The typical day

                Finally, Monday morning came, a day I had been anticipating for over a year when I had signed up for the mission. I quickly got into a rhythm, waking up at 5 am, and out of the room in 10 minutes. I did laps around the retreat, which sat on a bluff, overlooking a verdant valley to the west and the town and more hills to the east. It was dark at first, but by 6 am, the orange and blue of sunrise started appearing. We had runners, fast walkers, and those who strolled by this time.

Sunrise during my morning walk

After breakfast, served at 6:30, we were on the bus by 7:15, and at the clinic by 7:45.

A typical breakfast
Photo by Mary Frazer

We started each day in the pharmacy to go over what the stocks looked like. Melissa, the other ER doc was in charge of the pharmacy, and she was awesome at keeping everything organized. 2-3 times a day, she would venture out and let us all know what was out of stock, or when the daily shipment arrived with new stock. Since she was a doctor also, she was able to freely substitute a drug that was available for that which was not, based on the diagnosis and what we wrote for. The pharmacy rocked all day to Melissa’s iPod.

                The logistics of the clinic were interesting. The patients signed up months in advance and arrived early.

Waiting in line to register for the day, at the back of the church
Photo by Barb Bigelow

When we got there, there were already 15-20 people in chairs in front of the offices. They checked in and stated who they wanted to see. Usually they went to General Medicine (or Peds) and Eyes, but sometimes, it was just medicine. I suspect there were times when it was only eyes, but I didn’t ever see those. Sometimes GYN was requested for PAPs or vaginitis or bleeding.

Line up of chairs in front of the eye clinic from the courtyard. The clinics were on the
left, and the church was on the right.
Photo by Barb Bigelow

A magic marker line was placed on top of the piece of paper they carried with them: blue for medicine, red for gyn, green for peds and black for eyes. When I saw the patient, they handed me the paper in various states of folding or rolling, with their name, age and city they lived in at the top. The next section was diagnosis, then instructions, then prescriptions. In the instructions section, I would put down non-drug things to do, like stretch, or sleep hygiene. These would be reinforced at the pharmacy. In the Rx (Receta) section, I only wrote down the name of the drug, and it was dispensed the maximum amount we could give, which was usually 2 weeks. Occasionally, I would write out a full set of instructions when it was not clear. I would then use a blue marker to cross off that they were seen, so they couldn’t recycle and see someone else, and send them on to their next station. Ultimately, they ended up at the pharmacy, where they all got vitamins, tooth brushes and tooth paste.

My view of the "on deck" patients, while Fidel gets the history

The Medicine consultation room. The tarps came down and the tables where I'm
standing were replaced by a real exam table.
Photo by Mary Frazer

For the actual consultation, I would have the patient sitting across from me, and Fidel sat next to them. I would ask, in Spanish, why they were being seen, and they would launch into their story. After the usual back and forth, I would do a problem-oriented exam, write on the paper, and send them on. About 80% of the time, they invoked God in their parting greeting to me, like “May God bless you.” They would shake my hand with both hands, or give me a little hug at times, then tootle off.

A couple of trees in the "waiting room" which was really the courtyard. Sometimes
chairs were all filled, and when you walk out of the room for a bathroom break,
everyone is looking at you. It was fun to say, "Buenos dias" to them, and they
all said it back, in unison!
Photo by Barb Bigelow