A woman of 39 comes in for a pap smear. Although physically healthy appearing, she struggles to climb on to the table, breaths a lttle fast, weakly attempts a smile. She doesn't say much.
I put out my hand to greet her and realize that her little hand is burning up. I take her temperature which is almost 103. she never even mentioned she was sick - just here for a pap smear.
"Are you sick?"
"Yes, for the last month"
"Have you seen a doctor?"
With that, she smiles and hands me 7 little pieces of paper and says "yes, I just came from there. I'm supposed to get blood work done and buy these medicines but with a laugh, she says "pero no hay pisto"(but I have no money).
I look at the little notes - doctor-type chicken scrawl; all wrtieen on scraps of torn paper. One says "hematologia". What the heck does that mean?? Just do some random blood work????? Another says "urologia"! What's that? Check everything in the urine?
And then the meds are the best of all! The newest and most expensive brand of very broad specturm antibiotics - I imagine the drug rep just brought some gifts to the doctors at the clinic to convince them to write for these - yes, even in this desperate little country, the drug reps convince the docs to write for meds that could be replaced equally effectively with drugs that cost pennies. Did you know that the World Health Organization actually has a very reliable list of apporpriate meds for people in poor countries that work just as well as the latest and greatest! And actually, why don't we use them in our own country??? OOPS...better get off my current band wagon and get back to the story.
Another prescription is to cover the latest flu epidemic even though it's not flu season and her symptoms suggest nothing of the kind. So for the equivalent of about 3 months ssalary, this woman could go and get some blood workdone that would never be looked at by a doctor and some meds that cover EVERYTHING and will probably do nothing more than kill all God-fearing bacteria in her gut talking every last dime she has to her name.
I have the great fortune of having an exceptionaly intelligent, interested and compassinate med student with me on this trip named Brandon. I did my best to control myself from blaspheming the entire health care system here and we talked about jhow we should approach this. While I often feel anger at the doctors, I have to remember that when we walked into the clinic that morning, there were actually about 500 patients waiting for 3 doctors. The doctors leave at noon so whomever isn't seen just leaves. Other than a few alcohol swabs, tongue depressors, syringes, BP cuffs and stethescoopes, they don't have much in the way of supplies. So, honestly, how excited can they get about their jobs?
But somehow when we're here, we seem to have this attitude that whatever the stuation, we HAVE to find an answer. God seems to always provide; always enlighten; always give us the tools we need. SO we did a pretty decent proverbial history and physical, checked her blood sugar, BP, urine analysis and it was pretty clear that this was a garden variety kidney infection that had gone too far.
So we loaded her up with the right antibiotics and some tylenol for the road. She
teared up and accused us of being "angels from heaven"! Not bad for 20 minutes work!
And you wonder why I love working here!!!