Cinco puntos...

I stare out the window as the guagua waddles up the mountain. Mountains blanketed in vegetation loom into the sky, while the westen-bound sun trudges along, showing no mercy to those under Don Sol's potent gaze. The faint yellow trailings of the sun that cascade across the ancient mountains paint my mind and body serene. It has been so long since I have seen mountains, I realize. In fact, these ancient green giants are the closest representations of mountains that I have been around in far too long.  

The culprit...

Trivia 1. (Answers at the end)

Which substance(s) is/are best for cleaning 

wounds while promoting healing and pre-

venting infection:

A. Povidine-Iodine

B. Saline (Water + Salt)

C. Tap Water

D. Hydrogen Peroxide

E. Soap (or some sort of detergent)

My right leg aches, dragging my mind away from its humble fortress of solitude. Hours of stillness leave my muscles and body craving for proper rest. My right hand instinctively reaches downward, touching my right shin bone softly, as if to reassure myself that the five stitches are still there, and moreover to remind me of my bad decision. To think that tripping on and slamming into a two-foot tall cement step while carrying hamburgers was enough to result in a 2.5 centimeter gash and five puntos to close it up. On the bright side, I managed to keep the hamburgers on the plate, not sacrificing a single one. Plus, I got to see the Dominican health system from the perspective of a patient. Somehow I have a feeling there are better ways of familiarizing myself with the system, though.

Today we are in search of adventure, principally to experience 27 Charcos (27 Waterfalls) - a beautiful, semi-extreme outdoor adventure site between Santiago and Puerta Plata that requires unique methods to descend down the mountain. Of course, this involves submerging my body, including my two-day-old stitches, into water for several hours. It seemed like a good idea at the start of the day...


The bus pulls up to 27 Charcos while I'm wondering what the hell I have gotten myself into. The risk of infection and re-injury becomes a daunting reality. Nonetheless, I am committed so we pay our tickets and I sit down. My leg has been shaved in preparation for the work that must be done before we depart for the waterfalls. Reaching into my bag, I pull out some gauze, a plastic bag, and duct tape.  James wraps my leg up nicely, kindly preserving some circulation. The group gathers, we collect our gear, and I dig deep in search of some piece of courage from what's left of my "Rocky Mountain Oysters." Then either the best adventure of my life or my worst pesadilla begins. 



After 45 minutes of hiking through the jungle, which resembles some prehistoric creation (in fact some parts of Jurassic Park were filmed in the DR) we arrive at a pool set against a stone wall, its turquoise waters gleaming off the walls. I hesitated, resisting the urge to enter the water until absolutely necessary. After quenching my thirst at a nearby trickling waterfall, we treck down the river to the first waterfall. It was unavoidable at this point. Helmets on and chalecos for floatation firmly in place, we were off... 


...and so began the greatest adventure of my life. 

No... That's not me unfortunately...

Trivia 2.

True or False: Wetting a wound before removing the stitches increases the 

risk of infection? 

We slid down natural water slides into pools of refreshing mountain water while other times we jumped off waterfalls as high as 25 feet, plunging feet first into the depths. Sometimes we found ourselves wading and floating our ways through cavernous trenches carved out by millions of years of erosion. Tall walls would surround us while dazzling aquamarine water shimmered off the ancient walls encompassing us. The gentle jungle canopy overhead provided cover from the scorching fingers of Don Sol. I lost count of the number of times I jumped or slid down into yet another pool of refreshing water and sublimity. 


As we end the tour and I attend to my stitches, thankful that everything is still tied together, I take a moment to bask in the beauty of this country. When I would return to the clinic, rumors would fly that I had been the non-compliant patient who decided to go to 27 Charcos against medical advice. But as one amazing lady at the clinic would remind me: you are young, hay que aprovechar de la vida y la juventud! (One must take advantage of life and youth!). Stupidity and all, it was worth every jump.

I stare at the mountains as we head home down the mountain, exhausted, parts of my clothing still soaked. And for the first time in a long time my mind is quiet; I'm at peace, smiling from the inside out.

Answers:
Trivia 1: B, C. This might seem counterintuitive, but water, including saline water is perhaps the best substance for cleaning out wounds. Water dilutes the bacterial concentration in the wound, and combined with pressure helps to remove debris and other fragments left in the wound. Substances such as hydrogen peroxide, iodine, and detergents (such as soaps) are not necessarily horrible substances, but studies demonstrate that they can damage and kill special cells that promote healing (called fibroblasts). In the wilderness, water from a water bottle (especially useful from CamelBacks) or placed in a small ziplock bag with a tiny hole can be used to create high pressure water to clean out wounds. 

Trivia 2: False. In fact, some studies show that wetting the site as soon as 12 hours following stitches does NOT increase infection. That being said, I tried to be on the safe side and avoid water in my stitches.  

Source for answers: 2008 Oct 15. Forssch, R.T., "Essentials of Laceration Repair". American Family Physician. 78(8):945-951. http://www.aafp.org/afp/2008/1015/p945.html