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mercredi 9 septembre 2015


It is way past 7pm, and I have just returned to the Blue House after a day at a Medical Clinic, in an isolated part of this country, For the entire day, while feeling elated at the work we are doing, one becomes aware of the stress that Poverty alone can put one through.
By the forward vision of some of their ancestors, the clinic services are one of the few bright spots in their life. First of all, they are treated with respect, plus all the services are offered free, including all the medications and investigations.
Is there a big line outside my door in the clinic? No.
The priority of my patients is the Poverty they face rather than the sociocultural, patient oriented specialist service that I can offer in conjunction with some dedicated nurses.
A woman, who is barely in her forties, says I am going to be a Grandmother for the fifth time! Her son, who is sixteen, has made a girl pregnant, third in a series! Near my office is a big open jar of condoms any one can pick and choose and all the family planning services are offered free of charge!
Why then a sixteen year old, going around getting girls pregnant? How old are these girls, fourteen in this case!
She is a pleasant looking woman; I have known her for most of my time here in this isolated village. I was in the hospital recently, she says calmly, I was shooting up a drug and something went wrong and my whole arm was infected! She does not flinch as she gives me details of her life. She was thrown out of the temporary shelter of her own daughter’s house, before that she was thrown out by her own mother. She cannot remember the last time she was gainfully employed.
Please don’t judge this woman, she could be your sister or mother of your children, but the circumstances are different, she lives in poverty and in an isolated village where there is no access to almost anything except a clinic where she is welcomed by a doctor and a nurse she has known for a while. By the laws of this country I cannot prescribe narcotic medications, so that is not why she is coming to see us.
A little respite from the problems of the day, and night.  A place she knows she has friends, someone who would receive her with a smile, would not judge her, treat her as a human being, medically help her, before she disappears into the dark hole of desperation and suffering with no end.
I spend as much time as she wants; get her the medications, the e nurse making all the necessary arrangements for further treatment for her failing kidneys.
I don’t wish to discuss nutrition with you, I tell another patient, because I would cry at the end. They have no fresh food available and donations arrive in cans and all their attempts at being self-sufficient have been squashed by many government programs of help.
A school teacher arrives, at least she has a job, and the majority of my patients does not or cannot get jobs. Stress at work is driving up her blood pressure and we spend time talking about how to deal with stress. She is actually worse off than people who do not work, since her income precludes her getting assistance with food.
A pharmacist comes to reconcile the medications and we find that most of them are on medications prescribed by different providers, majority of the patients deny taking any of the medications on any regular basis. A great help indeed since we see the influence of much peddled drugs on the providers they had seen elsewhere.
Two nursing students arrive and they cheer me up a bit, as I tell them about the importance of a Nurse in such a situation and the socio cultural aspects of suffering and ill health.  The students are from middle class white families and for them these patients could as well be from Mars!
Another drives 90 miles having failed to get much attention at the nearby veterans facility and the entire hour is spent on convincing him the necessity to coordinate his medical care. After many a telephone calls we are able to get him a regular supply of his medications, but it may be already too late, as his kidneys were failing. He says to me proudly, if I live another 15 years, I would become the longest living member in my family, Poor people live way less years than the middle class white people in this country, in the case of my patients, the difference is close to 20 years!
Because of the nature of our patients, we can accommodate only about 8 or 9 patients in the course of a long day. Towards the evening I was getting emotionally drained. I had just travelled 4500 miles by air and 100 miles by car to get to this isolated spot.
I was happy to be here.
And I told the pharmacist who had come to help, as you have seen, these people need more than just medications, they need counselling, they need respect, they need comfort, they need friendship , the old fashioned friendship with tenderness, a non-judgmental look at their face and try to make them smile.
The highlight of the day was telling a young man that the Testosterone injections he has been receiving are not medically necessary. His face just brightened up as he thought he was suffering from some incurable illness. I had requested that the laboratory tests be sent to a reputable laboratory in California which returned normal values for this young man who had been given testosterone injections because he had complained of tiredness, and a laboratory value showed him to have low testosterone values.
The smile on his face was priceless!
I did enjoy my Cuba Libre…now to catch up on some medical literature while the silence of this village is so conducive.
Soon I would leave to join my Cuban Colleagues who work tirelessly along the Amazon River to bring preventive medical care to isolated communities, but these people, with whom I was today, whom I have known for a while now, would be in my heart.
You may wish to guess which country this clinic is located?
It is in the richest country on earth, The United States of America.