We had been warned that today and Wednesday we would see patients from some of the poorer communities. Each day of our clinic a different community came. They were “pre-screened” by the local health promotors and told to come on a certain day. So, we prepared ourselves for our last full day of clinic (Friday we were only planning on seeing 200 patients).
After taking a group photo at the retreat house in the gorgeous sun (which I will insert in this blog once we get the pics but for now you are stuck with a picture of me taken by Mary), we loaded up into the bus. This morning I especially noticed all the political candidate billboards and signs with paint bomb splotches or gun shot marks on their faces. We would often hear and see these trucks full of youth wearing certain political parties colors and waving the party’s flag. It was such a volatile political atmosphere. Elections are in March.
Clinic started off smoothly with Deb and I jumping into pap smears, breast exams, and consults on women health issues. I’m afraid I can’t tell you too much about the areas of the whole clinic but I do know everyone stayed busy. General medicine tried a new technique called group visits where one doctor and the med student met with a group of 10 or so patients at once. After getting each patient’s vitals and chief complaint, they would talk to those patients who had similar complaints and do group discussions with education. Thus, the patient received more information and time with the doctor. It worked well.
Deb and I were on a roll Thursday. We took a brief mid-morning break and kept seeing patients. There were several referrals from General Medicine and one from Peds. We were able to counsel a mom with a young teenage girl about her health concerns (women and those not queasy about women's health can read about this in a little more detail in the future women's only blog post).
During lunch, we watched the parish’s chickens walk around in the fenced yard behind us. (To the Left are several of the wonderful ladies who cooked lunch every day) The priest happened to be sitting next to me while we ate and said, pointing to the chicken I was eating, “He used to live there.” I thought he was joking but ...well, I wasn’t sure. Everybody got a kick out of my reaction once I translated what he had said. He was a very lively priest with a great sense of humor. I still wonder if he was joking. Those chickens didn’t look fat enough to be the one I was eating but..oh dear.
Later in the afternoon, one particular patient stood out for us among all the routine women´s exams. She was dressed traditionally with a head scarf and a long skirt with blouse. She was in her mid-40s and almost full term with her tenth child with some concern over pain. Most importantly, she wanted to have us deliver her baby in the clinic right there and now. (Word had gotten out the first day that there were WOMEN doctors covering the women's health consults) Ana informed us that the patient had no prenatal care, lived in the hills, and was supposed to have her baby in the hospital. Deb, following a brief exam, figured that she still had a couple weeks to go. We explained to the patient that she was not in labor yet but we should check her womb with an ultrasound. Salvador found an aging placenta which is not uncommon for a woman at her age. Still, that with the fact that she had had no prenatal care made them send her to the hospital immediately. The local Salvadorian doc said that at the hospital they would probably induce labor and get her some birth control/sterilized.
Note about Sterilization: It seemed fairly common for middle-aged women to be sterilized after their last birth by tubule litigation in El Salvador. Some did not even know how they were sterilized but they just knew it (!). Deb and I only had one patient who told us that her husband had been sterilized. We both could not help looking at each other surprised. When I asked her why she said that the hospital told him he had had too many kids so that was that!
Note about Birth Control: It seemed like less than 10 women were on a birth control pill and for all of them, it was for regulating heavy periods. Most pre-menopausal women that were not sterilized used the 3 or 1 month injection. About 20 women we saw had IUDs. And, only about 10 women admitted to just using family planning (calender).
The rest of Thursday went by fairly quick. We finished a little early with enough time to sit in the open area of the compound and compare stories with other volunteers who had also finished early. See the photo below taken by Mary of Leah, our awesome ear-wax removal queen and do-all-nurse in General Medicine, having a fun photo break with some new friends.
Deb decided to take some pictures of two local sisters, ages 7 and 9 who were hovering near by. They loved posing with big shy grins on their faces while Deb asked them basic questions through me like: “How old are you? What is your favorite color?” They eventually came to sit next to us and we slowly got them to chat a bit more about their life in El Salvador. They have nine brothers and sisters with only three of the youngest left at home. Their dad died suddenly a couple years ago after falling off scaffolding at work. (At this point we heard their younger brother burst out crying in Pediatrics so the oldest one went to check on her mom and scared little brother). The youngest sister continued telling me how they live in a tiny house with no running water or electricity and an outhouse up in the hills. When I asked her if they had a garden, she gave me a long list of fruit trees and some veggies like corn and beans that they take care of around their house. She also mentioned that she did NOT like music when Fidel inquired (Fidel is a volunteer interpreter from Springfield who is an avid music aficionado). Fidel could not believe it!
Before their brother was done in Peds, Deb showed the youngest girl how to take a picture with her camera. The girls had never taken a photo before. Getting to take pictures for the first time probably made their week! It was hilarious watching the youngest take her first picture of us and see the image on the small screen. I think Deb had at least 15 pictures of just Fidel, Deb, and I in various grins and faces. Eventually, Deb got her to take pictures of other people but she couldn't quite figure out how close or far to stand to take a picture. Next lesson will have to include: how to zoom. Oh, it was such a light hearted way to end the day!
After seeing those two sisters with their mom and younger brother walk out into the dark street, we loaded up on the bus and passed them walking slowly down the road on their long walk up into the hills on dirt tracks to their house with fruit trees.
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