Sunday, December 1, 2013

Medical Clinic

Elder Fagersten and I have had several occasions where we have had to take the missionaries to the clinic. It was different than the clinics or offices I have been to in the United States, but I thought it wasn't too bad. But that was my viewpoint from the waiting room. We sat on plastic chairs and there was a 20 inch TV which played a variety of shows from Dominican Soap Operas to showing the Disney movie "The Rescuers Down Under" (all in Spanish, of course).

This time it was different.  This time I was the patient.  I had been down for several days with a slight fever,  a massive headache, aches, etc., and I thought I had the flu.  No problem, I could wait it out.  However, when the word got out that I was ill, everyone wanted me to go to the clinic.  Not on your life, I thought. Then Hermana Douglas, our Mission President's wife called me.

"Hermana Fagersten, I heard you were sick."  How did she know?  Word spreads fast in the mission. . .
"Oh, I'm getting better.  I'm pretty sure it is just the flu."  Panic was setting in.  She wouldn't make me go to the clinic!

In her calm, reassuring voice she said, "You probably wouldn't know that here in the Dominican Republic there are many diseases that mimic the flu."  Oh, great, I thought.  "There is a disease called leptospirocis that mimics the flu.  It is very treatable, but left untreated, then it will cause serious damage to your kidneys or liver and you can die.  I would suggest you go into the clinic to get your blood tested."  O.K. so your scare tactics worked.  I will go on Monday and get my blood drawn.  "No, Monday is too late.  You need to go tomorrow."  Thanks Hermana Douglas, I will go tomorrow.

Wanting to be very clear to the doctor about what was going on, and not wanting to have anything done to me that didn't need to be done, Gary and I sat down and wrote down everything that I felt needed to be communicated clearly in Spanish so he could explain it to the doctor.  He decided we should take a native speaker with us, so we called our good friend President Diaz who, thankfully, went with us to the clinic.

Now when we walked into the clinic, no one asked us to fill out any forms and no one asked us for any information.  We went straight back through those once unfamiliar doors.  Immediately we were greeted by the sounds of men working in the adjacent room, fixing the air conditioning unit.  There are no doors on any of the rooms, so whatever dirt may be flying around was shared by all.  The smell of a generator added to the nausea I was already feeling.  My confidence was waning.

The three of us entered a room that had two bed-like tables on either side of the room. Curtains hung from the ceiling on either side to ensure privacy.  If we were in the United States, this room would be for one person only.  Gary and President Diaz sat on the bed, there were no chairs in the room.

The nurse came in and told me to get on the table.  (My interpreters let me know what to do.)  Just a minute, there was only plastic covering this bed-like table.  Where was the paper that covers the table so you know it is clean.  As a matter of fact, not too much looked very clean.  "Do you have any identification with you?" Of course. I gave her my Iowa Driver's license.  A doctor came in and the two of them went to work.  Out came the blood pressure cuff which the doctor put on my arm,  and the nurse was going to take my temperature.  She pulled out a mercury thermometer and proceeded to put it under my armpit.  She started the timing.  The last time I saw a temperature taken like that was when I brought my children into the doctor when they were new babies.  But I was grateful she didn't want to put it in my mouth. . .no telling where that thermometer has been.

Lie down on the table.  Then the doctor pressed on my stomach. "Does this hurt?  Does this hurt?  Does this hurt?"  I thought I already told him that my stomach really hurt.  Maybe if I yelled every time he kneaded my stomach, then he would get the message. "Oh, he said, I think you may have a bacterial infection in your stomach."  Of course I don't understand what is going on and Gary is trying to interpret in between his conversations with President Diaz.  "Are you allergic to anything?"  Yes, these are the two medications I am allergic to.  "O.K."

Remember, that no medical history was done on me.  No questions about any medications I might be taking or anything about my personal self.

Out goes the doctor.  What is going on, I ask my trusty interpreters?  "I think they are going to draw blood." I'm O.K. with that, I thought, since that was what I had come in here to do in the first place.  So the nurse came back with a needle.

An interesting method they use here in this clinic is the nurse comes in carrying her little fishing tackle box that is filled with empty and full blood vials.  She takes OFF her rubber gloves, lays them on the table, then begins her procedure with bare hands.  She ties my arm with the elastic band tourniquet, cleans my arm with ample rubbing alcohol, finds a vein and inserts the needle.  Not bad,it didn't even hurt.  She must have done that a million times. She was a pro.  However, I looked down to see why it was taking so long for the little vial to fill up with blood only to see that she was not drawing blood, but putting something into my body! No one asked me if I wanted to be injected with something.  I turned to my interpreters.  What are they putting in me?  "Oh, don't worry," President Diaz said, "the first vial of medication is to protect you from the second vial of medication they will be putting in you. This will help the bacteria in your stomach."  So glad you told me, that really put me at ease.  Wait, I thought the blood tests were to determine what was wrong with me and I hadn't even had any blood drawn.

No sooner had I thought that, then the second nurse came in to take my blood.  The same procedure was repeated.  Off came the rubber gloves, and she cleaned my skin with about a half cup of alcohol that was dripping down my arm and literally soaked the sleeve of my blouse.  However, she did take my blood with as much ease as the first nurse, which was a great relief to me.  After the blood was drawn, she saturated several more minuscule cotton balls (which were sitting in an open clump on top of her tackle box) with her bare hands and put it on my puncture wound and walked out. I wanted to cry out, wait a minute, don't I get to choose which Disney Princess band aid I get?  No, there was not a band aid to be found.  As a matter of fact, there was not a sink to be found either.  I wonder where they wash their hands in between drawing blood from patient to patient.  (To be fair, there were no sinks that I saw. . .)

So I thought, well what else could they do to me?  "Does this hurt?"  The first nurse said as she pushed the plunger forcing more fluid up my arm.  I had nine children I told her, I can handle this.  "You win," she said. The first vial went in like a dream.  Then came vial number two.  "Does this hurt?"  O.K., maybe I'm not so tough after all.  It felt like she inserted a pipe in my arm instead of a needle.  Every time she came back to inject more fluid, it was worse.  So of course, Elder Fagersten and I started joking about all of our hospital experiences and we got the giggles.  I gave the nurse the evil eye every time she injected more into me until we got her laughing and President Diaz laughing.  Hey, you've got to have fun somehow.

We looked up and another person was walking into our room with another nurse.  You'll have to move she said to Elder Fagersten and President Diaz who picked up themselves, their keys, wallets, books and papers that they had on the bed and vacated it for this lady.  I didn't see anyone wipe down the bed, or put any protective covering on it.  She proceeded to lie on the bed.  Hmmmm.  I wonder who was on my bed before I laid on it.  Just say'in.

My medications were finished, the needle removed, and we thanked the staff.  Then came those terrifying words. . .come back tomorrow.  No way, I thought.  "We need to make sure your platelets go up."  I was pretty certain that I would be O.K.

Elder Fagersten and President Diaz went to fill my antibiotic prescription and then pay my clinic bill for blood tests, and whatever medicine they injected in me.  I had been under their care for about an hour.  I wondered how we would handle insurance for this and tomorrow's clinical tests.  Elder Fagersten paid the bill, we hopped in the truck.   Not wanting to hear the answer, I still asked the question. O.K., how much did it cost for an emergency room visit, doctors check up, two drugs injected, blood analysis and a prescription filled? Well, Elder Fagersten paused,  he said, "menos que 1000 pesos, or $20".  What?!  I would have paid an extra dollar if they would have given me a Disney Princess band aid!  I guess we don't have to worry about submitting an insurance claim. What I want to know is who pays the doctors and nurses?  That $20 could have only covered the cost of the supplies and tests.

The clinic

Back to the clinic the next day.  It was 9 a.m. we tried to open the door, but it was locked.  So we knocked and an employee opened the door for us.  We went in and a nurse brought us back to the last room (the one that was being repaired because all of the beds were filled in the adjoining rooms).  We walked past all of the people and smiled at them, wanting to give them a little encouragement.

"Sit down," the nurse ordered.  I looked at the bed, at the room and thought, really, you want me to sit here? The ceiling had about four open tiles where the men  had been working to repair the air conditioning.  There were tools in the corner, dirt all around, the bed had a huge rip in the plastic cover.  Let's see, should I sit on the big hole, or next to it?  I chose to sit next to it.  The procedure repeated itself.  The nurse took off her gloves.  This time I was sitting up.  I held my arm out in front of me as she tied the rubber band tourniquet around my arm.  She grabbed several mini cotton balls from her pile of open cotton balls with her bare hands.  She drenched them with the rubbing alcohol and wiped the arm.  With my arm suspended in the air, she inserted that needle without  any problem and the blood was drawn in a matter of seconds.  As we walked out of the room, the nurse turned to Elder Fagersten and told him he owed her 300 pesos ($6.75) for the blood analysis. Yesterday it was only 200 pesos ( $4.50) for the analysis.  It must be more expensive on Sunday. He paid her in the hall. No receipts, no questions, no forms to fill out.  About 20 minutes later the nurse handed us the results in an envelope.  The doctor looked them over and compared them with yesterday's results and talked to us in the waiting room and told us that things were looking better.  He asked again if I had any symptoms that needed treatment as he would write a prescription for any medication that I might need.  We told the doctor we're fine, thanks.  "Did you pay the nurse?" he asked.  Yes, we did.  "Then you can go." Gracias!  This was an experience I will never forget. . .well I don't think I will :-)

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