How to survive on 60USD per month (by KRF)

Hello loyal blog followers. I apologize for the lapse in entries, but Em and I have been muy busy over the last week or so. On Valentine's Day we headed into the community for patient visits, and we realized that although the visits are amazing attributes of the family medicine model in El Salvador, they can take a LOT of time. In the afternoon on Thursday we only made two visits, and it took all afternoon. Why, you ask. Well, try going to a little old lady's house in the afternoon while she is watching her telenovela (soap opera - sometimes strangely enough with Korean actors dubbed over in Español) and sitting down on her couch, asking her about how she feels, and listening to her talk. And talk. And talk. Sra. X we will call her, not only told us about her hypertensive episode earlier that day, and how she was afraid she was running out of Enalopril, but she also told us all of the details leading up to the loss of her middle finger 25 years ago (factory accident), how her husband ran away with another woman a decade ago, and the depressing details of her current financial situation. After being majorly screwed over financially by both her former employer and ex-husband, this nice, sweet old lady who made us two beautiful napkin holders for souvenirs lives on approximately 60 USD/month. She can barely afford to eat and subsists on rice and beans. She has a German Shephard named Condesa (Countess). Anyway, I am particularly fond of this lady and hearing her story was, albeit lengthy, fascinating and put her entire present situation, health-wise and financially, into perspective. American doctors with 10 minutes to spend on a patient barely know the age of the patient, let alone the entire saga of their loss of an appendage. Anyway, this visit came on the heels of my reading of a NYT article entitled "You try to live in NYC on 500K/year". Well, what can I say, being here certainly puts things in perspective -- and makes me want to stop reading silly NYT articles!

The next lady we visited had an equally compelling saga, but in a way hers is a bit more acutely sad because she recently was the victim of a hit and run car accident in which her right leg was crushed. Since this woman is not employed and is not the dependent of someone who is employed, she must go to the public Ministry of Health Hospital (80% of the country uses this system) which provides resoundingly poor care. For example, Dr. M told us the story of a woman who went to the ER at the Ministry of Health for something like abdominal pain, and during the exam they found a thyroid nodule which was hard and they suspected cancer. So they made her an appointment for follow-up in TWO YEARS. Luckily this woman was insured and was able to get an appointment fast through the social security system (15% of the population - those who are employed - have access to this much better system of healthcare - Dra. M works for this system, not the Ministry of Health). Anyway, this poor woman not only has to suffer a hit and run, she is also getting poor care. Very sad. And even though we visit her because she is part of the neighborhood that we visit, we can't actually TREAT HER at the Community Clinic because she is not insured. Frustrations similar to those we find in the US - except in the US this woman wouldn't even have a Ministry of Health Hospital to go to......although I suppose she could have Medicare. Anyway.