Yesterday, I partially discovered why I love Wednesdays. Its not just because I'm immersed within the Haitian culture. Or because these patients truly need medical care. Or because, well, a big part of my heart is with them.
It's because I can practice in depth, complex medicine. Why? Because I have a translator. A translator who can ask them the complicated questions. A translator who is Haitian himself and can place our patients at ease when asking personal questions. Or who can help me understand my patients reasoning's for eating "mud pies (yes, actual baked mud) " during pregnancy.
With Dominicans, who consume the other big part of my heart, I am going it alone. Therefore, my questions and explanations are simple and in broken Spanish. I feel as if I'm not always delving deep enough into their histories or complaints, bc, well frankly at this juncture I can't. And so, I still don't understand why people drink a cup of limes when they have a cough- guess that's something I should ask my Dominican friends?
Entonces. Every day I am challenged. Every day I feel inadequate. In the states I practiced oncology. I treated and walked with the sickest of the sick. I practiced hard and intense medicine.
And what am I doing here? Half my patients simply desire cold medicine, or pain relief for a headache. Complex, challenging medicine? I think not.
But do these same patients deserve to have Tylenol cold when sick and Aspirin for a headache as we do? Should they be deprived of symptomatic relief simply because of their economic status?
Is primary care in the states the same? Many patients desiring remedies for common viruses? Probably.
But what am I to do when it seems I am being viewed as simply a pharmacy, because many times I provide medicine during my patient's office visits?
How do I provide comprehensive, good quality medicine to the poor without creating a dependency? What happens when I run out of my donated medicines? Will the patients still come? In a place that values what I physically give them, such as medicines, higher than my medical recommendations?
And how do I undo the damage that free clinics in our communities have already done? Free clinics that have the purest and best intentions but ruin the relationship I am so desperately trying to create. A long lasting relationship with routine medical care.
"Why must I pay to see you when once or twice a year other doctors from the states come and provide free care?" said a patient in Coracito on Tuesday.
Our nominal fee (the equivalent of 75 cents) allows our patients to have accountability, dignity and enables me to buy more medicines. But how can we teach responsibility when other do-gooders impair our relationships?
I thought when I left oncology the ethical questions and challenges would evaporate but clearly that isn't the case.
So how should I proceed? Consume myself in feelings of defeat and lack of purpose?
I'm not going to lie and say I haven't had thoughts like these. But as I do, and as I desperately seek within my bible and with cries of inadequacy to Christ, tangible encouragement is given.
~A wonderful conversation with Dr. Fernando, the Dominican Physician I serve along side who is pleased with my organizational skills or how we routinely practice in the states- each patient who presents at our clinics has a chart complete with a medical history and follow up. This simple record keeping that we take for granted has allowed us to effectively treat patients which hasn't been done in rural clinics previously.
~Two letters from previous students who went back to the states rejuvenated with a deeper faith walk and new possible vocations.
~And Brian Entrekin our incredible, faith filled leader offering encouragement with this simple word this morning. Time. And he's right.
With time and continuity and love and open-mindedness and faithfulness my site will become what it should be, frustrations and all. Noone said this was going to be devoid of challenges.....but suggestions I will accept :)
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