Notes from the Clinic, Part III

A couple of weeks ago, I had to stop by the hospital to get some medicine for an ear infection. (My body, still flummoxed by the environs in which it finds itself, insists on contracting diseases usually affecting small children under the age of five.)

I had the following interaction with a nurse, who weighed me, took my blood pressure, and proceeded to ask some routine check-in questions.

Nurse: How are you?
Cati: Good, thanks. And you?
Nurse: Alright, a little hungry, but that´s not your fault.
Cati: *blink*
Nurse:... do you have a fever?
Cati: I´m not sure, maybe a little.
Nurse: (touches Cati´s arm). AY! My God! You´re burning up!!
Cati: I am? I don´t think...
Nurse: (touches Cati´s arm again) Oh, wait, no, you´re normal.

Without touching a thermometer, she notes 37 degrees Celsius on my chart.

Here´s the thing: They always do this at that hospital. Just ask the patient if she has a fever without ever reaching for the device that would provide an accurate answer. Whyyyyy? Although maybe I should be impressed this time the nurse went so far as to use her finger tip to take a reading, because I mean, it´s the same as a thermometer, right?

I went on to be seen by the doctor, who examined the ear that was bothering me with the ear-flashlight-telescope thing. Then he asked me if the other one was infected. I said I didn´t think so, but wasn´t sure, and he sat down contendedly at his desk and started writing prescriptions. Why wouldn´t you look at the other ear? All he had to do was shuffle six inches to the right and take a peak. WHYYY?!

I always thought of medicine as a science, but am confused by the persistent lack of scientifiy inquiry involved in its practice here in Panama. Just saying, the medical professionals here are doing nothing to convince me that it is inappropriate for me to follow my dream of practicing Dr. Quinn-era frontier medicine in 2011.

A Ngobe Guide to Healthy Living

Many of the most memorable conversations I´ve had with people in my site are about health and home remedies. People here rely on botanical medicine and some of the local healers have extensive knowledge of the local plants that cure a wide range of ailments. What they know is impressive and to be respected. The only objection I raise to the use of natural medicines is in serious cases, when a person fails to get better, or needs urgent care, and the family inevitably waits too long to take the person to a doctor. Some of the medicine men´s remedies are guesses, and they have no ¨real¨ training beyond tradition. There are limits to what they do, although the people I live with will be just as quick to remind you that the same is true of doctors.

As a volunteer, it´s important for me to walk the line of acceptance and support for local knowledge, while also offering some ideas and tips from a more modern, clinical perspective.

During my time here, I´ve learned a lot about the basic beliefs and superstitions of the people in my area. Here are a few of the most common :

1. For parasites, diarrhea, stomach ache, etc., follow the following recipe:

Boil very stong coffee in only a few ounces of water. Add the juice of one lemon and dissolve an Alka Seltzer tablet. Drink it all and expect relief within a few hours.

Note: People swear by this. I doubt what value it could possibly have, but it certainly sounds like something that would flush out the pipes.

2. Skin infections. When I was having a lot of problems with infections of my legs and feet, people were always asking who I had been hanging around with. This question made little sense to me, until they explained that the sort of infections I was getting are usually contracted when the afflicted person spends time near a pregnant woman. They say that the ¨heat of her belly¨ causes the outbreak. Don´t worry though. There is a simple cure. Go to the woman´s house and ask her for a glass of water. Drink it all and the infection will go away. But it is important that you drink her water, or else it won´t work.

They are aware that this sounds a little fanciful, so they usually say, ¨I know it seems like a lie, Cati, but it´s true.¨

3. People believe very much in curses, and for people who are chronically ill and don´t get better, or who visit a doctor who cannot render a diagnosis, it is assumed that they have been cursed. The doctor can´t see the disease because it is only the manifestation someone´s ill wishes against them. For this reason, people often don´t take medicine given to them if they believe the root cause of the illness is really a maldicción. (Medical compliance is a whole other issue, which could be a post in itself.)

4. Relationships of hot and cold are extremely important and can explain away the onset of virtually any sickness. For example, one must never bathe right after working, because the cold water combined with a hot, sweaty body is a recipe for disaster. You should also only drink hot drinks when it´cold because that is the only time your body can truly handle them. I have offended more than a few visitors by offering hot coffee on a warm day.

I once baked using my neighbor´s stove, and she came in and told me not to bother washing the dirty dishes. She mentioned how I would get sick if I washed them, because I had been so close to the hot oven and taking pans in and out all afternoon. I thought this was her way of telling me she didn´t mind cleaning up my mess, but I washed the dishes anyway. I received a very angry scolding afterwards, and she checked up on me for days afterward to see if I was okay.

5. Worms (of the intestinal variety) are so normal that people believe they are necessary to digest food. When I talk about eliminating contaminants from drinking water, people have asked, ¨but how can we keep eating if we don´t have worms?¨ I didn´t quite realize how strongly people believe in worms being necessary for sustaining life, until a child asked me if I had worms, and when I said no, both he and his cousin asked in unison how I was still alive.

6. You must never eat pork if you have any kind of medical condition, real or imagined. Any kidney condition will be especially aggravated. (Many have already told me I will have to buy chicken for them when I have my goodbye party, because that pig I have been raising is no good to them.)

7. People usually don´t attribute diarrhea to bad water or unwashed hands. It is almost always caused by fresh fruit, vegetables, bread, or virtually any food that that they don´t eat every day. And you know, this may actually be true because some things are so unfamiliar to them, they may upset stomachs. Nonetheless, this belief is a serious inhibitor to good nutrition.

It´s always a challenge to determine if I should offer counter information and when to do it. Even though these things sound ridiculous to us, I am conscious of the fact that me explaining ideas like solar disinfection of water sounds just as preposterous to them. The invisible rays of the sun are killing the invisible microbes in the water? Sure, Cati. How can I convince them that their baby really shouldn´t pick things up off the floor and put them in her mouth when babies have always done that, and most of them grow up to be healthy, functional adults?

When I first came to my community, I was shocked at what I perceived as a blatant disregard for basic cleanliness. What I now realize is that people are very conscious of cleanliness and their family´s health, but their reasons for preventing or explaining illness are very different, and unfortuantely, in many cases, misdirected. They take great care sweeping out their houses, bathing their children, and generally making sure their homes look as neat and tidy as possible. They are doing what they think is best to be clean and healthy. Every mother loves her child and wants him to be well. She does everything with his best interests in mind. This is a universal human trait. If she fall short, it is almost always due to a lack of education or simply traditional beliefs that offer different explanations.

A friend recently explained it this way, and it makes total sense: Very few of us Americans have ever actually seen a germ. By this I mean, to have looked through a microscope and seen a cold virus, bacteria or anything else that causes disease. But we believe it because we have years of education and resources that tell us that it´s so, and we accept it as fact. We have had access to scientific information and education, and that is what informs our thinking and behavior. For people who haven´t had that access, there are other explanations and reasons for things that seem as plausible to them as a cold virus does to us.

Thinking of it that way, how can we look down on someone who has a lifetime of experience that indicates to them bathing right after work might cause the flu? It seems irrational to an American, but we sound equally so to them when we explain that there are harmful things in their water that looks perfectly clean to them.

Part of my job has been to touch on that common desire we all have to be healthy and offer some new ideas and strategies to be even healthier. And sure, I´ll drink that pregnant lady´s glass of water to clear up my foot infection, if she meets me halfway and puts bleach in it first.

My first year of medical school (updated)

So by now the secret´s out that I harbor delusional fantasies of practicing medicine, but posess neither the will or the skill to actually pursue a professional, (legal), career. But you know? Sometimes when you really want something, you are provided with opportunities. (I think I just heard you all roll your eyes.)

Yesterday I went to the nearby community of Valle de Agua Arriba, where another Peace Corps volunteer is wrapping up her service. The community was hosting a gira medica, which is essentially a traveling clinic made up of doctors, dentists, vets, and students, that descends on a town for a day and sees as many patients as possible. Unfortunately, I didn´t get to see much of what was going on in the medicina general room, but that all sounded quite boring compared to where I was stationed in the dental room.

Of course, my role was to translate for the students and nothing more, because none of them spoke a word of Spanish. And for a rural population who has never seen a dentist and has trust issues with gringoes and foreigners, my services were appreciated by both parties. I felt most useful when even the Spanish-speaking Costa Rican doctors asked me to speak with patients to explain medicine or treatment, because they could tell the Ngobes were more willing to listen to me.

But besides all of that, I got to see some pretty gruesome tooth extractions, record-amounts of plaque scraped off teeth, and explained how to brush teeth about 100 times (I have never seen anyone in my community brush teeth. Toothpaste is sold in the tienda, but I am quite sure I am one of perhaps three QP dwellers who purchase it.) I also felt the fierce defensivenes I´ve lately been experiencing when it comes to ¨outsiders¨talking down, or badly about the people here. It´s easy for some people to criticize when you have no idea about the context of their lives.. But people who have never lived alongside them, haven´t seen them haul buckets of water for 15 minutes uphill just so they can cook, or seen how little money they really have, cannot understand all of the barriers poor, rural populations face in trying to be healthy.

In between translations, I did decide dentistry will not be the fake medical-specialty I adopt in the vast vallies of my imagination. It is the only area of modern medicine that makes me cringe more than orthopedics.

Other Asuntos Varios on the health front:

So if you are wondering how my feet are, the answer is much better, thankyouforasking. The infections are gone, and I had a blood test today to make sure there were no more creepy crawlies hanging out in my blood. Luckily, there were not, but there are some other creepy crawlies hanging out in my skin.

So I had been suffering from a REALLY SEVERE ITCH ALL OVER MY BODY THAT WAS DRIVING ME CRAZY for about two weeks. Like crazy itching, especially at night, when I would wake myself up digging at my skin like a mangey flea-ridden dog. Then I broke out in a rash on my knees, which was a charming addition to the scars, cuts and bites that already inhabit my legs. These gams are getting pretty hard to look at, folks.

The doctor says I have scabies, and all of their egg-laying and pooping under my skin causes an allergic reaction. Which is beyond disgusting. I hope he is wrong and it is just an allergic reaction to the jungle. He didn´t dwell very long over the diagnosis, just pointed to two nearly miscroscopic dots on my scratched-up hand and said ¨That is where it went in, and that is where it went out!¨

So let´s allow ourselves to float around in the hopeful fantasy that it was a hasty, incorrect assessment. Because even though I am an imaginary medical professional, mites burrowing around in my skin is just a little too Victorian-England-jail-cell for my liking. Furthermore, you usually need to have some close human contact to get scabies, if you know what I mean, and I am a very single young lady living a very single life in the jungle. If I caught this wretched disease from having kids crawling all over me, then well... NO MORE COLORING AT CATI´S HOUSE!! Scabies... seriously?

So anyway, I am in Changuinola for the weekend, getting some PC work done and catching up on some R and R before I head into a marathon couple of weeks doing stuff in site. You might be hearing from me again.

The doctor is out

Health is a fun topic. No matter who you are, or how much access to education you´ve had, you probably still harbor some baseless medical theories, or cling to a magical cure that you swear will knock out a fever, stomach ache, low bone density, or what-have-you better than anything else out there. In my magical Ngobe village, it is the exact same, but more extreme, because bush medicine reigns supreme, and people hate going to the doctor. I have trouble walking the line between enjoying their stories to intervening when they say something that is completely untrue and bordering on harmful.

So my neighbor Julio is a ball of energy, and he has taken to coming over several nights a week (despite my loosely-enforced stay-out-of -my -house-after-dark policy). He is always overflowing with questions and enthusiasm, and sometimes I can´t bring myself to turn him away. Eventually his wife and sleepy children parade in one by one, and I am left explaining every medical condition or strange news story he has ever encountered while the kids fall asleep on the cement floor.

Last week, I exceeded even my own expectations and explained The Pregnant Man, and led him slowly but surely through a conversation about sex, gender, and sexuality. Last night, he came over and all of a sudden said, "What about AIDS!!!"

What about AIDS, Julio? I should be thankful, because Peace Corps wants us to teach all about HIV/AIDS, sexually-transmitted diseases, and other sex and gender issues on the side, and his questions give me great practice. He told me all about how he never eats in Almirante, because the plates could have AIDS, and also that he used to fear sitting on warm seats because the heat could have AIDS!!

This soon led us into a larger discussion about health matters in general, because he knew I was sick and had to come back to the city today for a blood test. He told me not to wash my face or brush my teeth before, because otherwise they couldn´t take the blood. To which I responded with one of my favorite exclamations, "Mentira!" Lie! He then told me another story about a time he was going to donate blood, and couldn´t because his wife was pregnant. Another mentira! (Although that´s kind of a cute idea. His blood is "weak" because his señora is preggers... like sympathy pains!) Then, he said he hasn´t been feeling well and the solution would be to fill himself up with horse blood. Because, you know? Horses are really strong.

Please join me in a collective sigh.

Lucky for me, Julio is a smart guy and he usually latches on to my lessons quickly, and can laugh at himself when I tell him frankly that his theory is way-off.

Bush medicine is still very popular in my community, and Julio`s wife´s uncle apparently had an herbal cure for cancer, which he distributed to Ngobes, gringos, latinos, and Afro-Antilleans alike who flocked to him. This magical recipe died with him, unfortuately, and it seems The World Will Never Know.

But in all seriousness, they do have success with a lot of herbal remedies for stomach upset, diarrhea, topical infections, snake bites and other such merriment that comes along with living in the campo. The medicines often work, and people only go to the clinic as a last resort. Those treatments have been along a lot longer than modern medicine, and are well-respected in the Bocas region. I would like to learn a lot more about what they use and how they know (one otherwise down-to-earth guy told me he dreams the cures). Of course, Peace Corps medical policy tells me I have to go to a real doctor, which is okay by me, because I don´t want to wait around for Green Plant Number 342 to kill my giardia.

But as I plan charlas about health education, it is important to incorporate both lines of thinking-- traditional herbal cures, and other modern ways they can treat common problems like diarrhea with rehydration drinks, etc. You have to start with what they already know, and build from there. No one will listen if I say everything they know is wrong. Because of course it isn´t. They will always know way more about what medicine the earth offers than I ever will. But the horse blood thing? I am definitely right about that.