* Meet Ana
The day is winding down at about 3:00 PM. Triage is taking
its last few patients before packing up the scales, tape measurers and blood
pressure cuffs. Their assembly line of first eliciting chief complaint, taking
patient vitals, and then measuring their heights and weights is winding down
after a barrage of incoming patients. Up in the mountains, we generally receive
an initial wave of mothers and their toddlers and infants in the morning,
shortly followed by a stream of school children leaving class a little after
noon with men leaving work at their tale. But at around 3:00 PM, we politely
begin telling patients that there is no time for them to see the doctors. Being
so high in the mountains requires that we leave around 3:30-4:00 PM so that we
don’t make the treacherous descent down the mountain back to Urubamba in the
dark (it’s unsettling enough in broad day light).
However, a mother and her daughter are slowly making their
way to the clinic as it’s closing. As our members prepare to tell them that
they have unfortunately arrived too late, they note that they 18 year old
daughter’s eyes are swelling with tears, her skin dry, scaly and cracked. Her
expression is a reflection of the physical and emotional tension wrought on by
a dermatologic disease externally manifested. As we bafflingly stared, we could
not determine whether she was tearing because her eyes were also afflicted by
the skin condition or because the social isolation due to her appearance was
emotionally frustrating. Although our doctors could immediately identify her
situation as Psoriasis with
super fungal and bacterial infections, the people of Ampay only knew this skin
condition as a congenital abnormality. On our first day of clinic, Dr. Morales
explained that the congenital abnormalities, as explained traditionally by the
people of the Sacred Valley, are understood as evil forces manifested in human
disease. This evil spirit can impregnate a women which leads to an abnormal
child. Our experiences in clinic did not reveal whether these beliefs and
sentiments are strongly prevalent in the community at present. But regardless
of such religious and traditional beliefs, stigmas associated with physical
diseases are continuous throughout various cultures and ethnicities. And it was
clear that this girl was a victim of such stigma. She was prescribed steroids,
antibiotic and antifungal medication. When I asked the attending how this patient’s
condition would be had she been born in the United States, the doctor informed
me that her condition would be no where near what it is now. Perhaps a bit of
dry skin, but their would be no lacerations that pierced her hands and feet and
no scaly plaques that single her out in the community.
*Names changed