Thursday, April 21, 2005

The Clinic

We work in the clinics Mon - Fri from 8:45 - 12:00. Occasionally we'll have some patients in the afternoon (OK, once). It is actually a really nice clinic, complete with nurses, a pharmacy, a lab, an x-ray machine, U/S, a small OR for minor procedures and 3 rooms in which we see our patients. And it is all pretty well stocked. They work on what is called the "30 baht system" which means they can all be seen for 30 baht each (less than a dollar) and then they have to pay for extra procedures/medicine - but it is all still pretty cheap.
It is definitely *a lot* different than working in the states. People here just don't have a good understanding of their bodies. They'll tell you they have low, low pelvic pain - so of course, reluctantly, you do a pelvic exam only to realize in the end they have a gastric ulcer! Not even remotely near their pelvis. They just have difficulty telling you where things hurt. Another irksome quality is the fact that they *never* bring their medicine with them, or know what their taking, or know what the last doctor said is wrong with them - they just don't realize this is important. But they are all just too adorable and so you can't ever be genuinely annoyed, and they are all very thankful. Most of them come to our clinic because they trust us, but they don't trust the other doctors in the hospitals, and they know that we genuinely care. That's nice...
It's also a little frustrating, a lot frustrating, because you can only do so much. There are serious limitations. You can't even put anyone on Coumidin (blood thinner) because you can't take an INR (to monitor the level of the drug - which for all you non-med. people is actually rat poison. That's right, your grandma takes rat poison every day for her heart...)
All of the people are really sweet. It's funny because all the men come in complaining of dysuria (it hurts when they pee) but only when they are working out in the fields - it's because they aren't drinking any water as they sweat half their body weight away and they get all dehydrated. Simple stuff like that. Of course, there's plenty of not so simple stuff too, and we don't have the resources to diagnose it. Another sad thing is that if you have chronic kidney disease they can't get treatment in this country - dialysis is too expensive so they just don't offer it!
How blessed are we to be born, and live in the county we live in. So many Americans have NO idea...but that's another blog.
A lot of the patients I see work in the rice fields - all day. No one is ever really clean. There is just a gradient of dirtiness - but you don't really notice it after a while. Everyone wears flip flops so feet are just in a constant state of being covered with a thick layer of dirt. I think I'm even a little dirtier! Especially with all the extra sweating - yummy!
This really is the land of smiles. I had one old man come in - he must have been smiling his entire life, the few seconds you could catch him not smiling you would see these wisps of white coming out at the edges of his eyes, like crows feet only it was where the sun had never hit. He smiled so much that the creases in his eyes never relaxed long enough to be tanned by the sun. How sweet is that :)


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