“Did she say why she took the poison?”  I asked the resident doctor for details when he told me we had another patient with organophosphate toxicity.  This comes from ingesting a chemical used as an herbicide on hearts of palm.  “No Doc, but don’t forget we’re still in the season.”

The season to which he was referring was Valentine’s Day.  We seem to see at least a few cases every year of love gone awry.  Despondent folks attempt suicide by ingesting this substance.  It is an extremely painful way to die.

Fortunately for the patient, the antidote is an old medicine called Atropine – generally available, but there has to be enough around.  In the US we are accustomed to giving 1 to 2 amps to a patient for other conditions such as heart block, but these patients require up to 150 amps, which can be a lot more than a hospital might even have on hand.  We managed to save this woman with 120 amps and other medications.

As Family Physicians, we addressed the causes of her distress after she recovered from her life-threatening intoxication. We even have a sociologist and clinical psychologist on hand to help us with patients facing these difficult situations.  The difference between rural Ecuador and the US is that there are generally no services or institutions in rural Ecuador to care for people with conditions such as suicidality.  The Family Doctors have to do the best they can.

This story does not have a happy ending.  Although the patient
survived and was ultimately sent home after some therapy, we never knew how effective our treatment was.  Yes, the Atropine saved her life, but what about her mood?

Depression is hardly recognized as a disease in rural areas in a country like Ecuador.  It certainly exists, but food on the table and a roof over one’s head seem to be greater priorities for most.

How to diagnose and treat depression remains yet another challenge for teams of doctors like ours.  Sadly, we’ll continue to see patients like this for many years to come.

– David Gaus

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Andean Health & Development
UW Department of Family Medicine
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