Doctors in Andahuaylillas

On Monday (May 11), a group of 35 doctors/medical students arrived. They will be providing free clinics and medicine in Andahuaylillas and the neighboring towns and communities until this Wednesday (May 20). This is a regular trip that they have made for four years now. Our main role with the doctors, as bilingual people, is to act as translators during patient consultations. We give them our free hours. They brought a few translators with them, and a few of the doctors are bilingual, but I found that generally they needed me whenever I was around. This is part of that idea of apostolic availability – we're available to do other work besides our assigned worksites.

Here are my diary entries regarding working with the doctors over the past week.

Day 1 – May 12

Words I learned: flema = phlegm, amigdala = tonsil (this caused some confusion because amygdala in English is an area of the brain. When the patient told me she had her amigdalas removed, the doctor told me that wasn't possible. We got it sorted out though.)

Word I wish I had known: stroke. I told the woman she'd had something like and “enfarto en el cerebro” (a heart attack in the brain). I explained strokes as best I could, but I wish I could have done more. She didn't show it much, but she was overwhelmed and scared. The doctor told her she needs CT scans and MRI readings. Somehow I doubt she'll be able to afford those in Cusco.

Resolution for tomorrow: Start with introductions. The doctor I worked with got right down to business. But in Andean culture greeting is fundamental. I want to start each patient-doctor interaction with interactions and explanations of who the doctor is, who I am, and what the visit will look like.

Memorable event: English-Spanish-Quechua (and then Quechua-Spanish-English) translation with an old man who suffered from chronic mountain sickness. In the US, I'm used to 2 people in the room: the patient and the doctor. Here we had 4 people in the room: the patient, the doctor, myself, and a woman who translated Quechua-Spanish.

Day 2 – May 13

There were less people today. I spent most of my time waiting around with the nurses doing traige. I did enter into a room with the head doctor to explain to a man that it was likely he had tuberculosis. The man was obviously afraid and upset. I don't know what to do in those moments. I would like to reach out and give comfort, but Andean culture isn't very touchy. Would it be a serious fax-paus to reach out, or am I playing it too safe, too worried about what's “correct?”

The doctor told the man he needed a chest x-ray. He also gave the man a surgical mask to wear so as not to spread it. Again I wonder if he'll get the x-ray, and if he'll be able to get the treatment he needs.

Day 3 – May 14

The doctors should do a better job communicating with the parish staff. They won't give exact numbers for lunch counts, and the señoras are left with more stress because of it. These woman are already working major overtime to serve their finest cooking to the doctors, they deserve clearer communication.

Today the clinic closed early. There weren't many patients showing up in the afternoon. I spent an hour of the morning with one of the doctors, seeing 3 patients. Again there was a possible TB case. Will the patient get the x-ray? Do they have affordable treatments for TB? Or will he have to spend a year in bed like my grandfather did? Can he afford to spend a year in bed? The spectre of disease here can be overwhelming, and proper treatment so far out of reach it might as well not exist.

Day 4 – May 15

I had the day off (I know, I get a surprising amount of days off. I was skipping meetings again). I went to Huaro (Warú on google maps) with a team of doctors for the day.

Words I learned: hemeroides = hemeroids. TBC = TB.

Patients I remember: Yet again a possible TB case. The head doctor says that TB is “endemic” in this area. Another man walked 3 hours from his community to get to the town of Huaro and see a doctor. He was looking for glasses. They hadn't brought glasses with them to Huaro, so he had to walk even farther to Andahuaylillas to get glasses from the main clinic there. It costs 2 sols to get from Huaro to Andahuaylillas and back. Two sols too much, it seems. Finally I remember teaching a woman the proper technique for lifting heavy object (with the legs, not the back). Will the 5-minute lesson stick? Or will years of habit override it. One of the nurses spoke about how they might be able to prevent a lot of the problems they are seeing with patient education. But after reading a whole book on habits, it seems to me unlikely that a short patient education session will change much of anything. After all, how many doctors in the US are explaining a healthier diet to an obese patient right now? How many of those patients will actually change their eating habits?

Day 5 – May 16

I spend the morning working with the nurses in triage. A lot of kids come in with basic colds. I remember a few interactions:

“Have you lost weight recently?” I ask a woman (the nurse is checking for signs of TB). “Oh, I wish!” the patient replies. The three of us laugh.

“I had a hernia two years ago,” the older woman tells me as the nurse takes her pulse. “They told me I needed an operation but I never got it because it was too expensive.”

I remember helping the three señoras from the kitchen jump ahead of the line so that they could get the doctors' lunch ready in time. Instead of complaining that it was unfair, the other patients encouraged them to sit at the front of the line. The last señora came in after they had closed the doors. They implied that she should just come back on Monday. I told her that if they didn't see her today, she could tell them that if they were hungry, they could come back Monday for lunch. We chuckled and didn't get up. She got seen.

 Finally I remember the frantic joy of rushing to roll spinach crepes in the bustling parish kitchen so that the doctors could eat on time. It's been a while since I've worked in a frantic kitchen. I was happy to be back inside one. After the doctors finished, we all sat down on the stools, leaned on the wall, and ate our lunches.