Saturday, February 8, 2014

Going to the Hospital in Spanish

Oh hi guys.

So it turns out I have a severe bacterial infection in my intestines.

For reasons I will not elaborate upon, instead of going to the museum field trip scheduled yesterday, I waited at school for my (host) mother to pick me up and take me to Hospital Vozandes's emergency room.

On the bright side of having a severe bacterial infection and having spent seven hours in an emergency room (we'll get to that in a second), this situation gave plenty of time for the public health nerd in me to do some observations.

Before I went to the hospital, I was instructed by everyone to exaggerate my symptoms so that they would agree to see me in the emergency room and not ask me to make an appointment, as well as to see the doctor more quickly.  When I entered the waiting room, I saw why this was the case- it was full.  But it turns out the waiting room is for the extended families that come to visit.  Huge groups of people turn up, not just to the regular hospital like in the U.S., but also to the emergency room, to support their family.  So, in reality, exaggerated symptoms were not necessary.  In triage there was only one person, a Chinese-appearing young man who could not stop coughing (luckily he was wearing a mask), with his mother.  So I was in my room and being seen by a nurse in about fifteen minutes, and I'm pretty sure it wasn't because I am American.  I have never spent this little time in an emergency or urgent care waiting room.

My host mother kindly requested a doctor that spoke English so that I would understand what was going on and not be scared, which was a good idea considering technical terms.  The nurse that first came in changed me into one of those stupid hospital gowns that was totally unnecessary for our purposes and filled out my intake form, asking me questions in Spanish.  This was terrifying because I knew from the U.S. that this is what they would primarily use to assess me and that I needed to communicate my allergies and the medications I had been taking.  Also I was half naked for a reason not at all apparent to me.  The nurse did not speak any English, so I did my best in Spanish and my mother requested an English-speaking doctor again.

In no time at all, a team of three doctors entered my little curtain partition of the emergency room and did the assessment again.  They decided that I needed a stool sample, a urine sample, and a blood sample for testing and that they were going to give me hydration via IV.

The IV hydration felt really unnecessary to me, but I remembered that medical malpractice laws are extremely strict here, so they were probably taking every precaution.  I kept this in mind as they took my blood from one arm and put the IV in the other.  My mother told me not to look, but I was looking to make sure everything was sterile.  This is, of course, a paranoid response.  I was at a modern hospital in Quito, probably the best city in Ecuador for having a medical procedure, being attended to by qualified professionals.  But they were sticking stuff in my veins and I wasn't taking any chances.  The IV was terrifying.  I have never had one before, I was really not sure I needed one, and the doctors didn't tell me exactly what was in it (saline solution) until my mother called one over after seeing the panic on my face.

The IV went into my right wrist, right below my Brave bracelet.  This was the first time I felt like I needed the reminder since I have been here.

I found the staff to be effective and kind, and after the initial scary testing, I had a really uneventful time.  We watched the IV solution drip into me painfully slowly for about five or six hours.  I slept, talked to my mother, met her sister who came to visit, listened to her tell everyone on the phone that she was in the hospital with me, and drank the Oralyte they gave me.  When my nurses changed, the new one actually came to introduce herself, unlike the other one, and poked her head in every now and again to make sure I was still okay.  When I needed to go to the bathroom or had a question, my mother simply grabbed the attention of one of the nurses that was always walking by.  (I give thanks every day for her assertiveness because I am not yet used to this way of being.  For example, it is encouraged to interrupt your professor if you have a question in the middle of lecture.  I feel, though I have not been told, that this sort of attitude permeates everywhere.  So long as you are polite, getting what you want or need requires being direct and interrupting.)

I spent a lot of time thinking about my visit and what it might mean in the larger context of the Ecuadorian health system.  People (especially me) seemed to stay in the emergency room a long time.  I explained to my host mother that there aren't enough beds in emergency rooms in the U.S., so people wait a long time to be seen by a doctor unless they are dying and are then sent as quickly as possible on their way.  I doubted that they would ever hook someone as well as I was to a five hour long IV in an emergency room, but I didn't know for sure.  I did not feel like I was getting special treatment because I was American.  There simply were sufficient beds that day and the doctors weren't taking any chances.  It surprised me that there were so few people waiting because Ecuador has a doctor shortage probably worse than the one we do in the U.S. and a resource shortage far worse.  But there are tons of hospitals in Quito, so I am guessing that the problem is more for the wider country.  I have heard that people who get severely ill in the more rural areas need to be transported to Quito- nowhere else can provide the level of care the hospitals do here.  This, obviously, can be extremely dangerous.

I also felt an immense amount of empathy for people who speak little or no English in the United States, who are not familiar with the health system, and find themselves, like I did here, in need of medical care.  I have studied this population in depth for one of my classes and intellectually understood why it is important to have doctors who speak the language of the patient (not, as is usual, unofficial, untrained interpreters), why it could be prohibitively scary for cultural reasons for this population to go to the doctor or hospital, and why health outcomes for this population are generally worse than in cases where the patient and doctor speak the same language and come from similar cultural understanding.  However, intellectual understanding is not at all the same as this deep, gut understanding that I now have at least part of.  The frustration at not being able to communicate symptoms, the fear that something will go wrong because you are not being understood, the terrifying feeling of entering a space where you have no idea what might happen to you, the anger at not feeling your medications were properly explained to you.  I have felt all of that.  And did I mention that MY doctors spoke English?  I simply cannot imagine using an interpreter, especially not an unofficial one, in a medical setting.

In the end, everything will be fine.  I have stronger antibiotics than my doctor in the states gave me (which I had already been taking but apparently did nothing).  I have to rest and eat bland food for two or three days.  I hate that I cannot go out and have fun and see and learn things here, but I always try to have a positive attitude because I am living my dream simply by being here.  So I see seven hours in the emergency room as a valuable learning experience, as well as a sort of bonding time with my host mother.  I kept saying I was sorry that we were here among all of the germs and that it was taking so long, and she kept saying that it was no problem.  When at first we thought they hadn't found anything wrong with me, she said that at least we were together for the day.  (My host family rocks.)

It was a bit embarrassing and overwhelming to receive as much attention as I did yesterday, but I also feel very loved and glad that there are so many people here for me, come what may.

1 comment:

  1. Your study-abroad journey is already more complicated than mine was way-back-when. I'm jealous that you have a host family. I think that it really does increase the experience (compared to sharing an apartment with Americans like I did). Your host mom sounds like she's quite the advocate. Feel better soon, and I look forward to hearing more.