Sunday, September 16, 2012

Medical Care - El Salvadorian Style

Current Location:  San Mateo, CA

Fall is here and are counting down the days for our return to El Salvador and back to our sailboat, Knee Deep.  We have tentative plans to be in Costa Rica for Thanksgiving, Panama for Christmas and through the Panama Canal in January.  'Tentative' being the key word....a cruiser's life is always flexible!
As promised here is a look back at another experience while in El Salvador…
Flashback #2 – Living in El Salvador; A Trip to the Medical Clinic

I’ll be honest, I really liked going to the doctor up until I was about 9 years old.  It was all about the cool toys in the waiting room, my mom reading aloud Mrs. Piggle Wiggle books while I lay in her lap and the vanilla milkshake I received afterwards.  But following my emergency appendectomy, it never really was the same.  Doctors were now people associated with hospitals, operations and I.V.’s.

This worked out just fine considering my father’s philosophy on medical attention. You only needed to go if limbs were hanging precariously from your body or there was a loss of consciousness.  Considering we were a family of eight and he worked two jobs, it was not a plausible option to cart six children back and forth to the doctor. I have memories of coming home with contorted fingers and bloody cuts on my legs only to be shuffled into the bathroom where the triage would begin. As a result I grew up believing duct tape, rubber bands and popsicle sticks were the standard in first aid.

My favorite memory is when I came home from a soccer game with two particularly bloody wide open gashes on my shin (I wasn’t wearing shin guards because…well, shin guards were for pansies…have I mentioned I have three older brothers?). My dad took one look at me and said, “I think we’ll need to go see Mich for this one.”

At his point you are assuming Mich Michelin is the doctor who resides in the neighborhood and you would be absolutely……...wrong! He was actually the Italian father of three down the street and a sheet metal worker by trade, however, he was the Boy Scout troop leader and he must know something about deep cuts bleeding profusely, right? So I hobbled towards his house and anticipated the expert medical care I was about to receive.

Fortunately, Mich didn’t have other patients that day and I was seen right away. After some head scratching and mumbling, it was decided the course of treatment would be a butterfly bandage. Needless to say, I still have two deep scars prominently displayed on my right shin, but I did not bleed to death and my soccer career continued without a hitch. This is what the youngest of six children can only hope for, so you don’t put up a stink about seeing a “real” doctor instead of Mich Michelin.

So as my ear began to hurt during our stay in El Salvador, I dismissed it as a minor issue and assumed it would clear up on its own. After several days, I had a throbbing ache in my right ear, lost my ability to hear and had trouble walking a straight line.  Ben frivolously suggested seeing a doctor. It did not take long to convince me this was a good idea and once the decision was made, I instantly turned into a babbling nine year old, asking him if he would take me so I didn’t have to go by myself. I did not, however, insist he read me a Mrs. Piggle Wiggle book. 

After dropping our kids off at our friend’s boat, off we went at 7:30 in the morning to catch a bus to the “Clinicia de Zapote”, which apparently was just down the road. As we left the marina, we found a taxi sitting at the entrance. He assured us he knew where it was, yet stopped to holler at the security guard asking him in Spanish, “Where is the clinic?”

After driving past it a few times, we reached our destination which concluded with us flying down the two lane highway for a ½ mile in REVERSE. Apparently there were too many cows in the road to do a U-turn so this was the only practical option.  We thanked the transportation Gods once again for our safe arrival (not a foregone conclusion when traveling on buses or cabs in El Salvador).

We entered a fenced in yard with a beautiful garden and walked towards a cinderblock and concrete structure. Approaching the entrance, we were met with the friendly, “Buena” and a genuine smile, which is the norm here in El Salvador. People were quietly waiting in plastic chairs bolted to the ground in the open air clinic.  Over and over again in El Salvador, I observed that people have infinite patience about waiting, whether for the next bus or necessary medical care.  Maybe it’s that they take nothing for granted as they are a country in a lingering hangover of a civil war.  After watching your family and friends being dragged away or killed in battle, waiting in line for groceries or for the doctor just isn’t a big deal.  This is only a personal conclusion I’ve come to, perhaps as a culture they were this way before. I can’t be sure since I have never stepped foot in El Salvador until now. Living here has provided me with insights about my own feelings of entitlement and how to be more appreciative of my life.

So the two gringos walked through the door (sounds like the beginning of bad joke) and were met with collective stares which we have grown used to. We engaged in conversation with the clerical staff, which after a game of half English, half Spanish coupled with charades, informed us the doctor was not in today. He would be back tomorrow at 7:00 a.m. To be clear I inquired again, “Sabado? Siete en la manana?” (Saturday? At 7 in the morning?).

A smile and nod confirmed that this was the case. After reading the hand painted signs on the walls, I deducted that most people were seeking dental attention on this Friday.  Baffled that a medical doctor would be holding examinations at 7 in the morning on a Saturday, we hopped on the bus back to the marina.

I awoke bright and early the next morning and hopped back on the bus at 7:00 a.m. By the time I arrived, there were already 20 – 30 people waiting to be seen. I spoke with the same clerical staff that showed infinite patience with me as I fumbled my way through the paperwork. Finally, the woman looked at me kindly and took the paper from me since I was unable to understand most of the questions. The doctor appeared and helped me fill out some of it, with the whole episode ending with the papers mostly incomplete. They looked at me, smiled and shrugged their shoulders, saying in Spanish, “You can go sit in a chair and wait to see the doctor”.

I made my way tentatively to one of the plastic chairs and took in my surroundings. Not a boutique office by any means, but it was clean and I was confident they couldn’t screw up my ear more than it already was. I noticed the armed guard standing at one of the rear exits, a familiar sight in El Salvador.

Apparently after the war, this was one way to employ the many men who had been trained as soldiers (a good part of the male population). We soon discovered this has continued as an economic strategy, not because there was danger around every corner. Upon closer observation, we saw most of the security guards’ weapons are old American automatic guns that are rusted through and contain no ammunition. I must admit it was intimidating at first.  While shopping at the El Salvadorian equivalent of Costco, it can be unsettling seeing a 30 foot guard tower looming in the parking lot, with a gun toting man’s silhouette. However, it’s interesting how quickly we became accustom to this. The security guard at the fabric store actually helped me carry my bags to the van.

So as I sat in the waiting room next to a father holding his feverish daughter, I did not give the armed security guard a second thought. After 30 minutes I was called over to have my blood pressure and temperature taken.  There was no fancy forehead scanning thermometer, just a simple mercury stick I knew as a child and was told in Spanish to put in under my tongue. I chuckled as I waited and waited for the nurse to return, until I remembered that these things took a long time to work. After all my vitals were taken and documented, I returned to my seat.

Soon afterwards, I was called into the examination room which was clean, but sparse. No magazines, televisions or fancy whiteboards for kids to draw on while waiting for their turn, just a chair, a desk and an examination table.  The doctor, who was about 30 years old, smiled and the conversation/charades began.  Communication was further hindered by my inability to hear out of my left ear.  Fortunately, I came equipped with my Spanish dictionary and a list of medical terms given to me by our friend Ann.  I passed the time during the bus trips and in the waiting room, practicing what I would say and surprisingly it translated well enough. Upon further conversation, I learned that the doctor did speak some English, but was embarrassed about speaking it.  I completely understood this, having spent the last six months bumbling my way through the Spanish language.

As he reached for the lighted ear examination thingy (sorry don’t know the technical term), he signaled for me to come closer since it was hard wired into the wall.  He started to place it in my ear, when suddenly he pulled it back and started banging it into his palm to get the light working. In broken English, he said almost apologetically “sometime it work, sometime not so good.”

We both chuckled and shrugged as he gave it another try.  This time he was successful and confidently diagnosed me with an outer ear infection. I was then told to return to the waiting room.  Curious as to what the next step was, and a bit confused of how this all worked, I sat back in my plastic chair waiting as he examined more people. After 20 minutes the doctor called me back in and wrote some notes on a piece of paper, directing me to go to the pharmacy to get medication. We shook hands and I thanked him profusely.  As he was about to call his next patient, I asked him where the closest pharmacy was.  He smiled….one of those, “oh, poblecita” smiles……..walked me across the room to a window and pointed to a sign, “Pharmacia”.

This consisted of a plexi glass window with a hole cut in the middle and a metal folding chair on the other side.  Soon one of the clerks came over and asked for my paper. She opened the door to the room which consisted of concrete walls and metal shelving with boxes of antibiotics, ibuprofen and other things I couldn’t quite translate.  You see in El Salvador and Mexico a prescription is not required for antibiotics, high dosage Ibuprofen, some sleeping pills and pain killers.  On a single bus ride, a person can buy a week’s worth of Cipro and some darn good pain killers along with some pupusas and a mango on a stick. I’m not exaggerating.  Vendors hop on and off at bustops selling all sorts of products.
This is the only pic we have of a bus vendor. This particular guy was selling fresh cut fruit.
Mickey enjoys his 5 cent watermelon slice. You can just spit the seeds out the cool!
So to be honest, I was not surprised that the clerk from the office was doling out my antibiotic ear drops and a butt load of high dosage Ibuprofen. Instead I thought, “Damn, I love this country!”  After loading up on my meds, I shuffled over to the office once again and asked how much I owed.  The woman in the office looked at me, quite baffled by my question and said, “nada”.

Confused I repeated again and showed them my money. She giggled and said, “No, no, no. Nada.” 

I then tried to offer up a contribution of a measly $10 which she vehemently refused. So here I was in a 3rd world country, living on a sailboat using their government funded health care system and there was no monetary compensation they would accept (and probably thought I was bribing them in some sort of manner). So with a respectful nod to Miss Manners ….I sat back down in the hard plastic chair and wrote a thank you note in Spanish.  Using my dictionary, I cobbled together a note expressing my appreciation.  It was the only thing I could think to do. 

When the doctor appeared again, I handed over the simple note feeling like a little school girl.  As I was apologizing for the mistakes, he looked up with a surprised look in his eye and thanked me.  

So I hopped back on the bus and returned to the marina with my new stash of meds. When I got back, I immediately googled the antibiotics given to me and this is what I discovered:

It is considered a prototypical broad-spectrum antibiotic, and as it is both cheap and easy to manufacture it is frequently an antibiotic of choice in the Third World…….. Due to resistance and safety concerns, it is no longer a first-line agent for any infection in developed nations…. Nevertheless, the global problem of advancing bacterial resistance to newer drugs has led to renewed interest in its use”

So there you have it, a good old fashioned, no frills antibiotic and my experience with a third world government funded health care was a positive one.  From the other cruisers I have talked to, this has been the typical encounter.  Within two days my ear was on the mend and I had regained the ability to hear all the frat brothers on the Floating Frat House.  Then again, maybe I should have held out a few more days!
The guard tower at the El Salvadorian Costco
Surpsingly the bus vendors don't sell these.....only in the store. Fifth roommate on the Floating Frat House?? I think NOT!!!