martes, 20 de abril de 2010

Medical Consult Day

Every Wednesday is medical consult day at the Parche. Last week, I saw three different patients, all street people. The first one complained of ulcerous pains and of coughing up blood. At the end of the consult, Dr. T offered the man some medicine and asked if he could pay anything at all for the medicine. He took out 200 centavos (ten cents) from his jeans pocket and said he would give it instead of buying bazuko (type of crack). This system of asking the patient whether he can pay anything encourages the patient to take his health under his own control. It also demonstrates a shift in the patient’s self-value.

The next man we had seen last week for a consult. Last time he came in because he had hemorrhaging in his left eye after being punched in the face. This time he came in with a stab wound on his side. He told us that around 1 am, when he was sleeping, a few men high on glue stabbed him and stole his shoes. He said that he didn’t bleed much, but the area around his lungs hurt him a lot. After examining him, Dr. T thought that the stab could have pierced one of his lungs. He was having some trouble breathing and his heart rate was very fast. Dr. T told him that he should go to the main hospital to check up on his lungs and get some x-rays. Immediately, the patient shook his head and said he would wait and see how he felt tomorrow. Dr. T told him that she couldn’t force him to do anything, but that his wound could cause serious complications if he didn’t make closely survey it. For some reason, this man really didn’t want to go to the hospital. He told Dr. T he would hang out in the Parche and see how he felt in a couple of hours. I thought this would be a perfect thing to ask him about. What is it about the hospital that made him not want to go, despite his serious condition?

The third case was a 49 year old who looked about 70. He was a complicated case, because he had developed some kind of dementia and was fairly incoherent. He had a long knife cut scar along his cheek. He came complaining that he was going blind in his right eye and had a lot of liquid coming out of it. Dr. T inspected it and thought he had a cataract and potentially something else that was causing dimentia and chronic headaches. We asked him if he was on any medication and he showed us: flucanozole, iron vitamins and antibiotics. She asked him if he could read, and he said not very well since he had stopped school in the third grade. This was a crucial question to ask, because he clearly was confused about which medications he had and when he should take them. After he had left, Dr. T told me that this was an odd combination of medication and that perhaps he had HIV. He had told us that the family he lived with were all drug users, so they couldn’t come with him to his medical visits, this further complicated the case because there was no one we could ask about his medical history.

After the consultation, Dr. T looked over some of the histories of past patients and gave me eight different cases where patients had experienced some kind of barrier that prevented them from receiving or seeking appropriate care. Dr T. is going to contact these patients via phone or through house visits together so we can see if they wouldn’t mind being interviewed.

Dr. T also gave me some great ideas for other potential research topics. One was researching sex workers’ myths and practices to avoid pregnancy and deal with menstruation while working. Some of the myths to avoid pregnancy are the following: drinking alka seltzer, standing on your head. To keep working during a period, some prostitutes stick sponges up their vagina before intercourse and then pull it out and reuse it for the next customer (infections!!). Another research idea was to knock on doors of the inquilinos (dingy tenements around the Parche) and ask about recetas caseras. The goal would be to produce a whole cookbook of home remedies that people use to cure themselves in these settings. It would be interesting to see the effectiveness of these home remedies and if people use these instead of seeking care in hospitals if the sickness is serious. There is so much that could be researched here. I think a major project should be conducted by public health specialists on housing and its effects on child development…I know this has been done in East Harlem, but I’m not sure about here.

One thing I’ve noticed is that a lot of the students here are extremely motivated and concerned with the conditions perpetuating poverty and conflict within the country. The elections, for example, are a hot topic…although it is debatable how much a new president can change the current situation. An article in the Washington Post evaluated the current state of poverty in Colombia despite massive financial aid. Instead of investing money in the war on drugs, perhaps the U.S should give more money to research involved in discovering, deconstructing and dismantling those structures that perpetuate poverty and fuel drug production/selling/consumption. Is poverty a major cause of the drug war? I know that it is much more complicated that that, but if so, could solutions to poverty (i.e reformed health care system, less taxes for the war more taxes for public services etc.) be offered before increasing military/police action (bottom up)? I obviously feel way too uninformed to offer a complete opinion, but these ideas have been floating around mainly due to listening to student conversations and spending so much time with street people.

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