I’m just days away from my departure from Roatan, and I can’t believe it. Somehow, this city girl managed to adapt to the island life. I spent the last few weeks happily doing the same things each day at a very relaxing pace. I am so grateful for the opportunity to have worked in the RVPC with Dr. Charles, Karina, and Rom. They really made an effort to include me as they treated patients and I learned quite a bit in the process. I’m also thankful for the relationships I was able to form with patients and their families. This is the aspect of medicine I look forward to most. Finally, I will not forget the peaceful walks home from the gym at night where nearly each night afforded a sky with an incredible display of stars and an accompanying lightning storm.
A quick summary of my last week in clinic: The patients we saw were sicker this week, and many had very interesting histories and diagnoses. Thus, although we didn’t have too many more patients, we spent a lot longer in clinic. I also learned that the nurses had been cutting us off at around 15 patients, which is absurd because we had two doctors each day. We asked them to make the default about 25 appointments per day, which will increase when Charles returns from the United States next week.
On Friday, the second baby died in the wards since I’ve been here. Although I was not there to see it happen, both Rom and Karina were really affected by what happened. Apparently Karina showed up in emergency to admit a patient from the clinic and saw a baby that was on the ward turning blue. The resident was suctioning the baby but no one was using a bag or trying to resuscitate the infant. She ran back to our clinic, got a bag, and tried to resituate the baby herself, but it was too late. Although everyone agrees that the baby should never have died, it did have signs of multi-organ failure and its prognosis was not good. Nevertheless, it seems hard to imagine that something like that could happen under the care of trained medical personnel in a hospital.
The other baby that died weeks ago died because of some kind of misunderstanding between the mom and the doctors in Roatan. She was told to get to a public hospital in La Ceiba for an exchange transfusion for her baby who had Rh disease, but she went to a private doctor on the mainland who told her that her baby was fine and needed no treatment. By the time the mom brought her baby back to the hospital in Roatan, he was essentially dead. This was a tragedy because the baby’s prognosis was good and the treatment for Rh disease so standard.
These are the kinds of situations that make practicing medicine in a third world country seem so difficult. I have heard Karina and Rom express frustration about the lack of available diagnostic tools or even standard first/second/third line drugs for treatment. I can only imagine how difficult it must be for a doctor who knows exactly how to treat a patient to not be able to do so because the treatment options do not exist. It seems unfair and inequitable that in certain parts of the world prognoses vary for a similar condition merely because the standard of care is not available. To accept this is to accept that certain lives are less valuable than others. This cannot be. Although I am aware of the arguments regarding cost-efficient treatment of patients in the third world, I am unable to forfeit lives to keep costs down. This is a subject matter that my experience in Roatan has uncovered for me and one I hope to pursue in the future.
