Cutting off toes

I am thankful that Jake can find humor in the content that ends up on my phone. Everything from lumps/bumps to x-rays to body parts and this week it was a lot of dead toes. The Honduran docs sit in wait outside the ORs, ready to pounce when I emerge. Just kidding, they very patiently wait for me to give them my attention. They usually complement their consultations with a picture since I am not able to physically visit with each patient, and hence why a scroll through the photo album on my phone will lead to more than a few surprises.

I thought about sharing one such photographic example from this past week of diabetic feet, but thought better of it. Diabetes is a horrible disease and plagues the Honduran population. Glycosylated hemoglobin (HbA1c) is a lab test that measures the level of blood cells that are linked to sugar molecules. I have had more than a few friendly arguments with the Honduran docs about an acceptable HbA1c, which started when patients were being presented to me with an HbA1c below 8%... as if that was a good and acceptable result. A Normal and Desirable HbA1c is below 5.7%. When I push back that 8% is still too high, they counter that below 6% is extremely difficult to obtain due to the Honduran diet being primarily carb-based, and too expensive for our population to afford anything different. Therefore the goal they like to see is below 8%. And so it goes back and forth, really with no good and perfect answer. What is the standard of health we are using? Can we alter that standard based on culture? Looking at all of the dead and infected feet that came through our doors this week, how can I change the scientific standard of 5.7% and now say 8% is acceptable, when I know the danger that presents to the human body. If I were to adapt to this cultural difference, would I be guilty of unjust treatment? And so the argument continues in my head long after our friendly back and forth has ended.

Much Love.