Today I started Servicio de Adolescentes. For the most part, the patients are adolescent mothers but there are also other adolescents that come in with whatever problem they have. To get to the clinic, I first walk for 30 minutes uphill to get to Hospital Obrero. From there, I wait for Dr. Santivañez, and then together we catch a micro to take us up to the northern neighborhoods of La Paz, where there is almost no such thing as a flat street. The clinic is located in Alto Miraflores, a north central neighborhood and most of the patients come from the surrounding neighborhood for their check ups. Apparently, in order to be able to get an appointment at a hospital, everyone must first go through their neighborhood clinic which then refers them to a nearby hospital. It’s a good idea to reduce clogging of the health systems but here, it definitely hasn’t eliminated the problem, probably of just the sheer need for doctors, time, and resources.
The clinic itself is very similar to the clinic I described in El Alto, except here I think they have a much better education program. They hold classes for young mothers and pregnant women on how to take care of their baby, themselves, and teach them different skills like knitting or sewing so the women can make goods and sell them to make a living. They also created a Young Leaders program where they take a 10-20 young adolescents from the neighborhood schools (13-16yrs) and put them through an educational program on adolescent health – everything from STD’s and AIDS to contraception and domestic violence. When the teenagers pass the program, they are certified Young Leaders in their community who can go out and teach others about what they have learned and participate in health fairs. It seems like a great idea – we got to meet the current Young Leaders and they were a really cool group. They knew about some things more than I did and they were mature enough to discuss sexual matters and female and male anatomy without breaking into fits of giggles. Although they did play a lot with the condoms that they were supposed to be using for demonstration.
Anyways, the room where Dr. Santivañez works is frigid, just like the one in el Alto. It has a desk, a filing cabinet, an exam table, and a small (dirty by our standards) bathroom where women can change into gowns. The walls are painted yellow so it is not difficult to notice the permanent line of ants that crawl in a line around the window every day.
Monday, we saw a lot of pregnant women who were all under 20 years of age. It always surprised me when I saw their age on the chart because my guess was always around 3 years too high. They all looked older however and some were pregnant with their 2nd child. The doctor was a great teacher, and the first day she taught us how to measure the height of the stomach, find the baby’s back and head by feeling the mother’s stomach, and listen to the baby’s heartbeat. Everything in children is different – and being in this high of altitude doesn’t help. Apparently, normal percentage of oxygen saturation here is around 88%, Hb numbers less than 14.5 is deemed as anemia, and the HR of a newborn is around 148. It makes me feel like I know nothing but I am also learning a lot because of that.
We also saw some women who had just given birth and we had to look at their wounds to make sure there was no infection and that they healed well. Some of their wounds were kind of gruesome and one girl couldn’t sit down because it hurt too much. I think the obstetricians made the cuts in order to prevent natural tearing but it still seemed barbaric and made me want to never give birth.
We saw a variety of patients – pregnant women, women who have just given birth, and women coming in for other problems. We saw a couple of which we suspected domestic violence because the woman was unhappy, shy, and refused to make decisions, deffering to her husband instead. Sometimes it seems to me that the single women I see seem happier than the married women. Maybe its because their family is more willing to help them out or because they at least feel they have some independence. It’s obviously too small a size sample to make conclusions and I know that this is not something that can be generalized – each case is unique. Our last patient was a 16 year old girl whose mother brought her in because of self-mutilation. She asked to speak to the doctor in private, so we were given most of the details afterwards by the doctor. She was really pretty and had a wonderful, joyful smile. The doctor said she wanted to refer the girl to a psychologist/psychiatrist but that the mother did not have the money to pay for one. Instead, she introduced the girl to the “Young Leaders” group and said she should get involved. Dr. Santivañez blamed the depression on the dysfunctional family, as she called it. According to her, parents try to control their adolescent too much, causing the child to rebel and desire all the things they are not allowed to do, leading to bad behavior and depression. Makes sense to me.
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