Hope

March 12, 2005

The first day of the brigade a 40 year old woman came in with a chronic ulcer due to severe varicose veins on her right shin. It started as a bug bite, she said. Most patients with this kind of ulcer in the U.S. are in their 70´s and 80´s.

My first question was, How many kids do you have? Six. Pregnancy is the usual cause of severe varicose veins in younger women. (The other leg had no varicose veins at all, which is often the case.)

She’d had it for over a year, and had been treated with antibiotics several times to no avail. The ulcer was slightly inflamed because of the body´s efforts to heal it, but it wasn´t then, and probably hadn´t ever been infected, since she was otherwise healthy and not a diabetic. In any case, antibiotics would only be an adjunct, to clear up the infection, not to heal the ulcer.

The treatment this woman needed was not high tech. She needed a weekly leg wrap with a zinc oxide-impregnated bandage for several weeks to months. The ointment would keep hard scabs from forming and allow new cells to grow into the ulcer. The foot-to-knee wrap would keep blood from pooling in the swollen veins and causing fluid to leak out into the tissues, resulting in swelling that impedes the arterial inflow needed for healing.

At home, I have these patients come in once a week to have the bandage changed by the nurse. Not rocket science. The bandages themselves only cost a couple of bucks. But they do need to be wrapped carefully and they need to stay on continuously between visits.

My heart sank. Even if we could find the bandage and teach her how to wrap it properly, how was it going to stay in place during a week of walking the dusty dirt road up the mountain? Our elderly patients at home can watch TV with the leg up and drive to the office. This lady had to go and stand in the market every day to support her family. Furthermore, even a few bucks was beyond her reach. And even covered with something, that ointment would attract dirt like crazy. It seemed like such a tragedy that there were so many obstacles to something so fundamentally simple. It´s not a heart transplant, after all!

As we talked, she began to cry and express her fear that it would never heal. I was afraid of the same thing. I really felt discouraged and hopeless. I asked her if we could pray, because I felt we needed a miracle. I had tears in my eyes as I prayed that God would heal her body, mind and spirit. Then I was led to pray that he would provide whatever resources were necessary to heal her.

Well, this prayer changed me. The feeling of hopelessness left me, and I went out to confer with the team about what we had on hand. Nurse Ruth soaked the leg and did a beautiful job removing all the dead tissue (anesthetic provided by the dentists!) while I saw a few more patients. The wound was not as deep as I had feared, PTL! We had a small supply of antibiotic ointment in the pharmacy, and an ace bandage provided the means to counteract the elevated hydrostatic pressure in the leg that was preventing adequate blood flow from reaching the wound to heal it.

Since it was the first day, I told her to come back on the last day so we could re-dress it at least once. She left, smiling, with her return ticket in hand.

On the last day she returned and we re-dressed the wound. It was too soon to see any change, but at least the bandage had stayed on reasonably well.

Ruth and I did our best to explain the how and why of the bandages. We strategized about some things she might use when our supply of two whole Ace bandages lost their stretch and the antibiotic ointment ran out. Petroleum jelly and strips of clean cloth would serve the same functions.

I don´t know how much she understood, or whether she could even afford Vaseline - oh, if only I knew how to find a parish nurse in this barrio! But we did our best with the resources we had. I know she felt greatly encouraged by our efforts and attention, and I am trusting that God will take care of the rest.