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homes and honk our horns to notify the villagers of our arrival . We pull up to a long , teal concrete building labeled “ Dolores Medical Post ” and start unloading the plastic bins from the trucks . Inside the clinic , we rearrange the haphazardly placed desks , chairs and examining tables to make a workable waiting area , pharmacy and examining area . The patients line up and slowly trickle into the clinic at a manageable pace . During this time I get to know Dr . Brown , the other Hillside director who also happens to be married to Dr . Thomas . Quite the contrary to Dr . Thomas , Dr . Brown is confident yet conversational , near-inappropriately sarcastic and adoring of the little Mayan children , whom he chases around the village as they squeal . He quickly nicknames me “ Typhoid Mary .”
Around 2 p . m ., the entire village suddenly seems to show up to clinic . Dr . Brown starts to get nervous , and he and I jump in and start seeing patients ourselves in addition to staffing patients with the students .
“ Double up ! Double up !” Dr . Browns yells to the students and the pharmacists , but the limiting factor is the two nurses we have to translate the Mayan dialects for us . After loads of fevers , impetigo , cold symptoms and even potential cancer diagnoses later , we finally start packing up around 4:30 p . m .
Days # 4 & 5 , The Camp-out , Part II
1700 . Rudy arranges our cabin ’ s dinner on the small square plastic table topped with loaves of white bread , American cheese , lunch meat , sliced tomatoes , lettuce , mayonnaise and mustard . He lays out tortilla chips and salsa as a treat , and we all devour our sandwiches in near-silence . We have a 6:30 p . m . teaching session planned for the village , and Rudy strings up two light bulbs attached somehow to our truck for power , which lights up the inside of the clinic fairly well . We set up rows of plastic chairs and the villagers file in excitedly ( not so much for the education piece , but for the prizes we give out afterwards ). With the help of some handmade posters , the girls present a small bit on basic wound care ( clean it , elevate it , and go to the clinic if it doesn ’ t stop bleeding or looks infected ), and try their best to engage the villagers , who mostly just giggle . Finally , we reach the prize portion of the evening , which involved drawing numbers and then making the contestant answer a question about wound care before they claim their prize . The prizes include small plastic sandwich baggies with assortments of colorful pencils , small plastic toys and even a pair of fuzzy “ Dora the Explorer ” flip flops ( won , of course , by a guy ).
Afterwards , we lay our foam mattresses onto the wooden floor of the cabin and plan to play a card game called Spoons , which I had never played before , and found out after winning multiple rounds that I had the rules all wrong . Whoops .
I sequester myself in another room with the nursing staff so that I don ’ t keep everyone up with my coughing all night and roll out my thin foam pad and layer my sheet and blanket on top of it . I make one last trip to the dreaded latrine ( I cannot even describe the pungent , disgusting smell , only that if I could no longer hold my breath , I was literally gagging ) and hurry my way back to the cabin . The night was filled with multiple coughing fits , wild dogs walking up and down the front porch , intermittent “ cock-a-doodle-doo !” from the roosters and a couple of bug bites , but overall not terrible . After a hurried breakfast of instant coffee and peanut butter toast , we pack up and head to the next village over in Oxotaca . The clinic is busy , and children gather around the open doors just to watch what we are doing . Pigs oink by in the grass outside and at a certain point , a chicken bursts forth from one of the windows and plops onto the exam table . Charlotte looks up from her note and shakes her head . “ You just cahhhn ’ t make this stuff up .”
With all of its merits , doctoring in a third world rural setting also has certain major frustrations . I can deal with the lack of running water , no electricity , the bugs , the farm animal visitors and even the language barrier , but the hardest remains the feeling of helplessness when you know there is nothing more you can do . In the parallel medical universe of the developed world , the same patient would have a diagnosis in half a day and likely multiple treatment options . But when you ’ re facing a 56-year-old woman who ’ s lost 20 pounds in two months with new onset vaginal bleeding , you have to send her home knowing she ’ s likely got end-stage cervical cancer and there ’ s not a thing you can do about it . Patients can ’ t even afford the meager fares for transportation to get to the closest hospital three hours away , much less the out-of-pocket expenses for diagnosis and treatment there .
Similarly frustrating is the issue of follow-up , where your next visit to that particular village may not be for another month or so , making all decisions default to worst-case-scenario and often over-treatment just because you can ’ t be sure the patient will make it until they are next seen by a provider . For instance , a four-month old baby presents with a 102.9F fever — an exceedingly high fever for an infant . While the baby also has a cough and a runny nose ( making a serious bacterial infection less likely ), it ’ s pretty scary sending a child that young home with only Tylenol and presumptive malaria treatment knowing the mom can ’ t run to the ER in the middle of the night if things get worse . So then what ? Do you give a dose of intramuscular ceftriaxone just in case ? Or try to trust your better instincts and just hand mom the Tylenol ? It ’ s hard . It ’ s really , really hard .
We load up the truck and pile in for our three-hour bumpy ride back to our home in Eldridge . I watch the thatch roofs , the colorful handwoven skirts , the piglets , the chickens and the little brown faces of the children all slowly disappear in the rearview mirror . I close my eyes and pray silently for that baby .
TO BE CONTINUED …
Dr . Perotta is Medical Director of Adult Congenital Heart Disease and Assistant Professor of Pediatrics at the University of Louisville School of Medicine in the Division of Pediatric Cardiology at Norton Children ' s Hospital .
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