During my last Turno, I saw two patients who had clear diagnoses and needed transfer for care that I could not provide in Santiago Atitlan, but whose families refused to allow the patient to go.
The first was an 80 year old female with acute left eye pain, headache, and photophobia. She had acute narrow angle glaucoma on exam, although I was not able to check intraocular pressure. After searching the pharmacy, I was only able to find one medication out of 3-4 recommended medications for this condition, which helped some but didn't fix the problem. She was going to require treatment by an ophthalmologist if she was going to keep her vision. I discussed this with the patient and her family. The family decided that they did not want to have the patient transferred, nor did they want to take her themselves, despite understanding that she would likely be blind in her affected eye without treatment. I believe it may have been related to financial concerns, however, they would not tell me this. Care in the national hospitals is free; the family only has to pay for transfer to the hospital (which is 200Q or about $30). The patient left the hospital with her family, with a bottle of the only medication that we had to treat her condition and the invitation to return should they change their minds.
The second patient was a 3 year old female with abdominal pain, fever, and anorexia for one day. Her examination was very consistent with appendicitis. I discussed the diagnosis and need for treatment with antibiotics and surgery with the patient's mother and grandmother. They declined any treatment of the child until they were able to discuss the problem with the child's father, who was out of town for a few days and not able to be reached. Despite repetitive explanations about what could happen to the child without treatment and pleas to at least allow antibiotics to be given until they were able to reach the child's father, they left without any treatment.