miércoles, 18 de julio de 2007

The Socioeconomics of Healthcare

Now that I've been working long enough at both the Hospital de Clinicas and the Hospital Militar to get over the initial shock value and start to observe interesting things about the patients, I've begun to realize quite how different the two institutions are. Both are governmental institutions (not private), but there are a few key differences. The Hospital de Clinicas treats the poorest patients in La Paz and El Alto, and it seems that most patients (understandably) use it as a last resort for medical treatment...which also means that most of the illnesses are quite grave by the time they are treated. The Hospital Militar, in contrast, is open to members of the military and their extended families.

Most strikingly is how differently the patients dress in each institution. In the Hospital de Clinicas the people dress in the “indigenous style” (forgive my crudeness, I don’t know how else to describe it) – the women wear the clothing typical of cholitas, and the men wear simple pants and sweaters. There is no makeup, and things are often worn, stained, or torn. In addition, people bring their snacks or chores (the sister of one patient brings her knitting every day) to the waiting room. In the Hospital Militar, the women wear paint suits and makeup, and they dye their hair, while the men wear nice suits or military uniforms and have shiny leather shoes. Interestingly, the Spanish is also a lot easier to understand in the Hospital Militar, probably because it has less of an Aymaran accent.

It’s kind of interesting to think about how in one place I’m seeing a woman with peritoneal (abdominal) tuberculosis, while in the other I’m seeing a little boy who has a wart on his hand. I’m sure there are areas of the Hospital Militar with more serious infections, but compared to the Hospital de Clinicas it feels like a walk in the park. For example, today a mother brought in her 6 year old boy who had some sort of viral warts or pox in the interior of his bottom, and for treatment (they’re contagious I think) they had to be removed one-by-one with a pair of tweezers. This involved having the boy lay down on his stomach with his pants pulled down as the nurse attempted to anesthetize his bottom. His mother was telling him that it wouldn’t hurt at all, but as soon as he felt that needle, he started crying, screaming, and clenching the muscles in his bottom. “Tengo miedo de las agudas, quiero ir a casa AHORA!” (I’m afraid of needles, I want to go home NOW!) I felt genuinely sorry for him, because until recently I’ve had a mortal fear of needles (along with fire), and I always hated when doctors would tell me that the needle wouldn’t hurt when it was always extremely unpleasant. But at the same time, the situation was inherently funny – here were the nurses wrestling with this little boy’s clenched but muscles while his mother told him to stop crying. I didn’t know whether to cry from sympathy or burst out laughing.

I find it hard to take an episode like that seriously after treating infected bedsores.

1 comentario:

Anónimo dijo...

I wonder if you'd find similar differences in the US? Probably not as dramatic, but I bet Cook County hospital in Chicago is quite different from Northwestern? Certainly the patients would be different and would have different expectations from the staff.

Of course, you'd never find open wards in the US these days!