Goodbye Altamirano

I had originally planned to stay at the Hospital San Carlos until I flew home for Christmas but as my work continued, the politics changed. When I had first come, I was told by the coordinating doctor that I should start in consult rooms with another doctor until my Spanish improved. As the first week progressed, I changed my role from observing the patient visit to doing the physical exams only, and then to interviewing the patient as well. The other doctors were very patient with me and gave me room to work with the patients as we alternated interacting with our patients. Finally, by the second week, I started the hardest part: writing the patient histories in the chart. So many words were new and that was a completely different education. For example, I did not know that “Costo-verterbral angle (CVA) tenderness” is “Giordano positivo” or that our “pitting edema” is “Segnas de Goethe.” Nevertheless, I learned a lot and by the end of week 2 was confident enough in my patient visit to start seeing patients on my own. This continued until about week 6 when I was called in by the oldest nun and scolded for not giving a patient with a viral throat infection some medicine. I tried to explain that it is viral and we don’t give medicine for that and that I did tell the patient to take tea with honey for her cough but that was hardly good enough. It seems the sisters are very keen on giving out some medication, even if it is only vitamins. This, I refused to do because the patients have to pay for their medicine. I suppose she spoke with Sor Maite, the head of the hospital because the next day, I was called up to her office and told I was not allowed to practice solo anymore – that I was a student and therefore not responsible for my patients legally. Although the idea of a lawyer coming to Altamirano is as funny as a liposuction clinic starting shop there, she had a point about legal responsibility. Unfortunately, she did not trust any of her own doctors enough to let me continue seeing patients on my own and presenting them to that doctor for their signature. In my mind and in the mind of the United States medical system, once a licensed doctor signs a patient history he/she is legally responsible for that patient. But that is not the mind of Hospital San Carlos. Dismayed and not sure if I could continue – for if I weren’t going to be on my own then I was not being helpful and I am past the level of training where being in general consult with another doctor is the least bit useful to me – I walked down the stairs of her office and followed, feeling like a puppy dog, into another doctor’s consult room.

me, intubating one of the cleft lip kids

That day, however, the coordinating doctor told me I could start on my own again with his signature on the charts. That continued through part of that week until an American Family Practice resident came down from California. He had wanted to observe consults so I invited him in with me, thinking I could use his “medical doctor” signature on my patient charts. We saw one patient and then I was called out and invited to a special meeting between one of the doctors with whom I was not close and Sor Maite. Sor Maite, with a very worried expression, repeated that I was not to be solo. Then the other doctor, aligning herself heavily with the Sor, diminutive the American doctor and told me that working with the new resident was unacceptable because they did not know his credentials. Thinking it unlikely that a plumber or hair stylist would make his way down to hospital San Carlos in Chiapas and then pose as doctor, I dismissed this error as an honest mistake. I didn’t know he was a hair stylist!

Then the other doctor accused me of using an incorrect dosage of an antibiotic. That really hurt me because the thought of doing that is really scary. I had looked up the dosage and I was pretty certain that I hadn’t but Sor Maite, who has no medical training became even more worried about my practice there. Now, forced to stay in the room with someone else, I felt like was wasting my time staying at San Carlos when I could have been helping teach the health promoters and seeing patients in Amatan. Still not ready to leave though, I decided to start working outside of the hospital in the community and had a couple very educational experiences as I have previously posted.

Finally, I made a deal with Lorraine, the older Ob/Gyn from Massachusetts, who had felt very isolated in Altamirano and had asked me to stay until she left, that if I were going to stay, she had to take me under her wing, let me assist on all of her surgeries and teach me. She agreed and I had a very good final week as an Ob/Gyn apprentice. To her credit, she had confirmed that the dosage of the antibiotic I used had been perfectly acceptable and in fact was the dosage she used all the time. She even told Sor Maite that much but after that point, there was no going back for me. Hospital San Carlos is a beautiful hospital that does many terrific things for the indigenous people.

The sisters who run it are very caring people but they are not without their faults and with my independence and normal problems with hierarchy and authorities it would not have been prudent to stay. That is why I am now in San Cristobal, having seen Lorraine off today and waiting to go with my group to the disaster zone of Hurricane Stan to work in a clinic down there. In order for me to stay in Chiapas, I need to feel either useful, helpful, or like I am learning something. Without a combination of those three, I would be wasting my time and feel like I am on a vacation when I do not wish to be on a vacation.

As a side note, Lorraine was nice enough to give me her digital camera for my remaining 3 weeks here so pictures will follow – although I am not sure if internet will be available near Tapachula. Until Next time, Ryan