The following article ran in the Longview News-Journal on Sunday, May 8.
Editor’s note: Kimberly Johnson with Refuge International originally posted this entry on Facebook, describing an experience she had in March in Guatemala.

March 17, Day 5 in Sarstún (Izabal, Guatemala)  …  Pretty sure I have scabies. But I don’t care.

On Monday this week, a family came in with their 2-year-old girl who “has a rash on her legs. She also happens to have Trisomy 21 (the U.S. also refers to it as Down’s syndrome). Her mother only speaks Q’eqchi (Mayan language), but her father speaks great Spanish.

The rash started two weeks ago with a small blister. When they unwrapped their little girl, she had multiple large, oozing wounds on her leg. One the size of an apple. This was not “just a rash.” Most likely it was MRSA (what some refer to as flesh eating bacteria).

Our incredible team of volunteers jumped into action … they always do. The doubt was stated, “It might be best to send her to the hospital.” But WE were their hospital. The team thoughtfully planned an arsenal of antibiotics and fluids and the little girl and her mom (and her 1-year-old sister who was still breastfeeding) stayed with us. Her dosing schedule was set. We gave her the 11 p.m. dose before going to bed and got up again at 3 a.m. for the next round. Her antibiotics were IV administered, meaning we had to leave an IV line in her little arm and find a way for her to not mess with it. Tongue depressors were taped together as an arm brace, padded with gauze and taped to her arm. A nonskid sock from post-op was an arm cover. And “little star” was a champ. She left it alone. We gave her “bien frio” (well-chilled … it’s HOT here) Pedialyte, fruit slush “popsicles,” anything her little heart desired.

Skin markers were used to trace an outline of the newest red/inflamed areas so we could monitor if the “rash” continued to grow despite antibiotics. Our general surgeon, the amazing Dr. E, evaluated her wound (it was so much more than a rash). And we waited.

This little girl proved to be a fighter (especially when we added oral antibiotic to mashed banana. I’ve never seen a toddler’s mouth so tight-lipped before. Full. Lock. Down. But we had a secret weapon in some strawberry ice cream our ambulance boat driver’s wife just happened to have.) But she was improving.

We put her on the surgery schedule so that Dr. E and team could debride the wounds (under anesthesia) and redress them. Already her legs were looking so much better. We allowed ourselves to breathe a little sigh of relief for this little girl.

Finally, by yesterday, she was animated again. She was sitting up on her own. Smiling. Giggling. Blowing kisses (OK, so we might have been a little weepy). And her wounds were much, much better. Her little body was working hard to heal.

Our pediatrician, Dr. Pengetnze (Dr. P), was the first medical professional to explain what Trisomy 21 is, how their little daughter will grow up just like all other little kids, she’ll need a little extra attention and focus in helping her skills develop (walking, talking, etc.) Dr. P gave them instructions for physical therapy. One of our interpreters (whose sister in Guatemala City is a physical therapist) reached out for a specific PT plan between the family, our nurses that are on staff here at the clinic and Dr. P when she’s back in Dallas. Photos and videos will be shared. Telehealth appointments planned.

And the entire family was given Ivermectin to kill the scabies. See, it was most likely a scabies bite that started this whole ordeal. The little girl scratched an itchy spot and it opened and got infected. Scabies is fairly easy to treat for someone like me. One pill of Ivermectin today. Another in eight days. And I will go home and throw everything in my suitcase in a hot wash cycle and then in a hot dryer. I am lucky. This family has to go home, boil a lot of water, put all their linens in to soak, dry it all in the sun and (best) put it all in a dark, sealed bag in the sun for three days. Not an easy process.

BUT our little star has a much better chance of healing because our team was here. This infection would have most likely killed her.

So, I have scabies and I don’t care. The whole care team probably has scabies. And nobody is upset about it. We’ll take our second pill next week. This is why we do what we do.


Kimberly Johnson is Director of Guatemala for Refuge International, a nonprofit organization based in Longview that provides a variety of programs internationally and locally aimed at “improving lives through healthcare, nutrition, clean water and education.” For more information visit,