Hi friends! Well Monday we got into our regular work routine- everyone in the house gets up around 5am in order to leave by 6am- Dr. F goes in one car to his work, and the rest of us head to school and then the clinic. The nice thing about starting work at 7 is that we are done around 3pm!
The clinic is a little ways away and on a busy street- the clinic's purpose is to serve the immediately adjacent neighborhood with primary care. The area is then split into 5 sections, and there are 5 teams consisting of a doctor, nurse, and a health educator. Of the patients, 80% have the national healthcare insurance, 15% have health insurance through their employer, and 5% have private insurance. It sounds great in that all people are provided with some basic health care, but it is essentially a three-tier system, and people with the national insurance who, for example, are diagnosed with breast cancer, may not receive necessary surgical procedures. There are only four public, free hospitals in the entire country (one children's hospital), and OR time seems precious. There are also only 64 family medicine doctors in the country, and the clinic where we are working is the only clinic with family medicine residents. The result is that Dr. M is responsible for 602 families on her own, and sees about 40 patients in a typical day (sometimes with only 5 minutes for a patient).
KF and I started our day reading some manuals to learn more about the clinic and the healthcare system, but when another doctor and two residents were headed out to make housecalls and we were invited to join them, we jumped at the opportunity. Each household has a folder with a list of problems and a family tree (sometimes very large!), as well as forms to track about 27 risk factors, including owning pets known to carry diseases (here a lot of birds), or poor sanitation, or no access to potable water. One day a week, each of the doctors goes house to house in their area to check up on patients, and to reassess any risk factors. So far when we have gone, usually it is the grandmother who is home, or maybe the mother, as well as any young children, and most of the time we are invited in, and discuss all of the members of the household (HIPAA rules seem to apply more to the family unit!).
So that was our morning. In the afternoon we went out into the community with a health educator and a dentist- on one block we knocked on all the doors and said, ´we are going to have a toothbrushing class for the kids in about 10 minutes at house X'. We ended up with about 5 kids and several adults, and the dentist demonstrated with a model, and everyone practiced. It was a fun time!
Some major highlights for the day included:
-getting coffee (at Subway) with J.C.- he is a janitor at the clinic, very friendly- he would like to practice his English, and appointed himself as our bodyguard.
-when we went out with the doctors, they stopped for some food at a local place nearby, and KF and I were served a delicious meal called casamiento (basically rice and beans, but very flavorful and rich- as KF says, it tastes like it was cooked with lard... yum!).
-being invited into so many homes and seeing where/how people live
-playing Blokus with the family- I brought this game from the States, and everyone picked up on it really fast
-doing exercises and dancing with the girls
-watching a movie in Spanish, ´festival de chiva'
TUESDAY 2/2/08
Again, left for clinic by 6am. KF and I went through the family folders collecting data for one section of Dr. M's area. The data were so interesting that we may continue going through the rest of the folders and looking at trends (risk factors near busy streets, or closer to the river, etc). We went and visited people´s homes with the health educator in the morning.
Highlight: we had lunch with Dr. M at a local place down a few streets- we got the daily special, which involved rice, a shrimp cake type thing, a tortilla, and fresh juice, all for $1.75. Really tasty.
In the afternoon, we went with a psychologist and a health educator to visit two patients that needed follow-up, counseling, and a longer visit. KF and I are to go on our own to visit one of them again on Thursday, but we are a little worried because we couldn´t understand her at all (due to slurring of speech), and she didn´t seem able to understand us either! Goodness. On our way home with Dr. M, we stopped at a super-mercado- it was a lot of fun to look at the snacks available, and we got some ingredients to make American-style macaroni and cheese the next day.
Shortly after we got home, we had a bit of an emergency- Ginger (the dog) ate a plastic piece in the street, had respiratory compromise, and almost died! Dr.M and Dr.F rushed her to the vet, and, I am happy to say, she is doing just fine.
No comments:
Post a Comment