At the beginning of this week I was pleased to see the ever-present "flag of the syndicate" removed from the entryway of the hospital, signifying the end of a three-and-a-half week strike. It's not clear to me what kind of resolution the workers and administrators came to, but from what I've heard the workers' demands were not completely fulfilled. The hospital seems to be up and running, though, and everyone seems to be in a lot better mood, so my life is a bit simpler now that the strike is over. Patients are being attended to and hopefully the hospital will see a return to some modicum of normalcy in the coming weeks.
Monday and Tuesday were surprisingly slow (only 12-15 patients per day), and I think that's probably because word was still getting around the island that the hospital had reopened. We had one interesting case of a mother coming in for a regular well-child check for her four-year old son (which is pretty much unheard of in our clinic), and she said that she comes in for monthly check-ups because he had had had leukemia. I duly recorded her comment on the chart, and looked back through his medical record for some more detailed history. The child had in fact visited the hospital with some regularity, but never mentioning any history of cancer. We checked the kid out and he seemed fine, and it was certainly possible that he had received effective treatment years ago for cancer, but something in the story seemed a little odd. The mother proceeded to tell us that she also had "cancer of the blood," as did her other baby, at which point we guessed that she was probably talking about sickle-cell anemia. Later in the day I spoke with someone who knew the mother and suggested that she was known for getting baby formula from free clinics to sell on the street, so my "index of suspicion" of the mother's spurious history increased significantly. Fortunately the situation we were in didn't put the child in any danger (except maybe an unnecessary blood draw) and we were able to confidently do what the mother asked (confirm his good health) without wasting many resources, but it certainly exposed our vulnerability to exploitation by our patients. We have to balance our trust and willingness to help the community with a reasonable level of skepticism. The role of this organization is to provide medical care, not to encourage entrepreneurship through black-market drug and baby-formula markets, so from now on I will actively try to keep my eyes open to the exploitation not only of community members, but also of community organizations.
When it started pouring down rain on Wednesday, I had to chuckle as the patients disappeared and the hospital quickly started filling with water. Luckily our clinic seemed safe from serious water damage, but I do not lie when I say that water was coming into the hospital from above, from below, and from all sides. As we drove away through several inches of standing water I saw one hospital worker futilely bailing out the hospital lobby with a small bucket. I think that providing first-rate evidence-based medical care is a fine goal for any public health system, but maybe a solid roof should be one of the hospital's first steps in achieving that goal. It's amazing that we are trying to build so much up on such a weak infrastructural base. Modern medical technology costs a lot more than a leak-free roof, but without an effective roof in place (and clean sanitation, and running water, and proper ventilation), the medical technology will be useless.
Thursday and Friday I was happy to see that the hospital dried out significantly, and we continued seeing patients, although fewer than normal probably because of the persistent rains and the quickly eroding roads.
In the afternoons Christine and I have continued working on drug donations and prepared for the upcoming tutoring session. Hopefully the last few pieces of paperwork will come together and we can see short-dated pharmaceuticals knocking down Peggy's door in no time.
In the meantime Christine and I have been baking a lot, running on the beach when the rain abates, playing Skip-Bo in our dark apartment during the downpours, and enjoying the company of other volunteers. Despite the rain, we've enjoyed a respite from the heat, and we look forward to sunnier skies someday soon (I think right now the wind is finally dying down after five blustery days). We also enjoyed meeting a young Canadian who works with HIV/AIDS testing, counseling, treatment, and prevention in Roatan. The three of us shared our different perspectives on the public health network here, and learned a lot from each others' experiences.
