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Outside Comfort Zones

Posted by Olga Lemberg, MD (a third year Pediatrics resident from Kaiser Permanente Oakland serving a global health elective at The Belen Clinic in Cuzco, Peru).  

I began to chuckle to myself as I read through prior global health blog entries. It both is, and is not striking how certain themes recur in so many of the residents’ experiences abroad. While attempting to process everything that has been happening here in Cuzco, it was reassuring to realize that my experiences thus far haven’t been much different. First, you succumb to complete chaos during the initial days of orientation to the new time zone, weather, food, language, geography, coworkers, protocols, charting (in a non-native tongue, nonetheless). Then there is the feeling of impotence and frustration that stems from a significant lack of resources necessary for quality patient care. Finally, you are overwhelmed by the humility that arises from the unavoidable confrontation with extreme poverty. I suppose this is what global health is all about.

The clinic where we volunteer is technically a “policlinico.” This is distinct from a “clinica.” Usually, a policlinico is a public establishment meant to serve mostly disadvantaged people with little or no resources to pay for medical attention. The quality of care is thought to be less than that of a clinica, mostly because a clinica is a private business with more “amenities” that serves a more affluent population. Our clinic is funded mostly by a local parish and is staffed with several hermanas, or nuns. Like Amy mentioned before, the diagnoses we make here are not terribly different from those we see at Kaiser (i.e. URI, herpangina, AGE, contact dermatitis), but there is a huge difference in the approaches to their management. Like in the States (but not nearly as bad), everyone wants a prescription for something (and local providers want to give it to them!), or they feel that they didn’t get their 5 soles worth (i.e. 5 soles=less than US$2 – this is what patients pay for a consult with us). Have a sore throat? Amox! Have a headache? Amox! Have vomiting? Amox! Amy & I are like broken records, explaining over and over the difference between bacterial and viral infections but the patients are so habituated to getting antibiotics (or antiparasitics) for absolutely everything it is difficult to convince them otherwise. Where I personally have stepped outside of my comfort zone is with the diagnosis and treatment of various parasitoses. Within days, we must have treated at least 1-2 dozen Giardia cases, several cases of Entamoeba Histolytica and a case of Ascaris Lumbricoides. Interestingly, patients are also being routinely treated for non-pathogenic ameba, which is something we are trying to raise awareness about.

There have been a few puzzling cases of rashes and congenital muskuloskeletal deformities that Amy & I discuss between ourselves but unfortunately we don’t have the luxury of referring patients so we make the best of it.

Today I traveled with our “mobile clinic” to the community of Accoracay. It is a very small town with only a few homes deep inside the Andean mountains over an hour outside of Cuzco. The winding dirt road up the mountain terrified me. The team consisted of myself, a young general practitioner, a nun/nurse and a pharmacist. As we drive towards the town we beep our horn and yell out the window, “Attention! Doctors are visiting! Come to be evaluated and bring your children!” We bring along some basic medications with us that we give out for free if needed (i.e. amox, cipro, paracetamol, diclofenac, vitamins, etc.) but you can imagine the poor medical stewardship that goes on. The most common complaint that parents have about their children is a lack or loss of appetite. This is secondary to parasitosis until proven otherwise (at least this is the thinking of many local providers). I did see an interesting case in Accoracay: a 7 month old boy with a a week long history of a huge neck mass and fevers. Sadly, there wasn’t much I could do for him out there but we educated the mother on how important it was that she go to Cuzco tomorrow to seek medical attention, most likely for an I&D. As you can see by the picture, she was hoping it would go away with the help of a medicinal plant she that affixed to the mass.

Having received the warm welcome that we did made acclimating to the clinic that much easier. According to one patient’s mother, the word on the street is that there are 2 foreign doctors working at the clinic that are very good. Stay tuned!

Dr. Amy Mugg with a patient in her clinic office
Dr. Olga Lemberg with a patient in her clinic office.
A 7-month old male infant with enlarging neck mass and fevers x1week, in Accoracay
"Triage " deep in the Andes
Patients waiting to be seen
My first patient in Accoracay.
Wilma, our clinic pharmacist
Entrance to our clinic
Jovana, our clinic lab tech

This Post Has 4 Comments

  1. What an incredible experience you’re having. The younger generation in & near Cuzco will flourish with the help of its two visiting specialists and Kaiser’s support!

    The frequency of the Amox Rx reminds me of going to my summer camp’s clinic – they always gave kids Cepacol lozenges no matter what complaints one came in with.

  2. The dedication of you and your colleagues is truly inspirational. I am sure that your experiences in Peru will be as memorable for you as the for the patients whose live you will touch.

    With such a proliferation of parasites are steps being taken to treat the water supply and provide education in hygiene for the villagers?

    1. I haven’t had a chance to inquire about the public health measures to treat the water supply (I am certain there are efforts underway) but our policlinico is involved in training health promoters (e.g. local teens looking to keep busy during their summer vacation) to go out into the communities and educate fellow community members regarding various hygienic measures. Their audiences vary significantly, from people with no “servicios” (bathrooms) whatsoever, to people with basic latrines (i.e. holes in grounds) to people with plumbing.

  3. Olga, wow…most of us wish we had something as profoundly life giving as what you have to give as a physician. I’ve been awed by your fortitude during your grueling intern process and this, I imagine, reaffirms why you dedicated yourself.

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