Mulholland, Philip

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The Linacre QuarterlyVolume 33 | Number 1 Article 16February 19661,071 had a Hemoglobin of 7.5 Grams % or Less ...Philip MulhollandFollow this and additional works at: http://epublications.marquette.edu/lnqRecommended CitationMulholland, Philip (1966) "1,071 had a Hemoglobin of 7.5 Grams % or Less ...," The Linacre Quarterly: Vol. 33 : No. 1 , Article 16.Available at: http://epublications.marquette.edu/lnq/vol33/iss1/16"family" , the m1 ss10n withoutthis uncle,: ,1g spiritual motivatingforce. A r,, Jessional man may wellgo with strictly humanitarian mo­tives but the wife and children needmore than this to keep going. Theyneed to have a solid spiritual foun­dation so that they can more easilyendure the many domestic incon­veniences encountered on the mis­sion. This spiritual preparation maybe more for some than for others,depending on personal backgroundbut it can be done on a personalbasis with local assistance and neednot entail any special classes, etc.To be really effective on the missiona family needs this spiritual outlook.The thrill and novelty soon wear off and then you are left with the day by day grind of living andworking with many inconveniences and difficulties. A good healthy spir­itual outlook will help surmountmany otherwise difficult situations and problems. Contrary to common opinion,families do well on the missions.One of thr- ;est problems withwork overs,: , the outlying areasis the lack : tertainment. Largefamilies ne, ,d time to be home-sick or lone : and have a mucheasier time His regard than thesingle persc n our particular areawhere polyi ,. was so common, alarge Cathe family in action wasan educatic or the local natives.The wor is changing, as weknow, and n in Africa we feltperfectly sai nd with the help olthe Sisters · c able to live quitecomfortably. you eliminate fam-ilies from mission, you willeliminate a d many professionalpeople. Dur ) the great numberof years ne,. l to complete theirstudies, mar ,)hysicians and den:tists are ma1 l and have childrenbefore they 1 ever conside r  themissions as ; ,ible lay volunteers.Please feel c to have prospectivevolunteers w, to us for more de-tails and, of ,irse, encourageme�t in their dee; ;n to give of theirtime to the rr · �ions.ANNUAL MEMORIAL MASS - 8:00 a.m. - JUNE 29Celebrant: MosT REVEREND JOHN P. ConY, Dj)., Ph.D., J.C.D.(Old) ST. MARY'S CHURCHWabash and 9th AvenueChicago44 LIN ACRE QUARTERLY had a hemoglobin of grams% or less . · PHILIP Muu-10LLA'.';D, M.D. internship, completion of military!medical missions provide a . d of a Genera t sernce an one year . Iand very satisfying way O 1fe and the basic motivation that Practice residency, my w . . h h realized we were in a pecuh�r s1hte-led a physician to c oose t e uation to spend two years m t art. missions. . physician who has gained �he We knew there were poor m our knowledge of restorm_g own city and that there were ot?erto a certain number of his desperate sections in our own Umt��ts, realizes e·arly in his career States, but yet we felt that we cou f he has an obligation to con- best do our part in the _ context. o a certain part of his life to the Pope's appeal for Latm �menca� ·who cannot afford to pay. On consulting the Catholic Med obligation must be distributed ical Mission Board in New York,hw�y throughout the professi?�· ·1 were happy that the Church a do not know of any physicians iven us this opportunity to_ se�k have denied this and 'I know g t the fulfillment of this callmg mno one who is not making some ��e context of Her work which was Ina of contribution to the less begun by the clergy. This gave '_ls flltlmate. the thrill of dedicating our work mThe Lord chooses how and when the name of the Church. The Pl�ce­lle wishes a person to do his share. men t Service of the Catholic Medic;�The ways of the Lord are not to Mission Board, with mor_e . than 1 '81km once they are made known. requests on file for phys1c1ans, sug­So often what appears to be a hard- gested that we serve in El Progres�,ship will in fact be a real pleasure Honduras, at a clinic under t�e di�la that we are fulfilling His Will. rection of the Jesuits of the MissouriWe do have an obligation to have Province . . ·th111 open ear and to explore and We found ourselves in a city wi lllllider whether various modalities a population of 14,000,. with anClllfonn to our particular situation additional 17,000 people m �umer­kl life. That is after we have given ous peripheral grass hut villages .due consideration to our family and The United Fruit Company _P�o­lnancial obligations. You may care vided a fairly good standard of hvmglo think of the fulfillment of your and medical care for about 5,000 of11111 obligation in the light of what these 31,000 people. This left ustin be done. · with a potential 26,000 people for. Por this reason, it may be of some whom to care. h datlnst to recount my own personal The Honduran government a llperience in the missions. After established some clinics for these 451966people but Jnetheless, the finan­cial limitaL. :; and magnitude of the health probiem were overwhelming. !he shortage of drugs and difficulty m controlling sanitation were prob­lems in themselves. But most im­pressive to me was the need for someone to get out and start treat­ing patients. Planning is important, but there was a great need for some­one to go out and see the patients here and now - the so-called "scut work." Many people offered suggestions and many had prepared extensive and detailed protocols . . .  but what ab�ut the �eople who were dying while these ideas were being imple­mented? �here was no difficulty finding patients. They came in great num­bers. We were faced with the di­lemma of giving rapid superficial treatment to a large number or at­tempting to focus on more careful management With some long term objectives. The two-year committ­ment was ideally suited. Likewise, we found that it was foolish to aim­lessly hand out pills without exam­ining patients, studying the stools for parasites, doing hemoglobins and other lab work when indicated. The greatest problem was malnu- · trition. And this was complicated by intestinal parasites and chronic diarrheas and dysentery. This basic trial, accounting for a majority of our work among children, was not only challenging but exhausting. The management of this problem demands a careful follow-up with scheduled re-visits and a definite personal doctor-patient relationship. 46 Sometimes. interrupt o times in a d dehydrated s1 ous fluids. 1was necessary to Jrk two or three o start a severelybaby on intraven· :other would sit inas our "speci 1ty nurse," and our trained Hone 1 girls would super· vise. I had heck frequently all the details t mre that the rapid dehydration asures in the first few critical h s were properly car-ried out as e babies were fre-quently alrea in shock. But even two or three 1 rs of constant atten· tion were nc ·nough. The long,tedious task < 2alimentation while trying to tit ,he tolerance of a traumatized · s t ine, teaspoo n  by teaspoon, wa. , en most discourag-ing. After t - three days of trial and error wit 1gar solutions, then skim milk, < • it often resu lted merely in de' ,1g the demise of a child whose le of nut rition was already irretri tble. For the ear· days of my expe_ri·ence in the cl c, I was faced with a strange situa on. The people w;o had watched s,, many of these chi· dren expire in , _;e past, had adopted an attitude of . he inevitable. They · knew before I did, when · we hadreached the pc:nt of no return. These were ilOt heartless mothe�who did not love their babies. In·deed they loved them so much that ' h methey wanted to take them � twhere they could exchange those as few hours or days of love between a mother and her child. For :11Y P:;; I never wanted to stop trying._il ofI did learn to respect the Wied h h n t to these mothers w en t ey wa . Ittake their children home to die. LINACRE QUARTERLY a problem I had never faced in .. States. When I began to feel the impact tf losing two or three children a 9k because they were unable tollllerate even the simple diseases like mpiratory infection or diarrheas, to ray nothing of the dreaded measles, taberrulosis and pneumonias, I des­perately sought to incorporate some basic preventive medicine measures limed at the most basic and obvious dmciencies which faced this specific group of people. The most accessible deficiency from my standpoint was the iron cleficiency anemias - or so�e prefer � call them the nutritional anemias. I decided to build up a treatment around them. During a period of twenty months, we had 5,222 pa -tlmts visit our clinic; more than � were children. Using a rapid, easily adaptable Sahli hemoglobin determination, we found 1,071 had I hemoglobin of 7.5 grams% or less (465were actually below 4.5 gm.%). Each of these patients were seen for an average of 3.2 patient visits. The treatment of the anemia was merely the administration of simple :r therapy (ferrous sulfate), some ihicb. we received from the Cath-Medical Mission Board and :ie We purchased in the  States. appointments took part � each day. \Ve examined a stool sp�cimen on each visit and, when om patients could tolerate an antihelminthic, we began this facet of treatment. The Honduran girls working for us helped begin classes of instruction on sanitation and nutrition and eventually the Honduran govern­ment, through President Villeda Moralas, contributed a movie pro­jector to enhance our instructions. The U.S. Information Service (ISIS) made available their library of Span­ish language educational movies -including an excellent animated film on hookworm by Walt Disney which we showed ad nauseam to the delight of all. One thing was indeed impressive. When we maintained patient con­tact by offering a system of planned followup, we seemed to improve our success rate of those whose anemia stayed in remission. 70% of those who were treated over a three month period, did not return with anemia recurrence. Among the remaining 30%, some required repeated treat­ment for anemia and related diseases for 10-15 months. We further analyzed our patients according to the kind of inte:tin�l parasites and degree of parasitos1_s. When we plotted this against ane�ia can be seen from the number of l!lurn visits, the treatment became only a stepping stone to seek out lllny of the underlying problems Clllltribut ory to the anemia. � plan of approach became as we went along. Soon we ::.:.ed CARE so that we could te skim milk during the CIDllne of our treatment. Followup prevalence, we noted that tho:e liv­ing in the small grass hut villages (20-200 families), were more severe­ly affected. Among those living in the city proper of El Progreso: 9.8% had anemia with hemoglobm less than 7.5 gm.%. Some villages were disproportionately high such as Guaymetas with a prevalence of 52.5%. Our figures showed the 47 ....UAl.y, 1966 hook�orm . ,alence paralleled the anemia ral!':. Yet, by actual egg count in thestools, there was not a sufficientnumber of hookworm to account for the blood loss quantitatively. Which came first, the anemia or the hook­worm? There were still many unan­swered questions. We wondered ifthe ?�gh i?cidence of protein mal­nutn t1on (1.e. kwashiorkor and lesser degrees)_ might not be related. The world literature in Tropical Med­icine likewise has many things unanswered._B:sides treating patients at our clime, we visited neighboring vil­lages one day a week. We wentfrom house to house doing hemo­globins on all the suspect children presc�ibing iron tablets and givin�appomtments to the clinic. 48 For the t\\•this method a genuine th:a hemoglobLand without patients agrhuman bein[ ·Yet, more my care at cdie ; and v.:anemias ha ,opportunityThe resulttion are totrmerely one what is witYet there is r.ing that w.should have only pray thtinue to makof fulfillingstate in lifewe may haveus we were there,·ery successful andl t's so easy to raise · n 4 to 12 grams­d transfusions. The:..Jecame productive1 120 children under.ime or another didknows how m anytpped back without,unt them. my small contribu­unknown. This isof trying to offerone's capabiliti es.1ys that empty feel­ould and perhaps11e more. We can the Lord will con-._1own to us the way obligation of ouronce known, that� courage to face it.L1NACRE QUARTERLY Palm-Hut �MedicineJose Luis Rementeria, M.D. A good part of my work wasrh/'omplished right at the hospital.During most of my two years inJocotan, I was assisted by two Amer­ican registered nurses and an Amer­ican medical technician. However,each week we spent one, two orthree days in the villages for public health work and an extensive vac­cination program. It is about ourwork in the villages that I wouldlike to relate in this article. the eastern mountains ofala exists a group of Mayan known as the Chorti. Theyoff the soil as best they can andthe years have managed toone hardship after another.a group they are quite malnour-and possess their share ofdiseases, which doesn't dis ­them from other groups ofin Central and South Amer­Our vaccination program con-They live in very rugged, moun­tainous terrain in villages which are111t the classic, well bunched groupti huts that one would expect in a � Indian village, but rather ielr villages are made up of huts 11111ely scattered over a vast area.To go from one end of a village to the other would necessitate a two totlm hour walk. These villages ar�IIOlated from the outside world, ex­upt for the many narrow, steep andtreacherous footpaths. sisted in taking D.P.T. vaccine to the villages every Thursday morn­ing. One of the nurses went to one village while I went to another,thereby vaccinating two differentvillages on each trip. After the youngsters were vaccinated, therewould be sick call during which time we tried to examine all the sick.Medicines were dispensed to the sick Through the Placement Service ofthe Catholic Medical  Mission Board,� was my fortunate experience to ve been assigned to this area ofGuatemala. In a small town called�tan, the Belgian Fathers ran amission which included a 28-bedhmpital, a dispensary and a phar­macy. The medical program was Cllly a small part of the mission�vors of the priests, as they also Ind a �ool, agricultural program,as well as to those too ill to present them<:elves for examination. We charged the Indians five cents forconsultation and physical exam andtwo cents for medicines. As poor asthese people were, they had enough pride not to accept everything free.A few days before we would go to a village, word was sent out so that preparations could be made forour visit. Some area in the centerof the village was chosen, preferablya schoolhouse or oratorio (chapel), in which a small clinic was set up.Many of the villages had neither, so our dispensaries were set up in adid much of their teachingthrough the use of radio sets. 50,000 people (60% were Chorti Indians 111d 40% were Ladinos or Mestizos)1le.e in this mission area of 1,600 lflate kilometers. palm hut, which some Indian wouldoffer us. The palm hut consisted ofjust that - palm leaves spread out49

1,071 had a Hemoglobin of 7.5 Grams % or Less ...

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1,071 had a Hemoglobin of 7.5 Grams % or Less ...

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