Brian Fong, MD, is an emergency room physician at St. Mary Medical Center, Long Beach. This is his third trip to Guatemala with the CHW Foundation for International Health. He also serves on missions to Mexico with the Flying Samaritans.
After working in the dark the first year, I'm pretty much prepared for anything. My first year I was concerned mainly with keeping up with the pace of the clinics. Now I find the rhythm fairly quickly and don't worry so much about what's happening outside my clinic room. I take one patient at a time and do the best I can for each person. There are times when it's clear the person who has come to see us isn't very sick. Sometimes they're just looking for someone to listen to them. They just want the reassurance that someone is there and cares. I'm very cognizant this year that I'm not going to rush through the patients, because sometimes listening is therapeutic too. We've been talking in groups about this process and we're all pretty much in agreement that if you help just one person then you've made a difference.
I really like traveling out to the villages and seeing people there. We get to see some of our previous patients and follow-up on their care and their living situations. It's not always happy news, though. I was sad, though not surprised, to learn that the girl who's MRI we saw two years ago had died. She was suffering from a brain tumor that was putting pressure on her optic nerve so she'd gone blind. Somehow, she was able to get the diagnostic test she needed to determine what was wrong, but didn't have the resources to get treatment. In the U.S., this would have been diagnosed quickly and treated. Here, there was nothing we could do for her and she died.
This is part of what we learn when we come into another culture to deliver care -- that we have to think about things in their terms. Some things would just be unacceptable in the U.S., but here they are accepted without much thought, especially when it comes to medical futility. In the U.S., we only talk about the futility of a situation behind closed doors. Here, it's fairly out in the open. There are a number of patients we've seen on this trip who needed to be referred to a hospital for additional tests or treatment, but they all stated that they couldn't afford to get these services. They feel pretty hopeless. In the U.S. we have this certainty that help is out there and we'll be able to get it; that we deserve to get it. Here, they've come to terms with the fact that the help may not come. It's a balance to figure out how to work with the values they have and the values we have.
A big part of figuring out how to help them improve their infrastructure is to understand what is already available. This is where the education we do is so important. We're trying to help the local nurses and health promoters learn a little more about what to look for and empower them to improve things. The desire to learn is there, but the structure for teaching isn't formalized. I'm looking forward to working with the medical students over the rest of the week, but would also like to bring in the nursing students. We need to reinforce what they're learning in the class room it by bringing them into the clinics and giving them hands-on experience. They can't call 911 and have someone there in a few minutes - they may be called upon to deliver first aid and medical care for hours.
Not every patient we see at the clinic is going to need immediate care or referral, so if we can integrate the nurses into what is a typical interaction. We need to make them do this work so that they have the confidence to do it when we leave. The only way they're going to learn is to engage and do it.
One good thing about CHW is that we've committed to coming out here for five years to see what we can get done. Can we help bring some self-sufficiency to people? No one really knows the correct way to do this, but we're getting better everytime we come.
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