La Clinica

This week I began my work at the health clinic in Santa Rosa, about a 20 minute combi ride from my house in Cusco. I cant begin to talk about my work at the clinic without first explaining the combi system. The combis are small- to medium-sized vans that run on bus routes around Cusco and the surrounding neighborhoods, and cost only 60 cents (in soles, mind you) per ride. The tricky part about the combis is getting on and off; they stop only briefly at a bus stop to open the door while someone manning the door yells out upcoming stops auctioneer-style, while telling you hurriedly to "Sube! Sube!"-get on! Often the combi will start to drive off before the door closes behind you, and you have to wrentch yourself up into another passenger's lap to stay on board. Getting off is just as tricky: you yell "Baja!" when you want to stop and pay the person manning the door as you are hurried off the combi, making sure to get your change before the rickety vehicle starts to move again.

The clinic I am working at is very small, containing one room each for an obstetrics unit, a pediatrics area, a dentist, a psychologist, a general doctor, and a laboratory (some of which are located in an outdoor area behind the building itself). After lining up in front of the clinic before the doors open in the morning, patients wait in the crowded hallway for what can sometimes be hours until they are seen. My first day I was placed in the obstetricia to work with the obstetrician and a nurse for my first rotation. While I spent a lot of my time sitting quietly and observing the doctor-patient interactions, I actually got to examine a patient and extract secretion samples on my first day! So far I have also helped to examine many pregnant women, locating their babies heads and listening to their hearts, and have helped update lots of hand-written medical histories. Today I got to spend some time working by myself with the general doctor in the clinic as well, which was great because he let me examine all the patients with him as he explained not only what he was doing but why. I got to observe several ultrasounds and learned the formula they use to ascertain whether a woman's belly is the size it should be for her weeks of pregnancy.

Throughout the course of a morning we see around 20 patients, so I've already been exposed to a variety of medical issues and patient scenarios. What first impacted me the most was noting that the average age of the pregnant women coming in (many already with toddlers) was 23. I saw a 16 year old and two 20 year old girls my first day working, all of whom were due to give birth before the end of the year. After talking with the médico today I learned that many women coming into the clinic, which draws mostly quechua-speaking patients from rural areas, actually started having children around the age of 15! What was further hard-hitting was the fact that many of the women coming in for prenatal checkups were malnourished, anemic, and underweight. While the obstetrician (whose demeanor is much like that of Christina from "Grey's Anatomy") scolded them and told them what they needed to be eating, I couldn't help b

ut wonder if some of these women had control over their dietary intake. Many came in without any sort of seguro, or insurance, and confessed that they ate mostly soup, potatoes, and bread- common sources of sustenance in poor, rural areas of Cusco. It was sad to watch these women get reprimanded; you could tell from their eyes that they worried just as much for the health of their babies as did the obstetrician.