While medical care is still far from adequate in the 400 or more square miles of the barrancas in which Project Piaxtla pervades services, progress has been definite.
Nutritional diseases, especially, pellagra, have been greatly reduced. I have not encountered a single new case or paralytic polio since the vaccination program was first initiated. Whooping cough epidemics have been restricted to the smaller populations near Ajoya, which as yet haven’t been vaccinated. And in the last two years I have not been confronted with single case of tetanus, except neonatal, which is still a problem.
Infant and maternal mortality have been considerably reduced, due partly to increased pre- and post-natal supportive care, and partly to the fact that I have encouraged women with severe parturition problems and multiparous mothers generally, to begin birth control. For the most part, the women are not only willing, but eager. Along with other medication, the Direct Relief Foundation in Santa Barbara has supplied Project Piaxtla generously with oral contraceptives, which has allowed us to maintain an ever increasing number of women on the “pill”. Some of the women are now on their third year. So far no pregnancies have resulted and to date there has been only one case of minor complications. As a foreigner in a Catholic country which does not even allow the Peace Corps, I am sticking my neck far out in sponsoring birth control, but I can see no alternative. In an area such as the barrancas, where economic and subsequent health problems are directly related to population pressure, it would be a costly mistake to conduct a program which saves lives without concomitant efforts to limit proliferation.
Problems of oral hygiene have also been ameliorated, due partly to the introduction of the toothbrush and fluoride and partly to rudimentary dentistry. When first I began extracting teeth three years ago, some of the mouths which opened for treatment were unbelievable, for most had never been seen by a dentist. There were many chronic abscesses, some draining externally, and cases where gross infection had limited jaw movement, caused blindness, or caused disfiguration. Some days I had to extract over 50 teeth. But now the chronic cases have mostly been taken care of; patients come earlier for treatment, and the number of extractions which Bob Steiner and I must perform has been reduced.
One of the severe diseases against which I have made little headway is infectious hepatitis, for there is no specific treatment and prophylaxis with gamma globulin is too costly to consider. Since I first came here, minor epidemics have struck the upper barrancas periodically. This Autumn, El Llano and Jocuixtita have been hit hard by a particularly virulent strain. The virus, passed in human feces, is spread principally by the busy noses of pigs, The problem is one of hygiene. I have tried to encourage the idea of an outhouse, but the villagers think it smells. (Some have them have visited relatives in the slums of Culiacán and Mazatlán, where the rank outhouses foul the entire atmosphere of the neighborhood. Villagers regard the pig as the more sanitary system of disposal. And if the pigs were not given free entry into the houses, they might be right.
Weddings, dances, and religious holidays—whenever alcohol flows freely—still not infrequently lead to bloodshed. The fiesta which saw in the New Year of 1969 ended with a knife fight which presented me with one of, the most delicate surgical problems I have had to tackle. A young man’s wrist had been slashed and several tendons severed. With the help of Miguel and Martín, who were back in Ajoya for the holidays, we succeeded in tying off the vessels and reuniting the severed, tendons. Healing was surprisingly successful, and today the young man has complete movement of the hand.