Hey y’all, I am feeling inspired tonight to write about differences between what my work looked like in the States versus what it looks like here at the hospital. It has been a while since I have written about my work at the hospital so now you don’t have to hold your breath anymore ;)
As many of you know I did my medical school training in Los Angeles and residency in Houston, as well as 6 months in a variety of Houston clinics as a fully-fledged doctor before I moved to Peru.
Now that we have reached 1.5 years of serving in Peru, I have noticed several differences between the way I practice medicine in the States vs here in the middle of the mountains (with stories included):
1. Very complicated medical cases: I see so many super-duper long-term complicated cases here in Peru that I wouldn’t even touch in the States. Just the other day I saw my young patient with lupus for her return visit. The first time I met her, she came into our ER in pain lying on a mattress in the back of a taxi because it hurt to even move. I myself fully manage and treat her lupus (probably the most complicated disease out there for you non-medical folks). The reason why I am in charge of her care is because I actually referred her to the public rheumatologist but the rheumatologist just gave her ibuprofen for her lupus (which without other medications is like a death sentence for someone with lupus)!!! She literally has no other place to go (because her family has little financial resources), so she comes to see me about every other month.
2. Super advanced diseases: So many of my patients either don’t have the resources (common theme here) so they went to the local health center with little resources or tried for a very long time to treat themselves through herbs and other forms of alternative medicine (sometimes because lack of $$$) that they come in super late in the course of their disease. In the States, you would at least be able to see a physician trained in residency at a county clinic or in an ER. Most of these cases are advanced forms of cancer or joint diseases like rheumatoid arthritis (where the joint destruction is so far gone that they need several very expensive joint replacements). I think the craziest case that I saw was a younger patient that came into the ER with shortness of breath than was progressive over a year of symptoms. Turns out he had preventable Hepatitis B (probably from birth), which then developed into liver cancer, which then grew from his belly up through his vena cava (the largest vein in your body) into the heart, and the tumor was literally millimeters away from blocking the inflow of blood into his entire heart. You’re probably wondering “A TUMOR FROM HIS LIVER GREW LIKE A SNAKE UP TO HIS HEART AND WAS ABOUT TO BLOCK IT??!!” Yes, that’s exactly it. Through our exams, we found out that this liver cancer was all over his body. And the saddest part was that even though he was young, we had to send him away as he was beyond the reaches of our medical care. So sad. In most cases, and especially ones like this, we offer the hope of the love of Jesus and pray for the patients (for only He can turn a situation like that around). Literally your faith will fall apart here if you don’t realize that God is ALWAYS GOOD and that He has a perfect plan for each one of us.
3. A larger number of illiterate patients: maybe a little less than 50% (my estimate) of our patients are illiterate and of extremely limited education. For example after trying to explain it, they wouldn’t be able to understand the difference between bone and joint (AKA it’s all bone). Because of this we use our nurses to redo key parts of the patient education about meds, diets, etc. because whatever they are able to remember will determine how well they follow your instructions. Because of this, many of them buy into expensive medical scams such as paying for a “magnetic resonance” exam in different cities which ends up being some sort of machine that you hold onto that spits out a bunch of numbers that tells you if you have diabetes, herniated discs, dry eyes, etc. The toughest part for me is that many of them have heard through the grapevine that our hospital is the very best and that we won’t take advantage of them, so they come with super high expectations that we will heal their cancer, or their irreversible conditions, etc. I think unrealistic patient expectations is my aquilles heel.
4. Patients sometimes bring gifts: You name it, avocados, paintings, clay figurines, a bow and arrow, brazil nuts, potatoes, cheese, etc. This is a huge unexpected perk, but when a patient brings me a gift, it makes my day. One of my latest gifts was from a young adult patient with anxiety who brought me one of his oil paintings of two hummingbirds in a green area under the moonlight (which he explained he used candle smoke to make the painting smoky). By far my favorite gift was from a lady in the ER who asked me if I loved cheese and then pulled out her own cheese that she had been eating because it was all she had and she wanted to show her gratitude. I had to take it because it would have been socially unacceptable for me to refuse it.
5. Patients come from very far away at a huge price (which means you may never see them again at a return visit): Many of my patients travel for over 24 hours to the hospital from some far-off corner of the mountains to get medical care. They may even sell their last chicken or pig to make the trip. So, you might see someone in clinic and give them an appointment to return but they may never be able to afford to come back. For example, in the States where you would just monitor someone over time and give the antibiotics if they worsen, here we might just bite the bullet and give treatment just in case.
6. Devyn gets to meet my patients: A HUGE perk of working in Peru is that there is no HIPAA (a strict law in the States that protects patients’ medical info), therefore Devyn is able to come visit my patients in the hospital, or I can openly introduce her to them without breaking the law. I think this has been refreshing for Devyn to see my patients and get to know a few of them. A while back, there was a young girl (like 2 years old) who got burnt after pulling a pot of boiling water down on herself. She stayed in the hospital for about a month with 2ndand 3rddegree burns down her chest and arms and part of her thighs and Devyn would come to visit her and bring her coloring books, etc. So then when she would come back for her return visits, she would ask me if we could call the “Señorita” over facetime (which I had done before so that Devyn could say hi). So awesome.
Now that I have listed the differences, on the other hand, the biggest similarity between being a doctor here vs in the States is that I love my patients and being a doctor is so fulfilling. I truly love my job, I just need to keep working on slowing down enough to love each patient individually and not rushing through a busy day (easily said, almost impossible to do).
Hope this helped y’all understand a bit more what hospital life looks like here in Peru!