Recurring Medical Themes

Recurring themes of the medical consultations

                There were several recurring themes to their complaints. One was that they were fatigued, going on from a few months to many years. There was not anything specific most could tell me, except when they felt this way in the past, and were started on vitamins, they felt better. Everyone got vitamins. After the first day, I didn’t try to explore this complaint further. If I heard this, I’d tell them that they were getting vitamins, and they were happy. It seemed like they felt they had to justify their need for vitamins, so they said they were tired. We later found a way around this when we did group visits, and we told them at the start that all would get them, no matter what. During these groups, fatigue was not usually mentioned. Hmmm.

Photo by Barb Bigelow 

                The second complaint was headache. This was always explored. ¾ of the time, they would sweep their hand across the forehead and touch the top of the head when asked where it was. The rest presented with temple headaches with a few which sounded like migraines. About 10 or so told me that they were numb on the left side of the face, always the left, for some reason. I could never figure this one out. Sensation was intact and they were not tender. If they were sore in the trapezius (upper back), I would ask about stressors at home, and often, if they weren’t sore too. A few of them had significant stress and almost all of those couldn’t sleep. Everyone with this complaint at least got Tylenol or Motrin, and this made them very happy, even if it was only 2 weeks supply.

Photo by Barb Bigelow 

                Occasionally, when the stress discussion turned to tears, we discussed depression and if that was the case, I would try to get them up to 75 mg of Elavil, hoping they would tolerate it. I would then give emphatic instructions to either follow up with their doctor if possible, or at least go to the drug store and continue the medicine for 6 months, since a prescription wasn’t needed. I would make sure they had some support and if they didn’t, I’d call in the big guns…Sister Susan.

Sister Susan.
Photo by Barb Bigelow 

She’d make sure they were cared for. I got the impression that this was the first time a doctor had ever asked them about their emotional well-being.

Photo by Barb Bigelow 

                Another common complaint was “ardor en mi estomago” or buring in the belly. This was the code word for wanting Zantac. Once I ascertained that there was no GI bleed, they got what they wanted.

Photo by Barb Bigelow 

                A more difficult one was “malorina” or burning with urination. This would be intermittent, lasting from 2 months to 3 years or so. They ALWAYS, or nearly always, said that they would drink plenty of water, and the urine test would be normal. I don’t know what they were looking for with this one, and they all said that the urine was clear yellow- not the dark yellow of under hydration.  I just told them to drink more clean water, or sometimes, if appropriate, looking for vaginitis, sent them for a pelvic exam.

Photo by Barb Bigelow 

                The last common complaint was joint pain for 2 months to several years. If over 50, DJD was usually the cause, and younger patients had various different causes, just like at home. No carpal tunnel syndrome was found, though I looked for it. A few rotator cuff strains, tennis elbow (from wringing the clothes dry) and patella femoral syndromes were found.

Photo by Barb Bigelow 

                In general, obesity was not common, like in the US. They were generally fairly slender, at times a bit stout, and I only saw 2 or 3 who were over 200 pounds. One of these ended up having cholecystitis, and was sent to the hospital. More on her later. They walked a lot, most likely because they didn’t have cars. It was hard when the poverty level was set at $2 per day and about half were at or below that level. Gas was $4.35 / gallon, so things weren’t necessarily cheap there. Despite this level of poverty, they came to the clinic wearing their best clothes, and many of the women under 40 even wore a little eye make-up. Just like everyone, they appreciated it when I shook their hand, made eye contact and read their name aloud to them.