Adventures in International Medicine

I got back from South America over a month ago. A tad bedraggled and worn out after 48-ish hours straight in airports across the Americas, with a suitcase stuffed full of smelly laundry and two SD cards stuffed full of memories, I went to bed as soon as I got home late that night, and went back to work on L&D early the next morning.

And that’s pretty much where I’ve been since. (Not that I’m complaining! Now that I’ve finished my first rotation of PGY-2 on L&D, as I may have alluded to, I can’t wait to go back.)

But, after my first day on the out-patient Gyn (vacation) rotation (after a completely overblown, irrational, and ridiculous bout of nervousness that kept me up most of the night before – I have no idea), I have remembered, ‘Oh, Yeah, wait a minute, I actually do like Gynie too!!’ (Whew!!!!)

Not to mention, the hours on this rotation are going to give me a little more time to catch up on things like all that smelly laundry, sleep, studying, research, and blogging. First on my agenda, of course, has been writing a bit about the Great South American Medical Mission Adventure. (I can always wash and/or burn that smelly laundry later. Hah.)

I wish I would have written about it sooner. I did try to write a bit to friends and family when I was there, but now trying to blog about it retrospectively, it seems like it was a million years and miles ago, like a dream almost.

A couple of things did stick out in my memory as I went through and picked some pictures to post. How beautiful the country was, how much I enjoyed and appreciated the warmth and friendliness of the people, and how much (much like when I left L&D the other night) I wanted to immediately start planning my next trip as soon I’d set foot on U.S. soil again (and still do!).

I think that growing up constantly on the move, with little money and few possessions, and a complete imperviousness to motion sickness (which comes in very handy while careening around switchbacks up remote mountain passes at high speeds in rickety vehicles, much too busy frantically snapping away at scenery to notice sheer drop offs) has made me highly adaptable (MacGyver came to mind more than once, especially during a particular incident when attempting to ask for a socket wrench in broken Spanish – to fix equipment, not a patient FYI), well-suited, and very happy to work in foreign places with limited resources. (But I did have to draw the line at doing pap smears with splintery Popsicle sticks at one point – just, no – and insist on being driven to a nearby clinic get proper supplies. Which still consisted of 1960’s era spatulas, microscope slides, and a can of Aquanet for fixative. The combination of which actually worked quite well tyvm.)

I think if I could spend the rest of my life alternating between Medical Mission Adventures and L&D, I would be a very happy Nurse, MD.

But the trip wasn’t all perfect, happy adventurousness.

I am still, and probably always will be, haunted by the ones I couldn’t help. And by some of the well-intentioned but completely half-@ssed interventions of the group I went with that I couldn’t avoid being pulled into. (It still burns, and I’m just going to say – there is a right way, and a wrong way, to do international medicine – and giving people expensive medical equipment when they have no infrastructure or training to actually be able to use it, is the wrong way.)

As for the people I couldn’t help, there was the elderly lady in a remote mountain village with stage 4 cervical cancer, no means to access care, and nothing to be done for her even if she could. The other elderly lady (I have no idea how old they actually were, and neither do they as they were born before any sort of record keeping was in place, most just said they were 100) who limped into one of our mobile mountain clinics at the end of the day. I held up the bus to see her. Initially all I saw was the giant shiner around her left eye, and I thought, Nah, there’s no way. Then I saw the wounds on her hands and arms bound with dirty paper and some kind of poultice. I gently unwrapped, cleaned and re-bandaged them with some bottled water, antibiotic ointment, and gauze. As I did this she told me (through her granddaughter who translated from the native mountain dialect into Spanish) how her father had beaten her when she was growing up and how her husband does now. I was busy bandaging (and mentally picturing finding said husband then breaking him over my knee like twig) when she grabbed me around the neck, kissed me on both cheeks, and thanked me for being so kind. I can still see her in my mind’s eye, sitting on a mound of dirt, surrounded by sheep, looking forlorn and giving a little wave as the bus drove away.

Or, there was the middle-aged lady who presented with symptoms that she thought meant menopause, but turned out to be early pregnancy instead. She burst into tears when I told her, distraught at the thought of supporting another child when she was barely managing to support the five she already had. The med student I was working with, so earnestly, turned and asked me if we should counsel her about “options.” “What options? She doesn’t have any,” I replied, reminding them that abortion is illegal in that particular country. All I could do was give her some Kleenex, a script for some vitamins, a little hug of reassurance, and encouragement to seek prenatal care.

But I also remember that there were so many I could help. I probably did 200 or so pap smears for women that otherwise would not have had screening, who will be able to follow up and be treated if necessary, and will (hopefully) never get to a stage 4. And I did countless prenatal ultrasounds, educating local providers as I did them, finding a case of cleft palate – the patient was subsequently transferred to deliver in a place with a pediatrician on hand to help with any difficulties that might arise.

And I know that there is so much that can be done. Programs that can be implemented, as in not just dropping off, but also training providers to use equipment and do preventative and life-saving procedures.

While I absolutely love and appreciate the adventure and opportunity to see and explore a new place and culture, seeing the prospects and opportunities to help women medically in a real, meaningful and lasting way – along with the memory of those patients, the ones I couldn’t help, and the ones I hopefully did – is what makes me anxious to go back, and to go elsewhere.

All of that being said, I had better get back to the business of catching up with everything else besides blogging.

Out of respect for patients and their privacy (no matter where I am), I refuse to take pictures of patients or pictures of the clinics with patients in them, but I will let a sample of the pictures that I did get tell the rest of, or their own story…………

 

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