by Danielle Dittrich
December 17, 2009
This week one of my prenatal patients that I had been caring for since I first arrived here in Xela had her baby. She was a gestational diabetic, so although she had had her last 5 children at home with a comadrona she agreed to go to the public hospital for the delivery. She borrowed a cell phone from her neighbor to call me when she started went into labor and decided to go to the hospital. I met her there as soon as a finished seeing my patients at the clinic. I couldn't play any major role at the hospital, but I think it was good to see a familiar face; she cried when she saw me at the OB triage station.
The public hospital has a bad reputation, which is seemingly fitting. The hospital looked pretty similar to the hospitals I visited when I interned for the public health department in the Dominican Republic. I assume that most public hospitals in developing countries look similar. The largest problem with that being that due to lack of space and resources, patient rooms are dormitory style with 10-15 patients depending on the unit. In peripartum units this is not as much a problem because women with the same chief complaint, such as postpartum are bunked together. However, I remember this being a huge problem in the Dominican Republic on general medicine floors where lack of resources would lead to immuno-compromised patients being placed in the dorm with respiratory illnesses and other infectious diseases, leading to cross contamination; I have heard that it is the same at the hospital here in Guatemala. But developing countries are called developing for just that reason. The hospital looks like what I might imagine a hospital in the states to look like some 30 plus years ago, and the equipment is just as antiquated as the original building structure.
But despite whatever image or feelings the description may conjure up, it is not the physical building, but the people that work there that gives it its reputation. The majority of the patients that visit the public hospital are indigenous. The hospital is only a last ditch resort after all herbal medicine and traditional healers having failed. It is incredible to me how life just 20 minutes outside the city can be like living in a different world, but it is in fact the way it seems. The indigenous rural women only come into the city to go to the market, to buy or sell their goods or agricultural products. There is a lot of racism that still exists against the indigenous Maya; some of it still remains of the civil war. Most hospital staff including doctors and nurses is not indigenous and therefore this racism seems to permeate the services provided. The patients are often not respected and instead are rather looked down upon, seemingly passed over and ignored.
I remember distinctly, one of my most vivid memories from the time that I lived in the Dominican Republic, one of the other girls that I interned with was told by the doctor to administer an injection. At that point, over 2 years ago, neither she nor I were trained as nurses or in any medical capacity at all. She politely declined giving that reason exactly but the doctor responded, "It doesn't matter he is a Haitian". The overt racism in the Dominican was absolutely unbelievable to me. It's execution easy, due to the blatant difference in skin color. In Xela, this distinction is more difficult and may mostly rely on the preference of indigenous clothing. However, as I spend more time here, it seems that the roots of racism may run deeper than I had imagined.
When I arrived at the hospital the patient had already been laboring for a few hours. The patient did not have any of her prenatal records with her; however I was shocked to find out that the doctors were not treating her diabetes, the exact problem that she was being sent for. I spoke to the doctors for a while, to find out why. Apparently, they had asked her if she took any medication during her pregnancy. She said yes but she did not know the name of the medication because she cannot read. Rather than asking what the medication was for and investigating further, her affirmative answer was just ignored. (There seems to be a very high illiteracy rate among the adults in the Valley of Palajunoj. It makes it difficult to give medication instructions. Often times we are forced to rely on pictures or the assistance of children or neighbors). When I arrived and told them the medication and about her diabetes, they quickly scrambled to pull together the diabetic services previously ignored. Unfortunately, I was not permitted to stay past visiting hours and had to leave the patient, still laboring, at about 4 o'clock.
In the morning, I went to the corner store where her sister works to find out about the baby. She had called her late that night to let her know that the baby was born. I returned to the hospital that afternoon to hold the adorable 6lb baby girl in my arms. The patient was having trouble breast feeding so the baby still hadn't eaten. She had asked for help, but once again it was ignored. I sat there with her while she tried a few more times until eventually successful. I sat around with her and her sister for another hour until visiting hours ended. Unfortunately, no one had made it clear to her that she couldn't eat anything if she still wanted to get her tubes tied that day. I informed the rounding doctor, which meant that she would have to wait a whole other day to have the surgery and go home.
Yesterday I visited the patient at her house. The 5 brothers and sisters seemed very excited about their new sibling. The baby looks a little jaundice so she is taking her out in the early morning and late evening sun for an hour. I promised to visit again today and to check on the baby.