Trust and Care

Almost two weeks ago I had to go to the hospital in the middle of the night, because I couldn't seem to stop vomiting. I not only had the geographical advantage, but the financial advantage to allow me to go to the private hospital here. Although the hospital seemed to be closed (we rang a doorbell and were let in by a security guard, and the hallways had no lights on), I was treated with kindness. The one thing I was not given, though, was explanations. I was expected to trust with complete confidence that my doctors knew best. A nurse came into the room to give me an injection of what was presumably an anti-emetic, but I asked what it was and she had no idea. I insisted for quite some time in knowing what was in the syringe. The Guatemalan woman who accompanied me, and the nurse both tried to convince me that it was fine, because the doctor knows best. One one hand there is such blind respect for doctors, and patients seem to have such little voice. As you can imagine, this means questions are not asked.

I met a Guatemalan man today who had abdominal surgery at the private hospital after being referred from the public hospital (aka with no money to pay the high fees). He told me that at his hospital he was treated as a second class citizen, in a group room instead of the fancy private rooms with TV and nurse call buttons. He says he woke up from his surgery at 10pm and wasn't visited by a nurse until 7am. He had to wait 9 hours for pain medicine after having a hernia repair (which now has a 4 inch scar)! When I asked why, his explanation only consisted of shaking his head and telling me that money determines everything here.

Why is it that doctors here demand respect from patients, and then group them into classes of people with or without money? Fortunately, the clinic where I am working seems to be incredibly kind and respectful, never judging or withholding care for patients without money. Sadly, sometimes this isn't enough, because there are patients in need of expensive procedures referred elsewhere, that we simply cannot afford to assist with. But over and over again, people remind me that this clinic is special, and unusual.

I have heard over and over again that patients have distrust of foreign medical professionals here. (What makes a foreign medical professional different? I don't know...) Although this may be true, I have yet to feel the effects of that concern. I spend a significant amount of time with each patient, and spend a long time explaining things to families. I try my best to explain not only the treatment, but the illness, and justify any laboratory tests that would charge them more money. (Today I spent almost 5 minutes justifying the cost of a $1.25 test to determine the cause of a toddler's diarrhea). I feel like my treatment plans are long-winded nursing care plans with rationales for everything. As strange as it may sounds, I think this wins over a huge amount of trust. The last thing I want someone to do is leave and ignore everything I said because they don't trust me. In the end, it's rewarding. I have run into patients a couple of times in Xela, and they have always been very kind and respectful. This morning a woman rode by me on her bike shouting "Good morning, doctor!"

But now that we (as medical professionals) have their respect, what do we do with it? How can we help even out these disparities? I truly believe we have to do our best in order to deserve that respect, and if that means helping to find money for treatments, or give free care, then I think that is what we have to do.