Monday, February 22, 2016

La Mesa Final - The Last Table

This is the fourth in a series of posts about the Feria de Bienestar Familiar - Family Wellness Fair that we organized earlier this month.  You might like to check out The Chicken Dance , Las Charlas and More Charlas before you read this story.  For the panoramic look at Missions of Healing over the years, put "Mission of Healing" in the search window and you will find a wide variety of healing stories from over the years.

The Mesa Final at the Family Wellness Fair was my responsibility.  As my Spanish has improved over the years, I moved from running the children's activities, to assisting in the pharmacy, to translating for doctors and nurses, and finally to teaching.  A few years ago, we added La Mesa Final as a control - a place where each participant in the Mission of Healing would stop and show me all of his or her medications so I could be sure the participant knew how and when to take them.  I drew many calendars with suns and moons to help non-readers remember when to take their medications.  I spent a significant amount of time clarifying that the pink blood pressure pill and pink allergy medication were different.  Heads of the household received "basic kits" (containing bandages, toothbrushes, acetaminophen for adults and children if needed, crayons, educational coloring pages and health information pages), so I also explained the items in the kits.  Last year, I added a little charla about purifying water in the sunlight.


This year, without a pharmacy yet still recognizing the need to provide education about medications, the Mesa Final became the place for a charla about storing and taking medications correctly, including antibiotics.  It was also the place to hand out information pages, to check over the participants' cards and add my stamp, and to give away the last premio - acetaminophen for adults and children (as needed).  


Everyone stops at La Mesa Final.  When big crowds moved through the fair, the Mesa Final was a little crazy.  For all of my fellow fair-workers, I apologize in advance for sharing once again my charla - this time not in my loud teacher voice, but via the written word:


Hello, my name is Linda.  Welcome to the Mesa Final.  Here we will learn a little bit about how to take medications responsibly, especially antibiotics.  I have wonderful education pages for you to use in the home, and at the end, a gift of acetaminophen for the family so when a high fever hits in the middle of the night from dengue or chikungunya, or zika you will be prepared.


How many of you take medications every day - like for sugar in your blood or high blood pressure or vitamins?  (Hands go up.)  It is very important to follow the instructions of your physician.  When we take medications every day for the rest of our lives or for a short time to take care of an infection, it can be easy to forget to take our medicines.  (People nod and start telling me about forgetting to take their medications.) I have a tip for you.  How many of you have one of these? (I pull out my little Salvadoran cell phone.  95% of the participants raise their hands.)  This little phone has an alarm, right?  We can set an alarm for the hour when we should take our medicine.  If we take medication twice a day, we can set two alarms.  It's easy.  (At this point people are nodding like this is a brilliant idea.)  


It is also very important, as we all know, to store our medications properly:  in a dry and safe place, not too hot and above the hands of the children.  If you have a liquid like amoxicillin, it is important to keep it in the refrigerator, and if you don't have a refrigerator, find a cool place or a neighbor who has one.  


How many of you are walking around today with a sore throat or runny nose? (Everyone raises their hands.  It's super windy and super dusty.)  Maybe you think you need an antibiotic to help you feel better?  (More than half the people say "yes" out loud.)  Antibiotics only work to take away an infection that is caused by a bacteria.  Many infections are caused by viruses and antibiotics cannot touch them.  To take them is a waste of resources.  How can you tell if you have a bacterial infection?  (They know this - go to the clinic and have an exam.  We go over the classic signs of a bacterial infection - including green boogers and phlegm which the teen boys love.)


The charla continues with a conversation about antibiotics.  The people are familiar with the instructions of a 7-day or 10-day course of treatment.  


How do you feel after about 3 or 4 days of taking your antibiotic?  (Better, they all say.)  So, maybe you have the idea to stop taking your antibiotic and to keep the rest of it for another time when you are sick. 


In the 4 days I spent giving this charla only one time did a woman stop me and say, "No, that's dangerous."  She proceeded to give my charla.  Every other time, dozens of heads nodded.  I say that this idea is dangerous.  The people look surprised and a little guilty.  


About 2 charlas into my first day, I realized that I needed props.  Since I had nothing better than my hands, I used them.  To really appreciate the full dramatic effect of this charla one needs to imagine my hands up in the air, acting out the fight between the bacteria and the antibiotic.


When your body has a bacterial infection, that means that you have bacteria growing inside your body.  (I hold up my right fist.)  When you take antibiotics (I hold up my left fist) there is a fight between the antibiotic and the bacteria.  (I hit my fists together.)  What does the bacteria want to do?  Survive.  So to survive it gets a little bit stronger and even changes its form a little bit.  (Keep in mind, I am about to explain something in compressed time -- not exactly the perfect science but accurate enough to make the point.  I open my right fist and wiggle my fingers to make stronger bacteria.)  When we keep taking the antibiotics for the 7 days or the 10 days like the doctor tells us (my antibiotic fist keeps pounding my wiggly bacteria), the bacteria dies. 


But what happens if we take away the antibiotic early?  (I put my antibiotic fist behind my back.  My wiggly fingers bacteria keeps on wiggling.  The crowd is with me now.  "The bacteria survives," they say.)


Right.  I feel fine, but inside me the bacteria survives in a new strong form.  Maybe I will get sick again soon.  Maybe I will get sick later.  And the antibiotic that I kept (I pull my antibiotic fist from behind my back) won't work to take away this strong bacteria. (My antibiotic fist can't touch my wiggly bacteria fingers.)  


And maybe there are no new antibiotics to take my strong infection away.  Strong bacteria like this is called drug-resistant bacteria.  If I have drug resistant bacteria in my body, and there is no medicine to take it away, what will happen to me?  (At this point I pause for great dramatic effect, and speak with a very dramatic voice.)  A tragedy.  (This sounds much better in Spanish.)


And if I pass my drug-resistant bacteria to you and to you (I touch people's shoulders) and to you?  A tragedy for the family and the whole community.  So please, take your antibiotics responsibly.  7 days means 7 days.  10 days means 10 days.  (Everyone is nodding and thinking about that stash of antibiotics they have at home.)


I finish up my charla by handing out information pages which provide basic home treatments for common illnesses and provide guidelines for when a clinic visit might be needed.  We review things like the common cold (no antibiotics needed), flu, stomach pain, back exercises and a recipe for making re-hydration solution in the home.  The last page I hand out is the constipation page.  


Don't be embarrassed, boys and girls, ladies and gentlemen, this page is about constipation.  (The youth giggle.)  We all know that right now in a home in this community there is a little kid crying out, "Mama, I can't go poo poo."  (I use this little kid voice which makes them all laugh and all the moms and grandmas say, "yes, that's true."  Then the old people volunteer the fact that they have this problem too.) 


All children have this problem from time to time, and we adults have it too, but we do not like to talk about it.  We just think, "I can't go poop."  


Seriously, the constipation page ends up being the one everyone really likes.  It has good tips on how to stay regular and how to encourage the digestive system to work when it isn't.  


With that, I complete my charla.  I hope you have learned a little something from me today, and throughout the fair.  Now you may line up in an orderly fashion to receive my seal on your card and your gift of acetaminophen.  Remember, if you have a headache do not take ibuprofen, only acetaminophen.  Ibuprofen can cause kidney problems if you have chikungunya.  Only acetaminophen.


Folks line up.  They give me hugs and blessings.  A few interlopers try to get the acetaminophen without listening to the charla.  When this happens I ask, "Explain what drug-resistant bacteria is."  They grin guiltily and others in the line tell them to sit down because it is really a good charla.  I hope so.


And that is how I ran the Mesa Final.



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