Water, Chicken, Insulin, Horse, Humility

Have you ever visited one of those countries where you can’t drink the tap water? Honduras is such a place (Try to keep your 1 year old from drinking any shower or bath water sometime – it’s pretty much impossible).

Fortunately, for us, we have clean tap water at our hospital (our patients are always a little awestruck when I tell them- not only can they drink the water straight from any hospital sink (without boiling or filtering it), but that my family and kids do so every day.

But for the rest of Honduras, there is a difficult choice: one can buy a Sprite or Coke at the corner store or bring river water to one’s house, boil it, wait for it to cool, then drink it. As you can imagine, it is a pretty easy win for the Sprite. Even though they can buy a bag of water cheaply (instead of boiling river water), its like convincing yourself to get a water when your combo comes with a drink- it is a hard choice. (Coke, to my shame, generally wins – fortunately for me I live 2 hours away from any fast food restaurants.) Given this reality, and the strong link between sugary drinks and diabetes, you can understand that diabetes and its complications make up a lot of our patient visits.

I was recently laying down the law, with a lovely elderly woman with mild dementia whom I had brought out of diabetic coma (thanks be to God). Her coma was the direct result of what we call poor compliance (a fancy way of saying the patient is not doing what we want them to do). Her blood glucose had been approaching one thousand- meaning she had so much sugar in her blood that is was becoming a syrup and shutting down her brain.

So as I was explaining to her, for what felt like the 10th time, how important her insulin was, I went for the straightforward simple explanation: if she did not allow her adult children to check her glucose and give her insulin on a regular basis, she would shortly die. She giggled a bit, and said, “Well I don’t want to die.”

“Doctor, I need something,” she said with a shrewd look.

“Okay.” I replied with slight hesitation.

“I need you to give me your phone number, so I can contact you any time I have questions or problems,” she gave me her most winsome geriatric smile and may have even winked at me.

I explained carefully but firmly why I would not give her my phone number, about 3 times before she gave up on charming me (for that time). Afterward she gave me a big hug and I discharged her home.

On the day of her follow up visit, her family was hanging around right in front of my door while I was trying to work through a extra long list of patients. I had seen several patients already, and was bringing back a different patient to discuss some bad news. Now, hanging out in front of my office door is a common strategy to try to get seen before others. So I was a bit short with them when I said, “Buenos dias.” And tried to slip around them without further ado.

“Doctor, can we have a moment of your time?” Hondurans can be maddeningly indirect.

“Si.” I replied trying to make it obvious that I had a list of patients queued up to be seen, they would be seen in that order, and this would all go much faster if my process wasn’t interrupted. (It sounds like I may not have had my coffee that morning)

“You remember my mother, she had the sugar coma and you saved her.” The daughter stated, leaving a pause for me to acknowledge.

“Yes, I remember.” I replied tersely.

This seemed to deflate the daughter, who said, “Well, uh, here.” And with that she thrust a large feed sack in my direction.

I eyed it questioningly. I did not want to take it without more information, but I didn’t want to be too rude either. So I moved closer to the bag and cocked my head to prompt a bit more explanation before I accepted.

“Its a chicken.” She stated with an uneasy smile, trying to regain her enthusiasm

“Is it alive?” I asked with morbid curiosity. She shook the sack a bit as if to find out for herself and the lump began moving and clucking indignantly. At this point the patient whom I was trying to bring to my room start laughing quietly at my predicament.

“O, thanks! Um, Could you hold it for a bit while I finish talking with this next patient?” I motioned to indicate the laughing patient I was trying to bring into my office.

“Yes, I can… But just so you know, its kind of hot, its a little hard for it to breath, and it pooped in the bag already. It really needs to be let out quite soon.” She stated awkwardly still holding it out for me.

“Okay. Thank you so much. I’ll take it as soon as I can.” I said as I retreated to my room to try and have a serious conversation with the patient I was bringing back.

After I had seen my next patient Bethany and the girls came down and somehow got the chicken up the hill to our house, out of its bag, and tethered to a bush.

Later that day, at their mom’s appointment, after thanking the family for their chicken and telling her it wasn’t necessary but was very appreciated (the poorest of the poor are often the most generous of people). We revisisted the importance of medical compliance (them following my directions regarding insulin). The family and little old lady who was sweet on me, broke down for me why it was sometimes hard to give her the daily insulin. First off it’s expensive, but they were choosing to make the needed sacrifices to purchase it. Secondly she was sometimes stubborn and decided she wasn’t going to let anyone stick her with needles. But mostly it was difficult because they have to send someone, usually her grandson who is 12, every other day to get ice to keep the insulin cold. Her grandson takes the horse to the pulperia (little store) where he can buy ice. Unfortunately the closest pulperia with ice is a 30 minute horse ride from their house. They then put the ice in the thermos (they were very proud to show me their insulated thermos) which keeps the insulin cool for another day or so.

“Do you not have a neighbor with a refrigerator?” I asked. Because typically, at least for medicines, neighbors will share refrigerator space with those around them who do not have a fridge.

They laughed good naturedly, “No, we don’t have any electricity in our community.”

And so I was humbled twice in one day by the same family. First for assuming they were trying to selfishly cut in line when really they were trying to selflessly give me one their best chickens. And second, when I tried to get the family and patient to take more responsibility and be better about giving insulin regularly- only to realize they were already taking this responsibility very seriously and putting more effort into their mom’s care than I had ever expected.

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Prayer Request & Praise

• Pray for my two little patients with kidney problems that are not responding well to medication (steroid resistant nephrotic syndrome):
• Axel, 3yo, is stable and taking a medicine that will hopeful remove or decrease his need for steroid.
• Maritzah, 2yo, is gradually worsening. She had an infection a few weeks ago, and nearly died. She has no clear options, and continues to have almost no response to medicines. She is very swollen. Pray for her comfort, our wisdom, and her mother’s breaking heart.
• Praises: Cristofer Daniel is doing great, eating well, and putting on some healthy fat.

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P.S. We will be in United States for most of July. As of now our plans are:

Sunday July 4th – Chattanooga Valley Church of the Nazarene, Flintstone Georgia

Sunday July 11th – Judson Baptist Church, Nashville Tennessee

Sunday July 18th – Reallife Church of the Nazarene, Murfreesboro Tennessee

Grace and Peace to you all!
Nathan Gilley