Haven't posted in a while and it's because I've been busy! I started working in the Pop Wuj clinic last week. It is nice to get back into practicing medicine, however, everything here is so different...
The clinic itself is located below the Spanish school. It has 3 exam rooms and a pharmacy and a triage area. The floors are concrete, the exam tables are ancient and we use plastic chairs for the waiting area.
Patients are scheduled - about 25 per half day session - and they start by getting checked in. Once checked in, vitals are taken and a chief complaint is elicited. They then return to the waiting area and the physician/student/resident calls them into the room for a more in depth history and physical exam. The only 2 test that are available is a point of care serum glucose level and hemoglobin level. No other labs are available in the clinic.
The reason for the visits range from follow up to seizure disorders to brain tumors. The patients are so impoverished and have little to no healthcare literacy...
Say what you will about the healthcare system in America, but at least we HAVE a healthcare system... in Guatemala there is no national health insurance (no Medicare, no Medicaid) and the expectation is that patients will travel to public hospitals for healthcare. Which could work, assuming each town or city has a hospital and people had great access to said hospitals. That, however, is not the case. Xela - a town of about 60,000 people - has only 1 public hospital... which means that even if the patients can get to the hospital from their small pueblos, they may be looking at waits, shotty resources, etc.
So... back to the patients:
1) diabetes - it is really common here. Insulin is out of the question given its cost so there are only oral agents to manage the disease... Our pharmacy is stocked with meds that have been donated so the supply is often less than ideal and changes week to week. This makes management of diabetes difficult because one month we may have metformin 850mg tabs then 1000mg tabs or no tabs. Which means there is a fair amount of switching meds based on available resources from month to month.
2) I also had a really sad case come in last week: the patient was at work and the mother was there requesting a refill on her anti-epileptic medications. The patient was in her 20s and had been having seizures for the past 3-4 years. However, recently they had been happening more frequently so she was referred to a neurologist. Long story short - she has a 4 cm brain tumor that requires gamma knife to remove. It will need to be done at a private hospital which will cost 30,000 quetzales... this is more than a full years salary for the average Guatemalan who makes $1.58 an hour. So the patient was at work and not able to make the appointment because she is trying to save up money for her procedure. Judging by the increased frequency of her seizures the tumor is growing. My guess is that she will likely perish before she saves up enough money for the procedure... not a happy case. :-(
So if you ever want to complain about the ACA, or how long you have to wait for your doctor to see you or why your insurance won't cover Botox injections remember: at least you aren't going to die from a brain tumor because you are poor.
Sorry for the Debbie downer story... hopefully my next post will be a bit happier.
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