Today was much of the same, except that we were given more of the responsibility in the physical exam. We saw many more pregnant women and we had to take their blood pressure, measure the height of their belly, find out where the back and the head of the baby was, and listen to the placenta and heartbeat with the little Doppler machine. Since there are so many patients to see everyday, and the doctor spends as much time as she needs with each one of them, we usually finish around 1:30-2pm, much later than many of the other rotations. But I realized that I don’t mind – I really like working with these women. This rotation is a good combination of learning, practicing, and listening to the patients stories. Some are heartbreaking and others are hopeful – most make you want to smile encouragingly because you hear they have been through a lot but you want to encourage them to have the strength to keep going and not lose confidence in themselves.
One 21-year old girl came in and Dr. Santivañez spent about 30 minutes just talking with the girl, giving her advice on her life and encouraging her to continue school. When she was 16 years old, she became pregnant but she didn’t want to marry her boyfriend, so they broke up. Her family was super distraught, especially her older brother, but they decided to help her raise the child so she could finish up school and start a career. Right now, she has one year left of accounting school. But lately she has been dating another boy, and once she accidently spent the night with him and didn’t come home until morning and of course, her parents flipped out. I wasn’t sure of her housing situation at the moment, but apparently the issue was not resolved and she wasn’t on good speaking terms with the parents. Dr. Santivañez was sympathetic and walked her through the different options (she either move in with her new bf, or she reconcile with her parents and stay at home). She asked her of any good reason she has to move in with her boyfriend and said she recommended that she stay at home, with her family who obviously care a lot about her. She made sure to mention that whatever the girl chose (and that the ultimate decision is up to her because she is an adult), the doctor would not stop speaking to her so she could always come to her for help if she needed it. At the end, she asked about the new boyfriend. “Does he have a future, is he in school?”. The girl replied that he recently dropped out of school but intended to go back in the future. “What does he do now?”. The girl said he worked in a breadshop (un panadero). “A breadboy?! Do you really want a husband and father who is a breadboy?!” I almost laughed but I did think it got the point across. The girl is obviously intelligent and has a lot going for her as long as she doesn’t get tied up with a breadboy who’ll keep her down. This is how Dr.Santivañez is with all of her patients. Even though she has limited resources to work with, she never makes it known that she is in a rush to see all the patients.
Another reason that we get out late is because of inefficiency. Once, the doctor searched for a specific form around her entire disorganized office for 10 minutes muttering to herself about how “tengo que organizarlo” (I have to organize [the office]) while the patient sat in the room and waited.
The last patient of the day was a woman who had just given birth and had a particularly severe cut from childbirth – it was bloody and moist and the sheets on the examining table got stained with blood while she was examined. This is when hygiene habits really came into question. The ants – they don’t really bother anyone. To change sheets for each patient who uses them would be nice but seems also kind of wasteful. To not change the sheets when they are stained with a patient’s vaginal blood that’s where I draw the line. In terms of American germophobia, I am not very hygienic. I share my glass and drinks with others, I let people use my mascara when they need it, and if I am really hungry I am even willing to extend the 5-second rule to 10 seconds. I know I know, it all sounds gross and not proper, but I argue that it builds up my immune system. But bloody sheets?! Putting a microscope slide with a pap smear culture on the windowsill where the ants crawl all over it? Throwing bloody tissue into the garbage can and smearing it with blood in the process (and not cleaning it for days – it was still there this Monday)? That goes even beyond my lax hygienic standards.
Then again, who am I to criticize a facility that lacks so many resources. At first glance, it’s not very noticeable. Yeah, it looks a little run down and everything from the seats to the doors and the floor is an older version of what is seen in the U.S. But at first, the care seems adequate – they see all the patients, they prescribe them medicine, and have the materials to perform pap smears and IUD insertions. But the more time I spend there, the more I learn about how much they truly need and do not have. There is no heating in the entire building – the actual exam rooms have little electric heaters but the waiting room is absolutely freezing. Since windows are small, the rooms don’t really heat up as the sun rises. Because of that, on super cold days, many less patients show up for their appointments. Today, the doctora also told me that the instruments that we use (otoscope, BP machine, and the Doppler machine) were all donated by previous CFHI students. She had to control her emotions when Sophie accidently dropped the otoscope on the floor and for a minute we thought it was broken. The little black caps that go on the otoscope that we throw out after each use? - They have 3 of them and clean them with alcohol before each patient. Regardless, the clinic and Dr.Santivañez are a great resource to these patients. The doctor takes her time with each patient, asking them about their academic future, encouraging them to finish school, and makes sure they know all the facts about family planning. I never saw her rush a patient, even when we were running late on time.
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