is interesting to note that while these symptoms scream cardiac disease among the general public in the US, up in the mountains of Camahaura, these symptoms did not signal an emergent condition to our patient. Here, public service announcements come in the form of traditional medicine, word-of-mouth and, sparingly, posters distributed by the government primarily targeting pregnant women. It’s no surprise that he was not alarmed by his cardiac symptoms and preoccupied with his musculoskeletal pain, a pain that is widespread amongst his community and prioritized as it can interfere with work and income.

We targeted the primary condition (possible congenital heart disease) by providing some information to the patient about a possible diagnosis. With just a history and physical, it is difficult to narrow down the differential diagnosis. However, we suggested that he travel to the nearest cardiologist in Cusco (about a two hour drive from his town) in order to have more conclusive tests performed. We were able to prescribe him ibuprofen for his back pain and sent him to our physical therapy station to learn more about proper lifting techniques and back strengthening exercises. Although we did the best we could in recommending he see a cardiologist, a local health professional explained that the likelihood that our patient will seek medical treatment in Cusco is slim due to his work schedule. Here, he explained, workers don’t take off of work to see the doctor until there condition is unbearable. Such a gauge inaccurately tracks the progress of cardiac disease as pain is a poor indicator of the insidious advancement of a congenital heart syndrome. 

*Names have been changed