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1/21/05 (Friday)

6:45 AM.  I awoke to the sound of many voices, all in Spanish, of course, and looked at the clock – 6:00 AM.  A look out the window revealed the clinic waiting area already filled with patients.  I then awoke much more with the cold shower.  With a little bending and contorting, I was able to shave and comb my hair in the reflection of the handle on the toilet tank.  I was amazed how much I could see with that little mirror the size of a postage stamp!  It is time for breakfast.

7:00 PM.  We finished early!  Only 36 patients today.  Our room was so hot and I just sweat and sweat.  I went through 4 bottles of water, some pop and fruit juice.  One time midafternoon I went outside to get some air.  The sun was bright and it was hot and humid but actually felt cool.  After being outside for a few minutes I went back into the exam room.  As I entered, it felt like walking into a sauna.  It was a wall of heat!  My glasses steamed over!  Now, it was probably 90 outside.  Our room was likely 120 or more to steam over my glasses like that.  I am just drained.  I did take a cold shower and that felt very good.

Tomorrow, Jane and I will head to Quito to pick up some supplies and meet Rob Lindsay at the airport.  He lands about 8:30 PM.  We will spend the night at the guesthouse and then return to San Lorenzo Sunday morning.

Wednesday night when we arrived here we went into town to eat.  Alex and Ian were here on a construction project.  Dr. John and Mary Dorfler are here for a couple months to work in the clinic.  John is a family practitioner and also does general surgery.  The 6 of us went to the El Choco restaurant.  It is pronounced el Choke-O.  I had to laugh to myself over this name because I seriously wondered if choking was going to be part of the experience.  I had fried fish, rice and beans.  It was okay and I choked some of it down.

As Jane and I schedule the surgery patients some of these women do not know how to write.  So they sign with a thumbprint.  Others want a sister, husband or friend to sign for them.  Those that do sign their names will embellish the signature with a variety of lines around and through the name.  I don’t know if this is to prevent forgery or what.  It is an interesting custom.

Today, a man came walking into the clinic leading an older man with a long board.  The older man was obviously blind and he was holding on to one end of the board.  The other man had the other end of this 4 to 5 foot board.  They walked along like they have done this before, probably many times.

The mix of patients is much different than the last time.  Then we saw lots of incontinence and complex surgical problems.  How we are seeing fibroids for surgery and women wanting pap smears.  Almost all of them complain about vague pelvic pain.  It is difficult to sort this out even when the patient speaks English.  In Spanish, the difficulty multiples because of all the translation and trying to communicate so I can understand the details of the pain.

We had a couple infertility patients.  These women are desparate to conceive and I feel totally helpless in doing a work up.  In this culture the men do not believe they could possibly be the cause.  One woman commented today, “A women who can’t have babies is not worth anything.”  Jane said this culture firmly believes this.  The barren woman has no worth here.  It is sad.  We tried to reassure this lady that she indeed had great worth.  She responded, “That’s easy for you to say but you don’t live here.”

One other lady presented with a positive pregnancy test on 4 different tests and an ultrasound from 2 weeks ago showing no evidence of a pregnancy.  Jane is worried about doing a D&C because this lady woudl accuse the clinic of taking her baby.  She came in with another positive test.  We are getting another ultrasound.  If it still shows no evidence of a pregnancy, we may need to explore the abdomen to make sure there is no ectopic pregnancy.  The lack of good diagnostic test and procedures makes management of this problem quite difficult.

It seems that most of the patients complain of some sort of vague pelvic pain.  This was like an epidemic – almost everyone has pain of some sort.  The more you talked about it, the more pain they had.  They seemed to want something prescribed.  A few ibuprofen and they would be happy.

These people lead such hard lives.  Many have no money at all and if they can’t pay for medical care, they receive none.  Jane tries to assist when she can and tries to balance between giving free care and at least holding the patient responsible for some portion of the care.  If you give something for free, the hands are back asking for more and more.  There is no shame in begging, I guess.

Tonight, Jane and I took the workers home and we stopped at a phone place where we could call the U.S. for 25 cents per minute.  I surprised Phyl with a call and we enjoyed talking for awhile.  My bill was 68 cents.  I hope to call again this next week.  Jane is getting me her computer so I can do some email.  Then it is time to hit the sakc.  We plan to leave about 9 AM tomorrow to travel to Quito.


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