Well, finished my first official week of practicing medicine in a third world country, and so far…   Kaboom!  …blowing my mind.

Where to begin?  With the limitations? or with the things that I really appreciate?  Now don’t get me wrong.  If you’re having a stroke or need a heart transplant ,or something, then for the love of God don’t come down here cuz you gonna die.  There are many technologies that are nonexistent here, and many medicines that are unavailable.

However, the number one complaint of patients in the states is accessibility.  Here, you can see the doctor every day of the week if you like.  But here’s the kicker:  you have to be PATIENT (funny how that’s the same word as the word for a person who goes to see the doctor, patient.  Why are we from the States so impatient?   hmm.  gonna have to think about that).  Appointments are not made for a certain time of the day.  They are made for THE DAY.  It’s an event.  You show up to the hospital on the day of your appointment and you will eventually be seen.  eventually.  I promise.  You can also show up ‘Sin Cita,’ without an appointment.  And again, we will get to you, one way or another.

You will arrive at the gate and the guards will grant you admission.  Then, you’ll check in and take a seat in the waiting room with about 50 or more people.  If there isn’t room there, you can take a seat down one of the halls.  It’s perfectly reasonable to bring your whole family and make a day of it.  If you get hungry you can go to the Comedor for a bite to eat such as a Balleada (which is a traditional meal here–guess what’s in it?  yep, rice and beans.  and some other stuff.  It’s yummy, I’m telling you).  There are times that I have some lab results and I can’t find the patient because they’re out for lunch.  funny 🙂

From a doctors standpoint, this model is wonderful.  I don’t have to cut people off and shuffle them out the door.  I can sit and actually think about the problem for more than 38 seconds.  I can go talk to some colleagues here about their opinion (at one point last week we had 5 doctors gathered around a little girl discussing best options for her care–very cool.)  Also, when I go home at night I don’t have to sit in front of a computer for 2 1/2 hours typing notes to appease Obamacare, insurance companies, and lawyers (oops, I was really trying to avoid being cynical, dag-blast-it, sorry about that.)  BTW, if you are a lawyer (and some of my favorite people are!) and you do medical malpractice, then I don’t recommend you come down here looking for a job, just sayin’.  Mind you, there would be plenty of work to find, as many of the patients come from La Ceiba, a larger city an hour and a half away.  They are looking for a second or third opinion, after receiving some ‘suboptimal’ care.

From a patient’s standpoint, there are some advantages as well.   Sure, you have to commit a day to this process, but you will likely have answers sooner.  We will do a consultation with you first,  labs and X-rays if needed next.  Here’s the nice thing, you will reconvene with the doctor and talk about results and your plans.  Then, I can send you to the pharmacy for meds, or down the hall to the emergency room if you are unstable, or across the courtyard to surgery if you need your appendix out.  One stop shopping.

I have a helper right now, while I quickly try to improve my Spanish skills.  His name is Darwin, He’s 16, and he grew up at the Children’s Center.  He speaks English very well, and he already has plans to move to the States for college.  He wants to go to Clemson, and He will live with one of the former Missionary families, The Pirkles, whom he considers family.  One of the things I like best about Darwin is that he is a Seahawks fan.  He and I watched the last game of our season together.  He doesn’t know it yet, but I brought my Russell Wilson jersey down here, and I’ve decided it would look much better on him.  Can’t wait to give it to him.

Anyway, Darwin sits in the room with me and corrects me when I say something stupid.   ‘Hey man, you just told that patient that her face was expensive.’  Oops.  Cara, not Caro.  Or, ‘Ryan, you just told him you are going to bend over for him to examine you.’ –awkward…  In the States, having a random 16 yr old young man in the exam room with me seeing patients, I’m just guessing, would not be Hipaa compliant (Health Insurance Portability and Accountability Act).

Here is another interesting aspect of the care provided by this Mission Hospital—The patients actually have to pay for their care.  Now at first I was surprised by this, but now I understand it and fully support it’s motives.  First, they don’t pay much.  An appointment for consultation with the doctor here is 70 Lempiras, which is a little over 3 bucks.  In fact, if they cannot afford even that then they meet with someone who helps adjust their pay scale.  Second, the fact that they have to pay for their care creates value to the care they receive.  They have a little skin in the game, which makes them come only when its actually necessary.  Next, it actually generates a little income which is helping the hospital approach self-sustenance.  The hospital is probably the biggest supplier of (legitimate) jobs in the area.  What allows the hospital to operate with such low overhead?  –All the doctors here work for free.  Finally, and maybe most importantly, having to pay for their care empowers the people with Dignity.

Here’s a scary thought:  We here at Loma de Luz, are the Ivory Tower of medicine here in this area.  Who is the ultimate authority and last stop on your journey to discover what has been ailing you?  Who is the master of Infectious diseases, Intensive care, Emergency medicine, Cardiology, Nephrology, Gastroenterology, Neurology, Gynecology, Dermatology, Hematology, and Machete-woundology?  Uh, well shucks, I guess that’s me.  That thought terrifies me, because there are so many aspects of medicine that I have forgotten long ago, or just flat never learned.   I’m not sure who is teaching who more here, the 3rd year resident Maria, or me.  But there is such a sense of collaboration here, that I don’t feel stranded on a desert island.  It’s like we’re at Hogwarts Castle:  “Help will always be given at Hogwarts Loma de Luz to those who ask for it.”  I am on call this weekend:  I foresee plenty of asking in the near future…

I will save the ‘Challenges’ of medicine here for another post, as there are ‘Muchas,’ many…

And now, for a drive in the country:

Ahhh, Jutiapa. How your charming streets have captured my soul…

Driving through Balfate, looking for a coke. oh, there on the left

Road trip to Jutiapa, small town half hour from where we live.