I should probably explain the point of this whole visit-a-third-world-country-by-myself excursion. I came to volunteer at El Centro de Salud, the government clinic in SJDS, through a Sister City program based in Boston with the Harvard School of Public Health. Today was my first day.
I worked with doctora Katya Rodríguez and felt like a first year again; worse, a first year who doesn’t even speak the language. I could understand less than 1/3 of the dialogue between her and the patients. Also, no Spanish speaker can say my name. I think it’s the “th” diphthong that trips them up, so she keeps calling me “doctora,” a title to which I have not yet, nor will I soon, become accustomed and NEVER know to respond to. We saw only women and children, who I think make up most of the population at the clinic, at least for the scheduled visits. I think the urgent care and ER portion of el centro see more men. Perhaps it’s because of el machismo that they tend to put off routine screening more than the women, though this is not much different than back home. Care here is completely free, and as a result the necessities of a doctor’s office are lacking. The JCAHO people back in the States would have a fit over the lack of latex gloves and hand sanitizer on every door.
Kidney stones, bladder infections y otros problemas de riñón, comprise a large portion of the diagnoses; there is something about the sulfa content in the imperfectly purified water causing all this trouble. I saw a few pregnant patients at various stages of gestation, and let me tell you, taking a detailed sexual history en español for a ministry of health form es MUY difícil. One little girl walked in with a rash and, after just coming off of derm and ER, I thought, “I’ve got this.” Chicken pox. Missed that one. Haven’t seen that since I had it myself as a kid, and likely won’t see it too often if at all in residency. There are big public health campaigns to get people vaccinated against this and other common problems that in the US are routine, and there has been amazing progress in the last few years.
Dr. Rodríguez asks me where I am in my training, a question that I always think means to insinuate something about my lack of clinical acumen, and I tell her that I have finished medical school and await graduation in May. I say I am going to be una pediatra (which is easier than figuring out how to explain Med-Peds en español.) She seems pleased and says she will see me tomorrow.
No lives saved yet, but stay tuned.
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