28 January 2010

There is a patient who has been coming to the clinic for about a year with rheumatoid arthritis, a nasty painful disease requiring very toxic medications to control its progression. To properly treat this disease, the patient needs to see a rheumatologist, a specialist that can only be found in San Miguel, about a four hour journey from the clinic. The patient had last seen the rheumatologist in December. At that visit, the doctor told him to come back in a month with some lab studies and gave him medicine only for one month. The problem came when the patient tried to make the appointment with the nurse. She said the earliest he could get in with the doctor would be in July and there was nothing that could be done.

A month later when the patient was without medication and his pain was increasing he came into our clinic. Luckily we had some pills that could tide him over for the moment, but he still needed to get back in with the rheumatologist. I decided to call the rheumatologist just in case his schedule had opened up. He was super friendly and said he would make space for the patient the following Tuesday, we just had to get there by nine in the morning.

Where we live, it is impossible to arrive to San Miguel before ten in the morning. As I explained the situation to the patient, he promptly invited me to stay at his house in Cacaopera, which is closer to the hospital. It was a perfect plan.
I left the clinic the following Monday afternoon to catch the final bus to Cacaopera. We met in front of the town’s equivalent to a grocery store and walked to his house. His family was incredibly gracious and hospitable to me, and it meant a lot to me. We spent the evening eating fried fish and talking about life in El Salvador during the civil war.

A neighbor walked by while we were chatting out in front of his house. She heard there was a health care worker here and had a question. Her 7 year-old son had a painful ear that had been draining blood for about 2 months. She wondered if I could take a look at it. I happily agreed, but I couldn’t do much without my otoscope to look inside ears. I told her I would be back on Wednesday and would make sure to bring my equipment to properly assess his ear.

I recently read the book, Mountains Beyond Mountains, by Tracy Kidder. It is about Paul Farmer, a doctor that works in Haiti. He often walks miles to see a patient. In the book he remarked that when he goes to see one patient and happens to come across another, he feels like his visit was a “good cast”. For some reason I really like this fishing metaphor. It reminds of reading the New Testament in college, where Jesus called himself a fisher of men. While I have no religious inclinations, I always liked this idea. Anyway, when I saw this boy I felt like my visit had been a good cast because I had the opportunity to help two people when I had only anticipated one. I ended up coming back two days later and removed a ball of dirt about the size of a jelly bean from his ear, and I also gave him some antibiotics. I recently went back to the house. The kid was at school, but his mom told me that the ear was no longer bleeding and he was without pain. A success.

But getting back the original patient, we woke up the next morning at 4:30 to catch the 5 o’clock bus to San Miguel. The doctor was great and saw the patient with minimal delay. We were able to secure four months of medication for the patient and got him a follow-up appointment for four months as well. I got back to clinic Tuesday evening. I was exhausted but satisfied.

--Bela