Diseminados. verugas. comezón. especialista.
Reading Paul Farmer and Gustavo Gutiérrez’s latest book, In the Company of the Poor: Conversations with Dr. Paul Farmer and Fr. Gustavo Gutiérrez, has been a wonderful complement to my time here thus far. I finished it just over a week ago, while sitting on Don Ciro’s front steps in Honduras as the quiet street before me was just beginning to awake from its slumber.
In the Company of the Poor is a conversation between Farmer and Fr. Gustavo Gutiérrez, one of his long-time idols and mentors. Bringing together the concepts of social medicine and liberation theology, Farmer expounds upon his inspiration for working towards a “preferential option for the poor” in healthcare. One quote in particular that struck me: Pg. 99 “For anthropologists, the messy details of everyday life and personal experience are considered central to ethnographic understanding; a physician is expected to elicit patients’ views and experiences and also to understand pathophysiologic processes that are seen everywhere and are the reason why an x-ray or a laboratory result, or a surgical procedure, are not so dissimilar or context-specific that a radiologist or a pathologist or a surgeon trained in Boston would be of no use in Haiti.” This potential harmony between the anthropologist’s and the physician’s training is perhaps the best way to describe what I seek to find during my time in Mexico. As an aspiring physician, the chance to experience healthcare delivery in a setting with its own unique belief systems, customs, and history—and to call that place my home for three months—is nothing short of fascinating. What follows are a series of brief vignettes about the days I spent with two visiting dermatologists and how they added to my perspective of healthcare delivery in more ways than one. And more than anything, they are about this, the hardest job you’ll ever love.
“Cúbrete mi cielo” said Alba, the visiting dermatologist from Mexico City who had been spending the past two days treating patients in our small clinic in the community of Honduras. She was speaking to a young patient, no more than five years old. I’ve observed many doctors with different bedside manners, but I had come to appreciate her ability to pepper her intentional, direct pieces of advice with phrases like these. “Cúbrete mi cielo” which literally translates to “cover yourself, my sky” was Alba’s way of reassuring her young patient as she finished examining the young girl’s bare back for similarly patterned white patches. The examination complete, she looked the young girl in the eyes and began her explanation. With pen and paper in hand she then wrote down notes in her beautiful script, being sure to repeat where she felt emphasis was needed and to pause every so often should a question arise. I had seen her do this more than a dozen times before by now—each time with the same intentional gaze, the measured speech, the endearing tone. It didn’t matter how old or young her patient was, Alba was a warrior in doctor’s scrubs, fighting to deliver healthcare across cultural and social lines in a way that no medical school textbook could have done. Just as Spanish and English were constantly being translated back and forth in my head, Alba too was translating what she had learned into something she could deliver. And then too, it was not just delivery, but inherently a response to each individual patient and his or her unique fears, questions, and circumstances. “Y eso sería todo” (and that will be all). Alba said it with a hint of finality and a wealth of grace every time she handed the paper with her treatment plan to the patient and searched their eyes for lingering questions one last time before she bid them farewell.
My iPhone flashlight was the surgeon’s light. But Alba insisted, “la verdad es que tiene mucho” (the truth is that you have a lot here (at the clinic)). She was referring to supplies, despite Argenis’s apologies that this or that surgical tool or piece of equipment wasn’t available. We were in rural Honduras after all. But this is also where I have had the chance to see the true creativity of the medical practitioner surface in real time. Here, you have to be able to do more than recall the correct algorithm from diagnosis to treatment—since the tools to get you there may not be available. No, you have to be the artist. The inventor. The problem solver who isn’t afraid to use what is available–rather than what the books say should be–to find a solution.
In the clinic’s operating room
That was to be my first biopsy, though I imagine it would look quite different if it were conducted in a hospital back in Boston. Still, it gave me an opportunity to observe the doctors talking back and forth as they discussed the patient and the case in a different setting than the typical consultation. This wasn’t a doctor-patient interaction but rather a doctor-doctor interaction as they bounced ideas off one another and worked together. I realized in that instance that even though I may be trying to immerse myself in Spanish here, I know that what I want to be more than anything is fluent in the specific language of the healthcare practitioners around me. Despite being a mix of native Spanish and English speakers, I see all of their eyes alight with the same excitement when they discuss one particular condition or the possible responses to another. In those moments, they are clearly speaking the same language.
Estrella fugaz. Shooting star. As we left Honduras behind, the two dermatologists and I were snuggly fit in the back seat of the 4×4 as we began our descent out of the mountains. It was dark, but I had utmost trust in Moi, who would be driving us that night. At one point, though several in the car were already keeled over in exhaustion, he stopped the car suddenly. I was confused at first, but then glanced at Moi and followed his lead. Sticking my head squarely out the window, I looked up. Never before have I seen a sky so lleno de estrellas (full of stars)—not in the refugee camps of war widows in northern Sri Lanka nor shining over a small community clinic in the village of Shirati, Tanzania. In the end, I decided that it must have something to do with these mountains. These ever-growing, ever-green, ever-mysterious mountains. On the one hand, their towering presence reminds me just how close I am to the ground. On the other, they remind me that they also have an incredible ability to carry us all closer to the stars.
Y eso sería todo.