December 12, 2011
Dear DGH friends,
The adventure continues in El Salvador. I just returned to Santa Marta after spending 5 weeks at DGH´s other site in El Salvador: Estancia, Morazán. This post is dedicated to updating everyone on what´s going on in this more isolated, rural site.
To provide a little background, DGH partners with a local NGO in Estancia—“Campesinos para el Desarollo Humano” (CDH) – to support the CAIPES clinic and patient accompaniment program, microloan program, early childhood development centers, and many other community development projects. There are currently two other DGH volunteers working in Estancia for the year—Nicole and Bonnie—both 4th year med students from Einstein Medical School. Nicole, Bonnie, and everyone at the clinic were extremely welcoming and made my short stay a wonderful experience.
As volunteers we were working with the clinic´s doctor, Juan Carlos, who is from Estancia and trained in Cuba. It was a great experience to see patients in the clinic and a perfect environment for learning. I really cherished the independence and responsibility of seeing patients on my own, but at the same time having a whole library of textbooks to refer to, as well as the knowledge and experience of the whole team. We saw a surprising number of very interesting cases: newly diagnosed heart murmurs and other cardiac conditions, a case of diabetes vs. rare glucose-transporter deficiency, PCOS and other infertility cases, kidney stones, and possible pituitary adenoma. It was a little frustrating to often not have the resources to fully work-up certain cases, but in all instances I believe we provided high quality care despite these limitations. Nicole was in charge of referring patients to specialists and did an amazing job of reminding patients of their appointments, following up their results, and accompanying patients when needed.
The clinic is not the only option for medical care for the population of Estancia—there is a new government health clinic in nearby Cacaopera that provides all consults and medications free of charge (CAIPES asks for a $1-2 collaboration if possible for medications). However, patients continually told us they preferred the CAIPES clinic because we were able to spend time with them and explain their conditions. At the “Unidad de Salud” the doctor generally sees 25 patients in a morning, and it definitely has a factory feel. In addition, the CAIPES clinic supports “special patients” who have complicated chronic diseases such as hyperthyroidism, seizures, vision problems, providing money to travel to their specialist appointments and subsidizing otherwise unaffordable medications. Another option for medical care in El Salvador is a private doctor: my experience has been that these doctors often have their own monetary interest in mind rather than the well-being of the patient. One patient I saw had been told she needed to buy Celecoxib and Ginko biloba— spending $20 (a week´s salary!!) when Ibuprofen would have been absolutely appropriate. It´s an outrage that doctors take advantage of their uninformed, humble patients!
While I was in Estancia we restarted weekly phone rounds with the help of prior volunteers Caitlin and Don Lassus. Once a week we would discuss complicated cases and questions we had with a US doctor who had worked in the clinic previously. These rounds were an amazing learning experience and helped us feel more comfortable dealing with complicated patients. We also began accompanying the health promoter, Etelvina, to her new site in San Miguelito. This community is extremely poor and isolated (2 hours walk away!) and was not currently being covered by the Ministry of Health promoters. Etelvina dove in to the project, and had already planned garbage clean-up, latrine building, and pap smear campaigns. The women of San Miguelito were especially excited to have Bonnie give women´s health talks, starting with family planning. Another really great project I got to work on was organizing the numerous donated eye-glasses in the clinic so that we could start using them. My favorite patient moment was when this elderly farmer, who I had assumed could only scribble his name at best, started reading the newspaper to me after we found him the right reading glasses. Amazing.
I hope I was able to give everyone an idea of the great care being provided at the CAIPES clinic in cooperation with CDH. I´m glad I got the opportunity to work with this wonderful community organization!