Dsidsi, who came from the village of Maronahua in Brazil, was hoping to get some medicine from me for her skin problems. She had sores all over her face and upper body, which she had painted with genitian violet for lack of something better. She said that the sores had started with just one on her face and had slowly spread to other parts of her body. She’s had the problem for a year. I didn’t know what it was, and I wasn’t sure what to give her for it. I did have the phone number of my dermatologist in Pucallpa, however, so I thought I’d try giving her a call.
Getting through to anyone on the village phone is pretty iffy. In previous attempts to contact people I’ve often had poor results. But the night I tried to call Dr. Sandra, to my surprise and delight the call went through and she answered. I told her about the lady with skin problems, asked her for her e-mail address and said I would send her some pictures. Fine, send them on, she said.
After a couple days when I didn’t hear back from her, I called again. She had not gotten the pictures! So we sent again. I don’t remember what the problem was. We hadn’t gotten a notice back that our mail didn’t go through. But on the second try they went through and she answered back. The lady probably has pemphigus, she said, and she should be on a supervised treatment of prednisone. Pemphigus is an auto-immune disease and prednisone is an oral corticosteriod.
On that same day, a nurse came to the village and I took Dsidsi in to see him. He thought she had rosacea, and he prescribed injections of penicillin plus topical corticosteroid and antibiotic. I decided to give her that treatment, since I had it and it was not anything risky like prednisone is. But thinking that it might actually be pemphigus, I had an idea to confirm that.
Alicia, a woman who lives across the airstrip from us in San Bernardo, has had pemphigus for 16 years. We’ve supplied her with prednisone and face cream for all those years. I remember how she looked when she was having the worst outbreak of it. Dsidsi’s case was not that bad. I asked Alicia to visit Dsidsi with me so they could compare their stories. Jokingly I also asked Alicia to smell Dsidsi’s face, knowing that pemphigus sores have a characteristic bad odor. She burst out laughing, and she has a loud giggly laugh that makes you laugh just to hear her. In Culina culture, sniffing someone’s face is something you do in greeting someone you love and haven’t seen for awhile, or what you do to babies. Similar to a kiss on the cheek. So my suggestion for her to greet her with a sniff was silly.
Alicia and Dsidsi got to talking about their histories, and if confirmed to us that the illness was indeed pemphigus. The sores start with blisters that itch and then sting when scratched open. It does have a bad smell. Dsidsi was probably a few months to a year away from a terrible outbreak that Alicia ended up having when she was without treatment for a long time. Prednisone is definitely needed!
Since I was going to be leaving the village for a few months and Dsidsi and family planned to return to their home downriver, I was not willing to start her on a treatment of prednisone. It needs to start with high doses and then get reduced little by little over a month or more until the outbreaks are under control and the patient can live on a small maintenance dose. The patient really needs to be supervised every 7-10 days during that period of high doses. If they get sick with something else during that time, they will need a strong treatment of something, because the prednisone suppresses their immune system. Or something like that. I’m not a doctor you know, just a linguist missionary!
So what I did was give her the 3 days of injectable penicillin, then to take home with her I gave 3 tubes of antibiotic ointment, 3 tubes of Clobetasol, and 7 days’ worth of dicloxicillin in case she got another infection. I wrote the name pemphigus and the proposed treatment of prednisone on a card and gave it to her husband to save in his wallet. I encouraged them to go to a doctor in a town downriver and present the card to him if she was not helped by the ointment and cream and wanted to try the pills. And I warned them that the treatment with prednisone pills had to be carefully controlled and supervised by a doctor or nurse.
I’d like to write that I prayed for her before we said good-bye, but I can’t remember if I did or not. My intention is to always pray with people, but I don’t always remember to. I have prayed for her since then, however, and I feel that God has endeared her to me so that I will look forward to seeing her again and finding out how she’s doing.