Strangely enough, I think I may have found it a more difficult transition returning back to work in the UK, than the initial challenge of starting work in Guatemala. Working in Guatemala was shocking for a number of reasons, but as I grew to understand the system and the culture, I found myself working harder, and achieving more. There is little more frustrating than not being able to help a sick and treatable child because the family has made the decision to leave it to God’s will. Until I began to understand and accept this as part of the necessary treatment regime, I found myself working against the system. After 5 months, and tears of frustration, I have learnt to negotiate, and to work with the family so they could accept medical as well as spiritual treatment.
I’ve returned for specialty training interviews, secured myself a training place for August, and I’m now locuming, and hunting for funding to get back to Santiago, to continue the great work.
I’ve been back for 3 weeks now, and I’m missing the drama and variety of Guatemala. I scrape the ice off my car every morning, saddened by the thought that there is no chance of me delivering a baby, extracting a machete, draining an abscess or frantically googling ‘how to deal with a lightning strike’. Not one of those things has happened on medical winter pressure beds, let alone all on the same day!
Working in Hospitalito Atitlan, I have had the privilege to use and exercise my brain and initiative more so than I find myself doing here. In Guatemala, if a patient presented with cough, fever, green sputum and signs on examination of a respiratory tract infection, we’d treat it. Initially I requested WCC’s, electrolytes and X-rays. And then the question was asked, ‘well why do you need it?’ I thought, and replied: ‘because they have an infection’. The logical answer to that, of course, is that if by using those 7 years worth of hard learnt skills you already know they do, why not just treat it?
Of course what this really boils down to is resource division, and trying to save the patient from spending the next few months diverting their pennies from other daily necessities, to pay off the bill for my compulsive ordering of investigations.
Since being back, I just wonder about all those patients getting daily bloods ‘to check that they are getting better’. Might it be more productive, and cheaper to determine this by asking the patient, looking at them, and performing serial examinations? There are of course times when investigations are appropriate to reach a diagnosis or to monitor patients, but often I feel that we are ticking boxes, crossing T’s and dotting I’s to protect or comfort ourselves. I saw a patient a few days back with end stage metastatic cholangiocarcinoma who had rapidly deteriorated to a semi-comatose condition overnight. When I suggested that perhaps he didn’t need a portable chest X-ray, I was jokingly told ‘You’re not in Guatemala now!’
The following day, while completing his death certificate, I realised that no one had even looked at, or used the X-ray that had been done as an emergency to diagnose or manage the patient.
I’m not saying that Western medicine has got it wrong, but in the throes of reparation of our precious and wonderful NHS, is resource division not just the same as preserving a rural Guatemalan family’s income so they can feed their children, but on a much grander scale? Perhaps we could all learn a thing or two from developing world medicine, for the least part to have more confidence in our clinical skills.
I’m hoping to fly back in a few weeks to be thrown straight back into a 24 hour on call. A new hospital is currently being built through the funds and dedicated work of Hospitalito Atitlan, which is incredibly exciting, but also an extraordinary amount of work http://www.hospitalitoatitlan.com/. I know that I can do good and meaningful work within the community of Santiago both with patients and with the ongoing development of the new hospital and the staff.
However I find myself struggling to find the funding to get there. Does anyone know of any organisations or foundations that provide funding for international work?
Louise Kenny has completed F2 year in the Northern deanery and has spent several months working in Guatemala.