As I mentioned before, Dr.
Malte is a pulmonologist working with us now.
He’s helping with all the patients a little but also our lung
cases. In the USA most of the chronic
lung problems I cared for were complications of smoking: COPD, asthma, and lung
cancer. Here we have lots of lung cases
but none are from smoking. Smoking is
very rare here. I’ve had a couple
patients who admit to occasional cigars, but never cigarettes. Here the people cook with wood and work in
silver, copper, and gold minds. Also
this time of the year at the end of the dry season everyone burns their fields.
I still see a lot of COPD (destruction of the lung walls and hairs that move
mucus and over production of mucus because of smoke and pollution) and
asthma. I also see a lot of tuberculosis
(TB) and scarring from old tuberculosis infections. Here if you have a patient with plural
effusion (liquid levels at the base of the lungs) its TB until proven
otherwise. There’s also a lot of
patients with pulmonary fibrosis (scar tissue of the lung as a result of
chronic inflammation). I have patients
with pneumoconiosis and silicosis (chronic inflammation caused by toxins/metals
they have breathed in while working. I
gave a bunch of my chronic lung patients’ appointments with the
pulmonologist. I’m thought he’d like the
challenge. I think he’s still trying to
figure out how to treatment patients in our setting---where people who don’t
have a lot of money have to pay for their CT, where the bronchoscopy is broken
(pray for a new one), and where the medicines we have available are very
limited.
This last
week he saw one of my ladies who I’m treating for an Aspirgiloma (a ball of
fungus in the lung). She doesn’t want
surgery (because she’d have to go to Cusco, and they don’t trust their own
Peruvian doctors very much), so I’ve been treating her with Itraconazol 400mg
every day for 4 months now. The
aspirgiloma is getting small little by little.
Average treatment length is between 2 and 13 months.
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