Today I had a 15 year old patient that was madly in love with her secret 21 year old boyfriend.
Here’s a little background about this patient...She finished school last year because her parents could not afford further education. Unlike most girls her age that we see in clinic, her family made it clear that they did not want her to date, or marry-off like many other girls her age do after leaving school - they wanted a better future for her. Her family was struggling financially and therefore up-rooted to another village where jobs were more promising. So, she now was working 1 day a week at the only available job she could find. She spent the rest of her free time at home, pining over her secret love-interest she was unable to see.
In the clinic, she initially was textbook depressed. That being said, after 15-20 minutes of chatting, she began to open up about her secret love and it was clear that her current emotional status was one of helplessness, anger and resentment toward her family for not letting them be together. Recognizing a chance for impact, I presented to Dr. Ruch who pulled in Myra so the 4 of us could all talk. After another 15-20 minutes, it unfolded that the patient really valued pursuing her education but felt powerless without the funds to make it happen. The 3 of us decided to use this moment to discuss the possible trajectories of her current dilemma: she could run off with this man without an education, little opportunity, and likely be pregnant very soon, or find a way to pursue her education and maybe get the man as well. With our help, she slowly began to realize that if he truly felt for her what he claimed, he would likely wait for her to finish her education, and maybe even help her pursue it. This is what those who respect you, those who love you, will sacrifice for you. --She nodded.
As we tied up the conversation, we felt a little lighter knowing we had seized the chance to impact the life of a young impressionable woman… until we were about to leave the room.
Myra quickly asked the patient in a secretive manner if she understood all of our previous conversation. The patient nodded shyly. Myra then asked her if she understood what the word “respeto,” or respect, meant. The patient looked down and embarrassingly said no.
Witnessing that some of these young girls and women that we treat do not have a conception of the word “respect” is absolutely jarring. Life as a female is a different beast for many of the patients we see at Sew Hope. When reflecting on the immense injustices women face here, it cuts deep to realize that many of these women will never realize that they deserve better – unless the idea somehow enters their world from an outside source. One visit with a patient like this can make a huge difference if the effort is made.
By the look on her face at the end of her clinic visit, I’m confident this patient left with her mind reeling with possibilities, questions, hope, and a budding sense of self-respect.
Hotel Paps – a story of comedy, tragedy and a really good outcome
I’ve been back from Guate now for 6 weeks but I was telling my friend a story of something incredible that happened while I was there and she said “you HAVE to tell everyone that story”. So here we are
“It was a typical day at” ……the clinic. Bumbling around in a sweat, I was trying to be a teacher to my 2 trusty med students while still keeping the patient flow moving. As I moved between rooms, our social worker, Orfe, came to tell me that the reporters from the television station were here to interview me. Seriously?? You’re kidding. She laughed and said I’d have no problem. In my Spanish?? You really think I’m even going to understand the questions?? And I have no make-up on. Bad enough to have a 58 year old face but one unmasked is even worse. And my hair! Really…my hair. Bangs were too long to wear as bangs but too short to pull back – a natural hair disaster which any women who has been there knows is a reason to hide much less appear on television.
So I said no. Then Orfe just laughed and said “Of course you’re going to do it. You have to. The people have to hear about what we are doing. Don’t you CARE about this??? OK….guilt always works with me.
So the TV crew set up their stuff and they put the camera seriously RIGHT IN my face!! Somehow I just pretended I was in the twilight zone and went on autopilot. They started asking about cervical cancer and I just went with it. I started thinking about all the tragedies I had seen..all the injustices…all the girls who had been raped at a young age or women who had been abused and as if that wasn’t enough now they were paying the price of having a disease inflicted upon them.
The TV guy seemed incredulous that I was pulling together the Spanish words and that I was getting a bit passionate about the whole thing. He asked “What can we do to prevent this?” So I thought quickly and said “Men need to stop cheating on their wives. Men need to stop having sex with very young girls. Women need to stand up for their rights. They need to demand access to basic health care.”
Anyway, they showed it on TV and they put it on facebook and I got more “likes” and ‘”shares” than I ever thought was possible for me –
So….next segment of the story.
The next morning Laura and I went for our 5 am run and when we came back, the hotel guy actually started talking to me. Before this, he was pretty much ignoring us. He smiled a lot and starting asking me about my run and how it went …I couldn’t understand why he was suddenly engaged. Then he says “I saw you on TV…it’s great what you all are doing” Wow! This was the closest I will ever come to celebrity status!!
So off we go to the clinic and then when we come back in the evening, this little young woman who works in the hotel comes up to me and says
Es possible que nosostros podemos hacer un pap? (Would it be possible for us to get a pap?”
So I think “of course” BUT how are we going to do it?? The clinic is about 20 minutes away by car and these poor little ladies have to work ALL day long.
So I say “do you want me to do the paps here?”
“Oh, that would outstanding”!!
Ok….so the next evening I will do the paps at the hotel.
We had a long day that day. We got back to the hotel and 8:30 PM and I was kind of pooped. I was hoping they forgot about it. We walked into the hotel and out of the corner of my eye I could see a tiny group of women way in the back almost hiding but clearly looking at me. But I was pooped and also kind of grimy. But I no sooner went up to my room than there was a knock at the door saying that the women were ready for their paps!
OK. Great. So me and my speculums, slides, spatulas, cytobrushes, and gloves went down to the lobby. And there were 8 women all really dressed up for the paps! You would have thought they were going to a prom. Many had 3 inch heals. All had really nice dresses and all looked beautiful.
I don’t know why but I was in a complete sweat. I really don’t know why. I do paps all the time. I guess it was just being in a hotel room and all of them treating me so nicely and all of them feeling that they had to dress up for this “special occasion”. It made me feel so small for some crazy reason.
So each one came in…they were so incredibly grateful and kind to me.
And I did each one but there was one that seemed like something was wrong. As I took the sample, the tissue on her cervix sloughed off. I have never seen that before in my 25 years of doing paps here. Hmmmmm. ……kind of weird.
So I told her to come to our clinic the next day which she did. And yes, I did a biopsy. And YES, the biopsy showed an early stage cancer.
Wow! Really! All because Orfe arranged to have a camera crew come to our clinic to interview a doctor who didn’t want to be interviewed and some woman had the courage to ask if she could invite her friends for paps and I said yes and on and on. Because of all those things, here was a 47 year old woman with absolutely no symptoms who just happened to have cancer. Wow! Do you call that coincidence? Do you call that a miracle? Do you call it God’s hand working through the love of others?
Well the story does not end here. When Orfe told her the diagnosis and that we could set her up for a curative hysterectomy, she went to her church and the pastor told her that only God could cure her. So she spent 40 days fasting and praying and staying within their church!! All during the time that I was working so hard to set her up for surgery.
But at the end of the 40 days, she did consent for treatment and ultimately yes, she had a hysterectomy. I think she is cured although only God knows for sure.
She is only person, only one life.
But how do you explain it?
If she gets to live another 10, 20, 30, 40 more years, the world will be changed in ways big and small. To her family, it will be enormous. Maybe in the world it will be enormous. Who knows?
I just know that it took a LOT of good people just doing the right things to make this story.
I’ve always believed the foundation of the patient-doctor relationship is grounded in trust. Here in the Petén region of Guatemala, while poverty and a culture of violence, mistrust, and corruption dominate, somehow the roots of the trusted patient-doctor relationship remain – for better or for worse.
Guatemaltecas have a unique devotion to health promotion despite limited access to resources and minimal education. On the whole, without their health they cannot work, and without work, life falls apart – so they do their best to take care of themselves in any way they know how. So, for many patients with limited resources and education, their only option in health promotion is to trust their doctors. We’ve seen patients paying exorbitant amounts of money for unneeded tests, treatments, and preventative vitamin injections, simply because "the doctor said so," even when putting food on the table is a constant struggle - and we're talking 1000’s of quetzales for treatment when a meal for a family may only cost 15-30 quetzales. Some of these patients live in homes with dirt-floors, however if the doctor says their health is compromised and can be fixed with X, Y, and Z, patients will somehow get the money, and make it happen. Many patients see no other options because without their health, they have nothing.
For some reason, local physicians are suggesting these exorbitant tests and treatments. I can’t count how many women I met in clinic who had their uterus removed for asymptomatic fibroids after unnecessary ultrasounds from outside hospitals. These women are being proactive personal health promoters, however they continuously fall victim to a system that shows no shame in taking their money and “matriz,” or womb, for no reason.
As a student witnessing this, it has created an overwhelming sense of responsibility as I proceed through my career as a hopeful future ob/gyn. These patients have given me clear, obvious examples of the repercussions of non-evidence based medicine directly impacting a patient and their family’s well-being. This experience has also allowed me to engage in valuable patient education on topics I never thought I would need to discuss. It’s humbling, and has ignited a fire to do absolutely right by these women.
(written my Cydney Siggins, 4th year medical student)
Imagine the best way to give a flavor of life here is to share a few patient experiences with you. Yesterday, I went into our "intake" room and noticed a woman talking to our nurse and Orfe in hushed tones. With tear-filled eyes, they completed getting her BP and blood sugar and weight. And then they did a pregnancy test which was positive. She broke down crying and then "passed" into my exam room.
She recounted the story. The day before was the one month anniversary of her 14month old baby s death. She described in great detail what happened - a day just like any other - she was caring for her 5 children as well as her 2 nieces. Her sister had "fled" to Guatemala City years ago and so the 2 nieces were left to her care. She was selling her tortillas and the 14 month old was running around feeding chickens. Suddenly the baby couldn t breathe and they frantically went to the hospital - a 30 minute drive. Sobbing, she described what happened then. Panic, doctors and nurses racing around, tubes being put in arteries and blood spewing in the air, tubes being put down the babys throat. And then the news that the baby was dead.
And now she is pregnant again. You might think she would look at it as a gift in this situation. But consider...she is caring for 6 children every day, little money, constant stress, never being given even a moment to grieve. Instead of everyone gathering around her to love and care for HER in this terrible time, now she faces one more trial - another pregnancy, another "mouth to feed". So all we could offer was love. Cydney treated her as if she was her sister - listened without judging - encouraged her to just talk about it all....talk about everything that happened....talk about her fears for the future. Orfe came and cried with her and prayed with her. We all acknowledged that in these times of great pain, it is only a loving God who can give us the strength that is sometimes hard to find. And that God acts through us. I felt so happy to have such a team of people here who genuinely care...who are willing to give their time and their hearts to right the wrongs, to be there for others in times of greatest need. I was glad we were there. At least we could give her an ultrasound so she could see the new baby and at least know when it would be born. We could give her some vitamins, some advice. The new psychologist will be starting with us next Monday and she eagerly made an appointment with her. In as society where women are looked up as expendible, I am so happy that we can be part of a change.
Finally a break in the action here so I have some time to write. So many of you have made this all possible – I wish I had the writing talent to draw the scene with words – to let you know the impact your prayers and your generosity are making.
My dad was a writer and he used to say just put the pen in your hands and it will lead you – not sure if that applies to a keyboard!
The days here are so packed with emotion, with love, with God’s grace. Sometimes we feel we are making the proverbial difference – sometimes we all look at each other with frustration knowing that only the power of a mighty God can fix the pain and suffering that some have to endure.
This trip is especially wonderful because I have my daughter, Laura with me. Laura is finishing med school in May and will be starting residency in Ob/Gyn in July. Never did I imagine that I’d have an opportunity to share my life’s profession with one of my children. It really is incredibly special. And to add to it, we also have a remarkable medical student, Cydni Siggins with us. Cydni has completed three years at Dartmouth and is taking a year to learn about many things you never get in med school – I hesitate to speak for her but I can see that this year for her is opening her eyes to the great needs of the developing world and she is seeing firsthand what global healthcare is all about. On top of that, she is perfecting her Spanish and learning so much about Complementary and Natural Health Care. So having these two with me brings extra joy to the day and also challenges me in new ways to look at things here afresh.
The week has brought its share of satisfaction, frustration, laughter. Through it all, I always feel God’s grace pulling us along.
First and foremost, the new clinic is unbelievable! May I thank each and every one of you who made it happen. No longer do we have to sweat it out in a hot and dreary building that was rented so we couldn’t improve it. Bright rooms have a cool breeze going through them throughout the day which makes for happier staff AND happier patients. The patients often comment “muy professional” which I think makes them feel that they are receiving the kind of care that the privileged receive.
We see the gamut of mundane to tragic; pregnant girls excitedly seeing their babies for the first time on ultrasound welcoming a new life with anticipation and joy; another sadly experiencing a miscarriage….too many girls with frightening stories of sexual and violent abuse…..
Somehow God seems to always provide what we need. On Friday, we were all feeling a little overwhelmed and helpless in knowing how to deal with so many stories of girls telling frightening stories of sexual abuse and domestic violence. Out of nowhere a psychologist with many years of experience in dealing with these girls came and said she would like to volunteer with us one day each week. She was able to connect us with an organization that provides help for these girls.
But those stories continue to haunt me. How does a girl escape abuse and exploitation if she has nowhere to turn? No money for the basics? Even her family doesn’t want to believe it because if they do, they will have to admit that she would have to leave her only source of support. I cry inside when I picture it. I have to believe that the children in our after-school program will have a different story. Here, they not only receive a real education but they also feel the love from our staff and from each other. They really are like a little family.
The cervical cancer prevention program is continuing to expand. Mayra Martinez completed her education in cytotechnology and now she is working for us full time! She is able to read the paps as we do them so that we can treat people immediately. We will of course be bringing all the paps back for review by our own cytotechs in Ohio but with time, I believe we will have a complete high-quality pap program with a cytology school here.
Laura and Cydney are doing an outstanding job in this challenging environment.
We put in long hours and Laura commented the other day “Hmmm…..this is kind of like a regular OB rotation!” They are amazing me with their Spanish skills and their ability to figure out what is needed from patients who live lives so different to what we are accustomed to hearing about. Sometimes it’s a simple treatment for headaches or gastritis and other times a biopsy for unusual bleeding or a treatment of a precancerous cervical lesion.
We’ve also had some time for laughter. Cydney wants to bring home a machete so she can cut her own coconuts so Ismael gave her a full lesson in the best cutting techniques! Popping open coconuts and drinking fresh coconut water is a pretty special treat. Today we ran a 5 K race with some of the children in our program. Two of our boys took 1st and 2nd place for kids under 13 and Laura and Cydney took 1st and 2nd place for all females! Because we were there, they called it an “International Race”! Randy says we have Gringa power!
Through it all we continue to thank God for our two very special program directors here – Ismael Martinez and Orfelinda Guerra. Day in and day out, they are the ones facing the challenges, working long hours, making it all happen.