I almost missed the clinic entirely. It was a steep, narrow, 2-lane mountain road with ramshackled houses and buildings on both sides. With the grade and the glaring sun at this altitude blinding me through my too-dirty windshield at 7:30am, I was lucky to see a sign on a building on which the word “Dengue” stuck out amidst the text — this had to be it. I pulled into the dirt/rocky driveway and through the rusty white gates, trying in vain to park my Texas-plated, double-cab pickup into a parking lot made for Volkswagens. As there were still no signs which carried the name of the clinic, I thought maybe I was in the wrong place, but soon I saw a classmate arrive and felt relieved. There was a talk going on about condom use, but from my vantage point, most of the people I saw listening were elderly. If one of these men had a condom in their wallet (a point stressed not to do by an monotonously scripted talk) on the off chance they may get lucky, I certainly didn’t want to know. I would find out later, specifically when it was my turn to talk about AIDS prevention–in Spanish–that these talks were part of the deal: the government pays for your visit and you listen to public health lectures so they hopefully don’t have to pay more later.
They split us up into groups, some with doctors in consultorios, or exam rooms, and others in the nurse’s station. The first shock was the room itself. A rusty exam bed with the thinnest of cloth sheets covering a nearly rubbed-clean, flattened black pad was the first thing I saw. There were huge stirrups winging off the bottom, one of which was broken. Even in the exam room, the sounds of roosters crowing would be audible all morning, which added to the ‘rustic’ nature of the setting. The doctor’s desk was a typical, industrial green metal institutional variety with a fake wood top, a squeaky well-worn chair that one would barely consider garage sale material was comfort compared to the bare-metal chairs for patients. I should mention that the “normal” course of seeing a patient in Mexico is for the patient to come into the doctor’s office to talk. Only if the doctor feels an exam is necessary is one given; the main point is the dialogue between doctor and patient in a front-behind desk way, not the exam table way. Patients are absolutely, positively unquestioning in what their doctor tells them, at least to their faces. I am constantly referred to by patients and proper doctors alike as “doctor,” which is uneasy. Even the patients whom I know know I’m a student still call me doctor, because for them, since I know so much more than they do about medicine, I deserve the title anyway. I only say this to give you an idea of the mentality of the public at large. We certainly don’t go calling each other “doctor” on campus or be referred to by that by our lecture professors of course, so it’s a change.
Most of the patients are extremely poor. They arrive by walking and/or bus, waiting patiently on a first-come-first-served basis to get a ficha, or numbered ticket. Mexicans are often called lazy because their culture does not really value time pressures, but these people are up at the crack of dawn for something as simple as a blood pressure check. For those that do have appointments, it’s often way too far in the future to make it worth a damn, such as the uncontrolled, in-denial diabetic (“why should I have diabetes if I don’t drink Coke anymore?”) with a lab reported glucose of 350 from last week who is given some metformin and told to come back in 2-3 weeks. Since everything is government (federal or state) paid, there are strict prescribing guidelines. Amoxicillin, ampicillin or erythromycin are given 90% of the time an antibiotic is needed, almost regardless if that’s the best abx for the job. If an anti-inflammatory is needed, naproxen 90% of the time; if it’s serious, then the remaining 9% would be something gut-wrenching, like diclofenac. Runny nose or cold symptoms? Why chlorpheneramine, of course. There is no care in telling patients what common side effects they might experience (particularly w/NSAIDS–casually saying “take it with meals” is NOT the same as “this might make your stomach hurt”) and pills are dispensed (as everywhere in Mexico) in the original packaging from the drug manufacturer, so there are no helpful stickers and/or informational printouts from the pharmacy. In fact retail pharmacists are not pharmacists, but 7-11 clerks with a slightly widened vocabulary; pharmacy as a career proper seems only to be confined to the lab and hospital.
On top of our week-long rotation, we have to go get journal articles, write the book-report style patient histories, by the end of the week (very similar to the style that most MS2 or MS3s start having to do in the US but of course, in Spanish), so this new schedule that doesn’t involve a lot of classroom work is a difficult adjustment, particularly when you factor the commute, etc. I will write more tomorrow, but for now, I wanted to pen this introduction as the start of a 3 or 4 part series. I hope you enjoy.