5 March 06
This week has been about doctors, medicine, and hospitals. My favorite subjects…
Kathe's carpal tunnel surgery was a success, it appears. A guardian angel took Kathe over there, and waited until she was done. It was a pretty simple operation, but she (Kathe, not the guardian angel…) was seriously groggy when I spoke to her afterwards. I laughed out loud when she told of her experience with the pain killers…
She decided to set them out before going to bed. Good idea. That way if she did wake up with pain, all she would have to do is swallow and sip.
Problem comes when she tries to take the child-proof cap off with the left (non-dominant, and not-operated-upon) hand. First she tried with just the hand. No dice. Next, she placed the bottle between her knees, and twisted the cap. Still no pills. Third try – she sits on ground, places the bottle between her feet, and used the non-dominant hand to remove cap. ( Voice over: As you can see, primates use simple tool and combinations of prehensile digits to manipulate small objects. And their natural curiosity compels them to attempt complex maneuvers… ) . Who the heck gives a post-surgical hand operation patient a child-proof bottle of pain pills?!?
Health care is much more variable here in Guatemala. And the doctors are much more likely to act like US doctors of a generation ago, in the sense that they tend to command, and not explain, with the assumption that the patient knows nothing and will just accept the order. He is, after all, The Doctor.
Matt ran headlong into this when he came down with malarial last year. The doc took one look, said "dengue", charged him ten bucks, and sent him back to the camp with a side trip to the pharmacy to buy pills that treat dengue (or bone-break fever, as it is known colloquially).
Unfortunately, the drugs he bought do not treat malaria, which is what he had. But the doctor, in total arrogance, just saw the gringo, made a snap judgment (one that could have been improved upon by a simple blood test) and moved on to the next patient.
And Matt came a whole lot closer to death than he needed to.
Combine the arrogance of most doctors with a less rigorous training program, and the resulting situation is enough to keep the thinking man out of the waiting room.
But that is where Matt and I ended up this past week. Luis has been the guard at the camp for the past few years, and he has been a very good friend of the project. He was worried because his youngest son (also named Luis, he is the one in the foreground of the picture in blue shorts) had almost died from intestinal worms.
That would get me worried, too. They had even given him up for dead when he went rigid and started shaking. But the little guy was a lot tougher than they thought, pulled through, and they went to a doctor in the neighboring village, who then peremptorily sent them to get some drugs to treat the worms.
They helped. But not enough. The little guy was still suffering from serious diarrhea, was not keeping food down, and had stopped sleeping because of a serious cough that he had developed. Pretty miserable little four-year old. We told Luis to bring him into town, and we would take him to the doctor (thinking that the next day would be a great time for it). He said, sure, maybe next Tuesday.
He showed up (sure enough, the next Tuesday) at 10, with everybody scrubbed clean and dressed in their finery. Another gringo mistake, not insisting on an early start time. The doctor gives no appointments. Everything is first-come, first served, and we did not get there first. Or second. As a matter of fact, we got there last. So we waited, trying not to touch anything in a waiting room filled with really ill kids. Three hours later, they lock the doors for lunch. We are the last ones that will be seen. An hour later, Luis, Mary Magdalene, and little Luis were ushered into the doctor's office.
Now the scene is a little strange anyway. Matt and I are basically acting like a combination bodyguard, patron, and guard (to make sure that Luis doesn't make a break for it, I guess). And we are decidedly out of place in a waiting room full of women with their children. We almost look like we are the enforcers, just there to make sure that the doctor´s diagnosis is good. Whatever. We make do, and read and sleep and watch the Latin version of The People's Court. And we decline the invitation to go in with the family to witness the interactions with the doctor.
Five minutes later, the examination of little Luis is complete, and the nurse insists that we join. We shrug, and walk in.
He explains what is going on. Actually explains, both to us and to Luis and Mary Magdalene. Constriction of inflamed bronchial tubes is his diagnosis (for the cough), a condition he refers to as "weezeen". But he also wants to send Luis to the lab for blood and stool samples. We later put together that the kid has bronchitis (I could have told you that) and that the weezeen was the symptom, and not the condition. Hmm.
We go to the lab. They take the samples. The kid cries. We wait. Finally, we take the results back to the doc, who has said that since we are coming back, he will let us zip in and out quickly, and we won't have to wait forever in the waiting room.
Which is precisely what did not happen. We sat in the waiting room with even more people this time, and waited until the room was empty again (two more hours) before getting in.
He was right to send us back to the lab. The intestinal worms had not been eradicated, and the kid was going through the whole thing all over again. For the bronchitis, he said it was pretty severe, and suggested that we get a respirator, and administer medicine through the respirator four times a day (that way the medicine gets where it is needed, rather than going through the stomach, and into the blood that way) . The instructions were pretty complex, and it was going to cost money (unless, the doc explained, we knew someone we could borrow one from. Yeah, right. Can I borrow a cup of sugar, and a respirator, please?). Luis was not comfortable with the instructions. The alternative was a syrup, and he felt much more comfortable with that. We took our leave, got the three drugs for the kid (a de-worming script, a bronchial syrup, and a steroid) . As we were headed for the door, the doc asked if there was a dog in the house.
Sure, said Luis. Does he interact with the kids? He looked over at the kid and laughed. Capitan is bigger than the kid – there is no keeping the two apart.
That is probably where he is getting his worms. You have to keep the dog away. Then he started to go rapid fire through a list of things that could be harmful to the kid and his bronchial infection, that could lead to asthma later on (the doctors in the audience feel free to skip ahead) . Smoke in the house? Yep. Wood fire in the kitchen? Yep. Dust in the house? Yep (dirt floor). Animals in addition to the dog? Including the monkey?
Basically told the family that their life was an surefire way to kill the kid. So please stop living the way you do. Get an education, get a job, get a condo. Stop interacting with animals, and install a gas line to replace your kitchen stove. Don't hug your kid until after you have bathed, lest he get some smoke off your clothes. Clean that dirty floor. Be civilized, for crying out loud.
He didn't really say any of that, but that was what he was asking them to do. They are in no more of a position to change their lifestyle than to become astronauts. A nicer family you will never find, but they simply do not have the means to change their way of life.
And they do not even have the means to take the kid to the doctor's office. The visit, the labwork and the drugs cost about $60. Matt and I split the cost out of pocket – no big deal. Except to them. I am pretty sure that Luis makes only a little more than that per month as guard for the property. There is simply no way to save anything when you have to buy food and provide for your family, and wage labor is unavailable. Even wage labor, though, only pays around $40 a week – and that assumes you can get it. So somehow he has to come up with two weeks worth of work extra that he can use to take his kid to the doctor.
So sad that something so preventable as worms kills so many kids every year. And sadder still that medical care is still prohibitively expensive to the people who need it most.
Analysis continues, and we are not any closer to getting to the field for the last two days of field work. In fact, that was a cruel joke this week. Instead of sending the police to Don Diablo, we went to the police to ask them to do more paperwork. And in a couple of weeks, they will send out a cop to talk to him, and we will be able to go out and work.
Except that it will never happen. Everyone talked a great game, with mention made of precedents and land repossessing and cancellations of contracts. But it will be business as usual.
I even have an ace in the hole now. Mario wants to follow up, and is willing to go and dig – all I have to do is show him on the map where I want him, and he will go and bring back more stuff. Assuming that I can get money to do it and permission. He is looking at this as a long-term thing. And it looks pretty cool. As long as we can really get some bureaucracy moving in our favor. Yeah right. That is the sound of me holding my cynical breath.
I head home on Wednesday. I can`t wait. The recent food porn has been pretty hard-core. Biscuits and gravy. Crawfish. Shrimp. Steak at Degas. Etouffee. Buttery biscuits with ribbon cane syrup. Chunky peanut butter. Coffee with chickory. Beignets. Barbecue.
I have a feeling I will be charged for the extra weight when I return, a mere two weeks later.
This week has been about doctors, medicine, and hospitals. My favorite subjects…
Kathe's carpal tunnel surgery was a success, it appears. A guardian angel took Kathe over there, and waited until she was done. It was a pretty simple operation, but she (Kathe, not the guardian angel…) was seriously groggy when I spoke to her afterwards. I laughed out loud when she told of her experience with the pain killers…
She decided to set them out before going to bed. Good idea. That way if she did wake up with pain, all she would have to do is swallow and sip.
Problem comes when she tries to take the child-proof cap off with the left (non-dominant, and not-operated-upon) hand. First she tried with just the hand. No dice. Next, she placed the bottle between her knees, and twisted the cap. Still no pills. Third try – she sits on ground, places the bottle between her feet, and used the non-dominant hand to remove cap. ( Voice over: As you can see, primates use simple tool and combinations of prehensile digits to manipulate small objects. And their natural curiosity compels them to attempt complex maneuvers… ) . Who the heck gives a post-surgical hand operation patient a child-proof bottle of pain pills?!?
Health care is much more variable here in Guatemala. And the doctors are much more likely to act like US doctors of a generation ago, in the sense that they tend to command, and not explain, with the assumption that the patient knows nothing and will just accept the order. He is, after all, The Doctor.
Matt ran headlong into this when he came down with malarial last year. The doc took one look, said "dengue", charged him ten bucks, and sent him back to the camp with a side trip to the pharmacy to buy pills that treat dengue (or bone-break fever, as it is known colloquially).
Unfortunately, the drugs he bought do not treat malaria, which is what he had. But the doctor, in total arrogance, just saw the gringo, made a snap judgment (one that could have been improved upon by a simple blood test) and moved on to the next patient.
And Matt came a whole lot closer to death than he needed to.
Combine the arrogance of most doctors with a less rigorous training program, and the resulting situation is enough to keep the thinking man out of the waiting room.
But that is where Matt and I ended up this past week. Luis has been the guard at the camp for the past few years, and he has been a very good friend of the project. He was worried because his youngest son (also named Luis, he is the one in the foreground of the picture in blue shorts) had almost died from intestinal worms.
That would get me worried, too. They had even given him up for dead when he went rigid and started shaking. But the little guy was a lot tougher than they thought, pulled through, and they went to a doctor in the neighboring village, who then peremptorily sent them to get some drugs to treat the worms.
They helped. But not enough. The little guy was still suffering from serious diarrhea, was not keeping food down, and had stopped sleeping because of a serious cough that he had developed. Pretty miserable little four-year old. We told Luis to bring him into town, and we would take him to the doctor (thinking that the next day would be a great time for it). He said, sure, maybe next Tuesday.
He showed up (sure enough, the next Tuesday) at 10, with everybody scrubbed clean and dressed in their finery. Another gringo mistake, not insisting on an early start time. The doctor gives no appointments. Everything is first-come, first served, and we did not get there first. Or second. As a matter of fact, we got there last. So we waited, trying not to touch anything in a waiting room filled with really ill kids. Three hours later, they lock the doors for lunch. We are the last ones that will be seen. An hour later, Luis, Mary Magdalene, and little Luis were ushered into the doctor's office.
Now the scene is a little strange anyway. Matt and I are basically acting like a combination bodyguard, patron, and guard (to make sure that Luis doesn't make a break for it, I guess). And we are decidedly out of place in a waiting room full of women with their children. We almost look like we are the enforcers, just there to make sure that the doctor´s diagnosis is good. Whatever. We make do, and read and sleep and watch the Latin version of The People's Court. And we decline the invitation to go in with the family to witness the interactions with the doctor.
Five minutes later, the examination of little Luis is complete, and the nurse insists that we join. We shrug, and walk in.
He explains what is going on. Actually explains, both to us and to Luis and Mary Magdalene. Constriction of inflamed bronchial tubes is his diagnosis (for the cough), a condition he refers to as "weezeen". But he also wants to send Luis to the lab for blood and stool samples. We later put together that the kid has bronchitis (I could have told you that) and that the weezeen was the symptom, and not the condition. Hmm.
We go to the lab. They take the samples. The kid cries. We wait. Finally, we take the results back to the doc, who has said that since we are coming back, he will let us zip in and out quickly, and we won't have to wait forever in the waiting room.
Which is precisely what did not happen. We sat in the waiting room with even more people this time, and waited until the room was empty again (two more hours) before getting in.
He was right to send us back to the lab. The intestinal worms had not been eradicated, and the kid was going through the whole thing all over again. For the bronchitis, he said it was pretty severe, and suggested that we get a respirator, and administer medicine through the respirator four times a day (that way the medicine gets where it is needed, rather than going through the stomach, and into the blood that way) . The instructions were pretty complex, and it was going to cost money (unless, the doc explained, we knew someone we could borrow one from. Yeah, right. Can I borrow a cup of sugar, and a respirator, please?). Luis was not comfortable with the instructions. The alternative was a syrup, and he felt much more comfortable with that. We took our leave, got the three drugs for the kid (a de-worming script, a bronchial syrup, and a steroid) . As we were headed for the door, the doc asked if there was a dog in the house.
Sure, said Luis. Does he interact with the kids? He looked over at the kid and laughed. Capitan is bigger than the kid – there is no keeping the two apart.
That is probably where he is getting his worms. You have to keep the dog away. Then he started to go rapid fire through a list of things that could be harmful to the kid and his bronchial infection, that could lead to asthma later on (the doctors in the audience feel free to skip ahead) . Smoke in the house? Yep. Wood fire in the kitchen? Yep. Dust in the house? Yep (dirt floor). Animals in addition to the dog? Including the monkey?
Basically told the family that their life was an surefire way to kill the kid. So please stop living the way you do. Get an education, get a job, get a condo. Stop interacting with animals, and install a gas line to replace your kitchen stove. Don't hug your kid until after you have bathed, lest he get some smoke off your clothes. Clean that dirty floor. Be civilized, for crying out loud.
He didn't really say any of that, but that was what he was asking them to do. They are in no more of a position to change their lifestyle than to become astronauts. A nicer family you will never find, but they simply do not have the means to change their way of life.
And they do not even have the means to take the kid to the doctor's office. The visit, the labwork and the drugs cost about $60. Matt and I split the cost out of pocket – no big deal. Except to them. I am pretty sure that Luis makes only a little more than that per month as guard for the property. There is simply no way to save anything when you have to buy food and provide for your family, and wage labor is unavailable. Even wage labor, though, only pays around $40 a week – and that assumes you can get it. So somehow he has to come up with two weeks worth of work extra that he can use to take his kid to the doctor.
So sad that something so preventable as worms kills so many kids every year. And sadder still that medical care is still prohibitively expensive to the people who need it most.
Analysis continues, and we are not any closer to getting to the field for the last two days of field work. In fact, that was a cruel joke this week. Instead of sending the police to Don Diablo, we went to the police to ask them to do more paperwork. And in a couple of weeks, they will send out a cop to talk to him, and we will be able to go out and work.
Except that it will never happen. Everyone talked a great game, with mention made of precedents and land repossessing and cancellations of contracts. But it will be business as usual.
I even have an ace in the hole now. Mario wants to follow up, and is willing to go and dig – all I have to do is show him on the map where I want him, and he will go and bring back more stuff. Assuming that I can get money to do it and permission. He is looking at this as a long-term thing. And it looks pretty cool. As long as we can really get some bureaucracy moving in our favor. Yeah right. That is the sound of me holding my cynical breath.
I head home on Wednesday. I can`t wait. The recent food porn has been pretty hard-core. Biscuits and gravy. Crawfish. Shrimp. Steak at Degas. Etouffee. Buttery biscuits with ribbon cane syrup. Chunky peanut butter. Coffee with chickory. Beignets. Barbecue.
I have a feeling I will be charged for the extra weight when I return, a mere two weeks later.
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