Clinica Santa Teresita: a volunteer's experience

by Cathy Scarbrough, RN, MSN

Nothing in my 20 years of nursing could have prepared me for how sick and malnourished the Tarahumara children were that I cared for this past September when I volunteered for 2 weeks at Clinica Santa Teresita in Creel, Chihuahua, Mexico. When I worked at the 75 bed hospital in September the average number of pediatric in-patients was 28 per day with only 4-5 adult in-patients. Having worked as a pediatric nurse for 12 years, and speaking Spanish, I choose the pedi ward as my site to work 7 hours a day with the children who all suffered from severe malnutrition.

The hospital is staffed by full time doctors, medical residents, RNs, student nurses, pharmacist, pant-time lab and radiology workers, all trained in Mexico City or other large Mexican medical centers. It is a coveted clinical training site for 4th year RN students who attended the Mexico City Daughters of Charity nursing school. The pedi ward staff was led by Dr. Rosie Olivares and Sr. Lourdes. I worked the evening shift with one RN charge nurse, one or two student nurses, and two clinical assistants. This staff covered 28-30 pedi clients, including the 6 bed pediatric intensive care.

The tenacity and dedication of the staff was impressive and inspiring for me. The residents, student nurses, and Sisters would come back to the pedi ward during their off hours to help with feeding times. The children, most who did not have the luxury of parents staying with them during their hospital stay, were held, hugged, carried, kissed, and sung to by the medical and nursing staffs. Dr. Rosie, the lone pediatrician, worked phenomenal hours, never complained and is constantly exploring opportunities to bring more medicine, improved treatments, and medical equipment to her Tarahumara clients.

Most of the pedi clients are toddlers and it is the toddlers who are the most at risk for malnutrition and dehydration.  I cannot forget the 3 year olds who were so thin and weak they could not hold up their heads or sit alone to eat. These children cried and whimpered so weakly they could not call attention to themselves in the crowded pedi wards, that held 7-9 cribs per room. I remember the child with a hemoglobin of 3.3, the sisters who needed surgery from the ravages of chronic amoebas, the orphaned baby whose mother had died of TB in the summer.

But most of all I remember the incredible love and dignity of the beautiful Tarahumara people, independent subsistence farmers who keep their simple, rural lifestyle and their language. Dressed in colonful traditional attire, most Tarahumara live on their farms far from Creel.

They speak Raramuri until they are taught Spanish in the 3rd grade at the Jesuit mission schools scattered throughout the canyons and valleys. My roommates were three young women from Guadalajara and Leon, members of the Jesuit Friends Society, who had come to the area to serve as volunteer elementary school teachers at the mission school in the beautiful mountain valley of Rejogochi, an hour's drive from Creel. In their few spare moments, these young ladies, the student nurses and I went to explore the canyons, visiting beautiful waterfalls, breath taking canyon vistas, hot springs, ancient missions, flower filled mountain valleys, trout filled lakes, and alpine forests. Some of the exotic places we visited were not even on the local maps, but were found with guidance of Sylvia, the pharmacist/adventurer at Clinica Santa Teresita. Interested in community health, I asked Sr Lourdes if the Daughters of Charity offered any preventative outreach in the remote villages. Sister invited me to come with her to Mission Cusarare on the Sunday she would go there to offer a religious service for the Tarahumaras at this 16th century Spanish mission. Sr. Lourdes, 5 student nurses and I drove to Cusarare one Sunday morning. Sister introduced us to the Mayor of the ancient village, who promptly rang the bell in the old mission tower to call the Tarahumara out of their homes in the hills and the valley to come to church. After an hour's wait, watching the people come down from their homes in caves along the cliffs and on the dirt paths, around 75 Tarahumara arrived for the service. Sister led a beautifully sweet service, reminding everyone of Christ's words to us to care for and love the little children as we love ourselves. Her message was so touching, coming from this pediatric nurse and sister who cared for such gravely ill children everyday. She then offered communion. At the end of the service everyone filed outside and sat on the ground in front of the old Spanish mission. At this time the mayor repeated the entire service in Rarmuri. Upon leaving, a woman approached Sister, reporting her 1 year old child had not eaten well for 3 weeks. Sister told her to hop in the 4-Runner to be transported back to Creel to the hospital. The Tarahumara mother gathered her things, her child wrapped in a shawl worn around her shoulders, and was taken to the hospital where she was admitted with malnutrition and dehydration. The mother could not stay but a few days, and had to return to her family and farm to work, but returned in a week to check on her son, as all the Tarahumara parents did with their children who were hospitalized.

On my last day in Creel I enjoyed attending the celebration of the Fiesta de San Vincente, the mass of St. Vincent de Paul. After working with the Daughters of Charity in Austin , Texas, off and on for my entire nursing career, I was not going to miss this event. The mass and celebration were held behind the hospital under the trees. The Daughters of Charity who worked in nearby villages came. The entire hospital staff and many patients and tarahumara families attended.

Pediatric patients brought food to the altar to be blessed by Father Gilo, a pediatric resident brought her lab coat, and a nursing student brought a nurse's cap. Sister Genoveva played the guitar and everyone sang praises to the life and works of St. Vincent, the saint who taught so many the importance of caring for the poor.  For me it was the perfect way to spend my last day at Clinica Santa Teresita, at least until I return again, I left my heart there with the beautiful Tarahumara people, the children, and the dedicated and loving staff.

A Volunteer Returns to Clinica Santa Teresita

by Cathy Scarbrough RN, MSN

In July 2001 I returned to volunteer as a pediatric nurse at Clinica Santa Teresita.  I was last there in 1999, and it was an experience that seems to have changed my life permanently.   The 30 bed pediatric ward was bursting at the seams with severely malnourished and dying Tarahumara children in 1999.  One night three toddlers died.  I could not forget them and longed to return, where I knew my help was so needed.

Finally, I was able to go back to the beautiful mountains of the Sierra Tarahumara in the state of Chihuahua Mexico.  Clinica Santa Teresita is in the bustling town of Creel, the economic hub of the Copper Canyon and the Tarahumara.  When I arrived, it was clear God had answered my prayers, the Tarahumara children were better.

 Instead of a full pedi ward, there were only 16 patients in the newly renovated pediatric facility.  Why?  The children that were there were not as gravely ill as two years ago.  Why?  There were less cases of severe malnutrition among the in-patients.  Why?  The children who were extremely ill were quickly transported on the fully equipped hospital ambulance to the modern Hospital Infantil in Chihuahua.  Why?  The pediatric mortality rate at the hospital was reduced from 34% to only 1%.  Again, why?

God’s faithfulness in hearing our prayers and caring for the little children has go to be the main reason “everything was better” at Clinica Santa Teresita.  God’s hand along with the incredible work of Mission Tarahumara is another reason for all the improvements.

I went to the wonderful pediatrician, Dr. Cruz, who directed patient services for the children at the hospital, for answers.  Dr. Cruz told me the reason so many children present at the hospital less ill than before (and easier to treat) is the increased health promotion outreach in the outlying canyon areas.  There are now little clinics led by the Promontores de Salud in San Jose de Pinal and Choquitas.  The Tarahumara health promoters are teaching mothers signs and symptoms to look for that lead to malnutrition and how to prevent this problem.  They are learning how to recognize dehydration in their children and seek help early.  This alone can nip malnutrition in the bud.   The health promoters also teach the mothers how to add food supplements to their children’s diets.

Increased distribution of food supplements by the Jesuits, the Sisters of Charity of St. Vincent de Paul and others have helped greatly in maintaining adequate nutrition in children year round.  This is so important as the Tarahumara are now in their ninth year of drought.  Food distribution helps them survive when the meager harvest has been consumed.

Because forty new clean water wells were drilled in 2000 by Mision Tarahumara, fewer Tarahumara are suffering the devastating effects of gastrointestinal parasites.  Father Verplancken and the Sisters have been working diligently to educate the Tarahumara in the remote canyon areas on the importance of drinking the clean water from the wells versus the occasional rainwater that fills the polluted streams.  Gastroenteritis and the complications that accompany it in this primitive area has long been a number one killer of the children, and now, it is finally beginning to subside.  Father Verplancken gave me a tour of the new wells.  It was thrilling to see the sweet, clean water pour from the well that served the cave dwelling Tarahumara family nearby.

The diligence of Dr. Cruz in providing the very best standard of medical and nursing care for the Tarahumara children has led to improved patient care at Clinica Santa Teresita.  He has worked closely with the entire hospital staff to improve patient care skills and techniques.  He has been quick to realize when a gravely ill child’s condition was beyond the scope of the services Clinica Santa Teresita could provide.  Dr. Cruz has ordered the timely and life-saving ambulance transfers to the larger, modern Hospital Infantil in Chihuahua.  He is a real hero in pediatrics in a remote rural setting.

I saw children come in with the dreaded diagnosis of malnutrition and they improved faster than two years ago.  Their mom’s had learned the symptoms of illness and they knew when to seek help.   Yes, “everything was better” at Clinica Santa Teresita.   I guess I did not feel as needed as I did two years ago, but, you know that felt good.

I was able to bring a load of donated medical equipment from Heart of the Rockies Regional Medical Center in Salida, Co., where I now live.  Clinica Santa Teresita is still greatly in need of modern medical equipment and supplies.  Although conditions there have improved greatly, they are still in need of so much.  The laboratory lacked equipment to analyze electrolytes and do blood cultures.  These tests are crucial to correctly diagnose many of the conditions the children suffer from, such as pneumonia, kidney disease, etc.  There are no electronic pumps to regulate tube feedings for the malnourished patients.  There is no pediatric cardiac monitor.  Antibiotics, the number one medicine in saving pediatric lives, were in very short supply in the pharmacy.  The list goes on. 

The support of generous Mexicans and Americans is how Clinica Santa Teresita grows, thrives, and improves its services for the Tarahumara.  With the support of our contributions health conditions for the Tarahumara will continue to improve, as Father Verplancken, the Sisters and the workers of Mision Tarahumara know exactly how use our donations to better help the Tarahumara.

Ed. Note: Currently Cathy is working with the Daughters of Charity in Austin at Children's Hospital where she is a staff RN in the Post Anesthesia Care Unit.  She is hoping the Austin Daughters and Children's Hospital will decide to formerly "adopt" or 'twin" with Clinica Santa Teresita to provide on-going support to the wonderful work that is being done in Creel.

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