La Clinica

I arrived late in the day to this sprawling banana plantation guarded by guards with stray dogs and pigs roaming around, surrounding a set of plain white buildings that serve as clinic, research labs, and housing. 

Our cooking/cleaning ladies led me to a room shared by me and a few others though its surprisingly nice. Of course my roommates are some of the only native Spanish speakers in the housing so our communication so far has been pretty basic, though maybe it’ll force me to speak more Spanish. I’ve also clearly weirded them out already by shaking out my sheets for possible scorpions (I was told there’s been a few sightings recently!), wearing long sleeves and pants even though it’s scorching hot and humid and setting up a mosquito net… can’t risk that chikungunya (or dengue or malaria or zika).

There’s a common area where all our home cooked meals are set out for us (breakfast lunch and dinner!) so we had some food and I met the other people staying here. There’s mostly pediatrics residents but also OB/GYN, internal medicine, pharmacists, researchers, MPHers, nutritionists, and epidemiologists some native Guatemalans but mostly from the US. All super friendly, and reassuring that my Spanish will get better, one even did what I did (fluent in French so tried to teach ourselves) and she’s doing pretty well, so there’s hope for me!

Sooo clinic started the next morning. I lucked out and there is a PA student who is fluent in Spanish but needs to staff with a doctor, so we have this lovely symbiotic relationship where I go in with her (and understand almost everything!) and then discuss the plan with her which saves the supervising doctors and the PA student the extra time it takes to go over everything again separately. I can also give back by teaching her, but it’s super nice to have training wheels these first few days.

Patients wait in line starting at 8am and are seen in order, once they are seen, if any labs need to be ordered (pay out of pocket) they get it drawn and then have to wait there a couple more hours for results since follow up is nearly impossible otherwise. By the time a medication is prescribed they could have been waiting nearly all day (these cost out of pocket too) and yet no one complains.

The physicians are all super nice and don’t mind how slow/poorly I talk. Same with the nurses and other Guatemalan staff. Also, it’s nice to take time with patients and not feel the constant pressure to rush like we have in the US.

The lab, imaging, and medication options are much more limited than what I’m used to in the US, and it’s kind of challenging to pick and choose what you can do both based on availability, necessity, and the patient being able to afford it. Sometimes you can’t complete a work up and just have to treat what you think it is, and sometimes you hope they’ll come back but you never know if they will. The clinic does have a team of nurses that do community outreach to try and close the loop though. On the other extreme, if they need more intense care the closest hospital takes about 2 hours to get to.

In the first couple days, I’ve already seen a wide array of acute and chronic illnesses, pregnant women (which is not something internal med docs are comfortable with), and triaged a few people to the hospital (which is not an easy task here). Also one patient with severely untreated hypertension told me that God is the only doctor but he seems to have given us some good tools to try. I wonder if God uses amlodipine too.