The body of Alejandro Ramos was deformed after an accident while searching for shellfish more than 30 meters deep. Doctors have never seen a case like it and doubt: congenital disease or a sequel to diving never seen before?
Minutes after having surfaced, the body of Alejandro Ramos began to swell and has remained so for the past four years. It does not reach 1.60 meters in height, but he wears giant shirts that look like they’re out of a football player’s uniform.
His shoulders barely fit in them and the blue jacket that protects him from the cold in winter owes it to a friend who added pieces of the same color so that his arms could enter the sleeves. Ramos, or as his family calls him, Willy, shows the garment with a mixture of pride and affection in the room of the Naval Medical Center that he occupies since December, when the Navy of Peru offered to study his case.
Until then, he had barely been treated for lack of money … and the embarrassment of going out with his new body.
From the elbow to the bottom, his arms could pass like those of any healthy man of 56 years. They are his biceps, with an outline of 62 and 72 centimeters each, which makes all eyes look upon him. From each elbow a lump is born with an even larger one that merges with the shoulders. His pectorals, inflated, hang on a stomach that, like the back, hips and thighs; It also has a larger volume than it should.
To the aesthetic factor are added the pain of bones that prevents him from walking normally and the hiss that his chest emits every time he breathes. Willy is convinced that all these evils are the aftermath of a work accident he had at the end of 2013 while diving more than 30 meters deep in search of choros, the name given to mussels in Peru and other countries in South America. If true, your case would be unique and unprecedented in the history of diving.
Until the bladder holds
The choro is fixed with hardness to surfaces such as ravines and cliffs thanks to a secretion called byssus.
The shellfish divers who work in an artisanal way, like Willy, spend long hours taking them off and collecting them before they can return to the surface.
The time they remain submerged under the cold waters of the Humboldt current is determined by the “need to urinate,” several divers from Pisco, the fishing town 230 kilometers south of Lima where Willy lives, explain to BBC Mundo.
He says he could hold up to eight hours. “Sometimes I went up to urinate, but for me it was wasting time,” he recalls.
Giving freedom to the bladder in the depths of the ocean is not an option when one wears a suit made with truck tire cameras.
“If a drop of water enters a hole, we get all wet.”
Younger divers prefer neoprene, which cost an average of US $ 200 but a shellfish does not last for four months, according to Enrique Quino, the Pisco artisan who dismantles giant wheels in search of rubber to make them.
He, on the other hand, charges US $ 183 for a team that, according to BBC Mundo, will serve between three and four years.
It is composed of jacket and trousers so wide that the mariscador fits inside and several layers of warm clothes.
Includes fins, a mask, a rubber band and a belt with more than 20 kilos of lead that helps them sink into the water.
That was how Willy was dressed when, at about three o’clock in the afternoon, almost at the end of his working day, he felt the thin hose in his mouth begin to steal the air instead of giving it to him. “Every diver knows what that means.”
A diver never goes fishing alone.
Several meters above your head, one or more crew members are responsible for receiving the collected product and feeding a machine with gasoline every 90 minutes.
This compresses air and sends it to the diver through a hose that has to be placed directly in the mouth, since most Peruvian shellfish farmers do not have regulators, an accessory that would guarantee them between 10 and 15 minutes of oxygen in case of emergency.
That afternoon, a boat got too close to the boat for which Willy worked and where his son and another partner were waiting for him.
The maneuver caused a propeller to break the hose and condemned the diver to have to suddenly climb 36 meters.
A journey of a few minutes, but that could have cost him his life.
The danger of nitrogen
“When we dive, we are under more pressure and that causes oxygen and air to undergo physical changes,” explains Raúl Alejandro Aguado, underwater physician at the Naval Medical Center. Air is 78% composed of a gas that the human body does not use: nitrogen. The pressure of the bottom of the sea causes it to dissolve and seek refuge in the fatty tissue. But, during the return to the surface, the nitrogen gets into the blood system, where it begins to return to its gaseous condition. That’s why divers need to climb sections, with stops every so often.
A rapid rise can push nitrogen to create bubbles that are too large to block blood circulation, which is called decompression syndrome. A slow climb, on the other hand, gives the gas enough time to travel through the blood vessels, while still having little volume, until it reaches the lungs, which will expel it from the body.
There are tables that indicate how many minutes and even hours should be devoted to the rise in terms of time and depth to which you have been submerged. 42 meters under the water.
Willy was lame at age 30, shortly after deciding to follow in his father’s footsteps and engage in shellfish diving. “But that’s normal for the divers,” he said.
At that time, his companions called him “pampito” because he did not dare to go down very deep (Peruvian fishermen call “pampa” the shallow part). “But my oldest son was asthmatic and suffered attacks, with the jousts he breathed.”
So, he began to go deeper into the waters of Pisco to find more seafood and be able to pay for his treatment, since being an artisan, he lacked health insurance. “In the time of my father, all the Pisco islands had choros, you did not need to go down more than 14 meters, now it only grows to 25 meters,” laments Willy.
This is the depth at which divers take off the choros. But then they must descend even more to pick them up. Sometimes, up to 42 meters. “We have to take risks, if not, we do not win.” “Deformed”, but alive.
The day of the accident, when Willy finally surfaced, he had to resort to an emergency maneuver used by artisanal divers. It consists of going back to submerge at the same depth and ascend, this time yes, respecting the security stops. “It’s like taking back a decompression that was omitted,” explains Aguado. “It helps in something … but it is not very safe because, what happens if the diver loses the knowledge in the water? It can drown”.
The fisherman took the risk and sank once more into the sea with the compressor lent him by the fishermen of a nearby boat. But the men were impatient.
They had already finished their fishing day, so they had to go to the port to try to sell the merchandise. Soon, the rush was more than solidarity and they left, leaving the diver without a compressor. That’s how Willy could only complete the first 30 minutes of the two hours that, according to the decompression tables, he should have dedicated to the promotion. He arrived at the hospital in Pisco “bloated like a sweet potato,” he recalls. “I have been saved by a miracle, I thank God that, well, he deformed me but I am alive …”
“Although sometimes I get a depression that would not be here because I know I’m becoming a burden.” Willy tried to find a cure for his swelling during the first months after the accident, but could not afford it for long.
The doctors, who had never seen a similar case, asked for at least an MRI to see what was under that great mass of meat that made him carry 30 kilos more. But it is an expensive test that must be done in one part of the body at a time. Only on the shoulder, it would have cost at least US $ 150, a huge amount for someone without income. Even with employment, I would have had trouble paying for it: as a diver, there were times when I did not make more than $ 30 in two days.
Without resonance, the doctors he went through worked blindly and attributed the inflammation to decompression sickness. So, they prescribed the traditional treatment: the hyperbaric chamber. Oxygen as medicine, Divers know that the best weapon against decompression syndrome is a kind of cabin in which the atmospheric pressure is increased and where pure oxygen is breathed. Thus, the gas manages to reach damaged areas where it could no longer reach naturally.
The device is called a hyperbaric chamber and, according to Aguado, sometimes even manages to “create blood vessels where they did not exist before”. The San Juan de Dios Hospital in Pisco has two because the Camisea Consortium, led by the Argentine oil company Pluspetrol, donated them in order to benefit the group of artisanal divers from the region. But the price of the sessions dissuades the shellfishers.
Pedro Espinoza Aguilar, a 58-year-old diver who still exercises despite the limp that caused the decompression syndrome, admits that the camera provides a “momentary” relief to the pain of his “care” bones.
“But it’s very expensive … We have to do a lot of paperwork and sometimes we do not have time because we live for the day: if you work, you have. Most think like him, so they only resort to hyperbaric medicine in cases of emergency.Willy, who can no longer work, says they asked for 80 nuevos soles (US $ 25) per session.
His doctor was able to convince the hospital that he would allow him to give sessions without charge. But it was a difficult task. “Not even for being an unpublished case they treated me (for free)”, complains the diver. “You are horrible!” While it may leave sequelae for life, decompressive disease itself is never chronic, says Aguado.
Even without treatment, Willy’s body should have returned to normal shortly after the accident. Seeing that the doctors did not know what was wrong and that trying to find out was going to be very expensive, began to discourage the diver.
But what ended up sinking him was the phone call of an old girlfriend: “Hey, I’ve seen you in the hospital, you’re so awful, how are you doing! Pasu macho, what a shame!”
“Everything is paid, everything goes around,” says the mariscador, who, decades ago, had planned to marry her … Until he decided to leave her for another girl.
“She will be happy that I am now like this …”, she lets go with more resignation than sadness.
The woman had seen pictures of him in the hallway of the San Juan de Dios Hospital in Pisco, which had been exposed to explain what decompression sickness was. According to Willy, without his permission. The institution did not want to respond to BBC World on this point.
That conversation depressed both the mariscador, who stopped going out into the street. “For three years I have received calls from several people: ‘That you are a monster, how you have deformed …’, he says. “I got a depression … That people give you descriptions and see you with pity … Ideas passed through my head …”
Decompression or tumor?
For four years, Willy only showed up when he visited his brothers or, occasionally, when he approached the beach at low hours to see the sea. “I almost do not go out because I’m ashamed that people stop to look at me like a weird animal,” he confessed in September by telephone to BBC Mundo from his home in Pisco. Now that a team of doctors is studying his case, he claims to have received an “injection of courage” and that the “psychosis” has already passed.
His appearance on a Peruvian television program made the Naval Medical Center aware of his case and offered him free care. So, in the last few weeks, Willy has had all the MRIs, ultrasounds and nuclear medicine studies he so badly needed.
Although, at the moment, he only receives treatment for pain because the doctors do not want to assume that his problem was caused by diving and they try to reach an accurate diagnosis. According to the first results, what deforms his body would not be gas trapped, as was thought until now, but fat that develops from the hypodermis, the lowest layer of the skin, explains Aguado.
The doctor believes it would be “imprudent” to draw conclusions, but at the insistence, admits that it can be a kind of fat tumors. “If so, it could be a congenital disease that had not manifested until, coincidentally, the accident.”Another possibility “further away,” he says, is that it is a “sequel to diving never seen before.” But he did conclude that the mariscador urgently needs a hip transplant, since his osteonecrosis is too advanced.
The institution will operate it for free, but the diver must get the prosthesis by his own means. Willy hopes that some NGO or private entity will donate it after hearing about his case. Meanwhile, the diver takes advantage of the free days that physicians give him from time to time to travel to Pisco. There, he spends time with his family and goes to the port to remember his days as a diver.
It always does it on a Monday, Wednesday or Friday: the days when shellfish go to the terminal to sell their product Among meshes full of mussels, snails, clams and crabs; You can see Willy walking with difficulty. Although it is not the only one. As the afternoon progresses, canes and even a wheelchair can be seen inside the fishing terminal: they are retired divers, who carry the consequences of decompression sickness.
They go to the port to beg for “propinitas” or some seafood and then sell it and have some income, since their craft does not entitle them to a pension for retirement. “This is how we finish the divers, all because the State does not care about us,” laments Willy. He is fortunate to have many brothers who look after him and support him. But, even so, he longs to go back to submerge in the sea.
“I plan to keep diving because, apart from my source of income, it was my hobby, as they say … I love diving”.