Today was
my first day at the clinic. Although the day began pretty innocuously,
it became quite interesting.
This
morning was again canned peaches on my way out. I got to the clinic at 8:00 and
went to the consultación (consultation) where I
would have my first “rotation”. Luckily, while I didn’t remember the man in
charge, he remembered me and we got along very well. The consultation is set up
as follows: first the patient who desires an HIV test has a pre-consultación (pre-consultation) where a
psychologist goes through a lecture about HIV, AIDS, treatments, and life
expectancy. They explain what test will be run and how to avoid contracting HIV
in the future or spreading it. They have these lectures every hour on the hour
and you must go to one of these lectures before you move on to the lab for your
test. After your test, you wait 45 minutes for the test to run and then return
to consultación to get your results.
You receive your results through a certified psychologist. There is a room
right next to the consultation rooms for anyone who is having a hard time
adjusting to their diagnosis.
During my
first pre-consultación, when we were
going through the presentation a women raised her hand to ask “Why are we here?
Where did all of the other people who were in the lines in the lobby go? Why
us?” They explained to her that those people were HIV+ and in line for the
pharmacy and that the people in the room were here for an HIV test. She seemed
satisfied with this answer and listened for a little while longer. Then she
asked, “Can HIV be transmitted through a toothbrush?” The doctor went back to
the slides explaining how the disease was transmitted and said that it was
impossible because HIV is not transmitted through saliva. All of the presenters
that I observed were very good at explaining the disease in the most basic
terms and connecting with the patients. For example instead of saying here are
the symptoms that you will have if you get HIV one woman said here are the
symptoms that I will get if I get HIV. What can “we” do to prevent the disease?
“We” can wear condoms, “we” can not share needles, etc. They explained that the
prueba rapida (fast test) looks for
antibodies to HIV, while the longer test for which you must return to the
clinic in 10 days looks for the antigen (the actual virus protein) During that
10 day period the clinic also runs tests for Hep B, C and syphilis. After the
presentation they fill out a questionnaire that asks about their sexual habits,
and their general life style.
After
that I worked the front desk for a while triaging all of the different people
that came to the clinic. While I was there I learned about NOM – the norms of
practice for Mexican physicians. All doctors (whether they are in a government
hospital) or not must follow these norms. The norms dictate what medicine to
prescribe in which situation; every procedure, every prescription, every
diagnosis is outlined in NOM. There is no way for a doctor to side step the
norms and use their best judgment either. This whole conversation started
because I asked if it was common to stop and restart treatment for HIV as it is
the USA. The theory is that the virus adapts to each drug that you use against it,
eventually becoming resistant. Then once you see this spike in virus (carga viral or viral load) you switch to
a different antiretroviral that attacks a different part of the virus. Years
later once you have rotated through all of the drugs available, and the HIV is
resistant to them all, a new practice is to stop treatment entirely for 6
months to allow the virus to adapt back to its optimum form in your natural
body. That is, without the presence of drugs in your system the virus will go
back to the way it was naturally. Then, after their respite, one should take
and combination of the original drugs to eliminate (hopefully) all of the virus
in your system. This practice is at least 5 or 6 years old because we watched a
video about it in 9th grade biology. Yet, when I asked the doctor
about it he said that they don’t do that in Mexico as it isn’t written into
their NOM. There apparently is no way for a Mexican to received this type of
treatment in Mexico, no matter how much they pay, where they go, or what they
do. To receive it they must come to the USA and pay for the expensive consultation
and antiretroviral on their own dime.
This
conversation started a personal reflection about socialist medicine vs
capitalist medicine. (Skip this next academic paragraph to get to the story
about my new bff the suicidal murder, rapist, druggie, and prostitute.) That
moment I realized as I looked out at a line 50 people long and 3 hours long and
as I read Mexican NOM that this scenario was exactly what struck fear into
American hearts when they hear about “socialist medicine”. Does it have to be
this way I wondered? Does universal health care have to be sub-par? Perhaps if
the government is going to pay for medicine they want to know exactly what they
are going to pay for. It seems pretty unrealistic for a government to write an
open check to doctors and say run whatever tests you want, whatever procedures,
whatever medicine you want. Can systems of government paid and regulated
medicine for the indigent co-exist alongside of a capitalist top-notch system?
Maybe. But wouldn’t the people in the government health care feel slighted?
This seems to segregate people into categories poor and rich. (Wait, isn’t that
already what our current system does? Place those who have insurance above
those who don’t?) Additionally, once you have doctors doing whatever they want
to, practicing they way that they see fit, it will be very hard to ever change
that. Especially with the enormous lobbying power of the AMA. As I reflected
about the nature of the Mexican health care system, I found that maybe some of
the American fears may not be that far off. The money just isn’t there without
that capitalist incentive. The computers don’t work well, and the lines are
long, and the doctors tired. I began to think about health care in terms of a
simple x,y coordinate graph with annual income on the x axis and quality of
care on the y axis:
On the
left is what I think everyone agrees would be a perfect world: everyone
receives the best care possible regardless of income. However this is nearly
impossible to implement. How will the ACA implement the USA’s graph? Will the
USA work to move towards cutting government costs or focusing on universal
care? Will Mexico try to emulate the USA’s health care system as its president
hopes? Will people in Mexico lose coverage? We’ll just have to wait and see.
Back at
the front desk, three guys came into the clinic straight out of jail. They
reeked to high heavens and each carried a bag with all of their worldly
possessions, but because they fit all of the criteria – they had
identification, they hadn’t eaten in 4 hours (probably much much more), they
claimed that they weren’t under the influence of any drugs or alcohol (highly
debatable), and that they had 2 hours to devote to the test, they got a free
HIV test just like everyone else (including the impeccably dressed businessman
in a suit next to them on the waiting bench). They got a little rambunctious
waiting for their test results so one of the councilors took them to the space
where people could have the peer-to-peer chats so that they wouldn’t disturb
everyone else.
Lunch
came and went and I had forgotten about them. Then, after lunch I was wandering
around looking for something to do and I ran into the guy I had been following
the whole day talking to one of the men that I had connected with some. The man
recognized me, and the doctor invited me to come sit down. The man did not look
happy. But with all of the scars covering his face, I wasn’t positive. The
doctor showed me his chart. All of the results were negative. I look at them
and happily said, “Wow! That’s great!” But the man shook his head back and
forth. “No, the sheet is wrong. I have to be positive. I want to be positive. I
was a prostitute and haven’t ever used a condom and I know I should have HIV.”
As I tried to comfort him, he looked up at me past the scars where his eyebrows
should have been with tear-filled eyes and whispered, “You don’t know me. I
don’t have a heart.” My own heart skipped a beat, I swear. I was sure this was
some slasher movie where he would lunge out and slit my throat, cut open my
chest cavity and take my heart, cause, you know, he couldn’t find his.
I
composed myself and said “No, no. That’s not true. If you didn’t have a heart
you wouldn’t be crying. Tears come from the heart.”
“You
don’t know me,” he repeated, “I have done unspeakable things. I was a
prostitute; I have killed people. I shouldn’t be clean. I don’t deserve to be
clean.” Through his tears he pleaded, “Its my time to die. Please, the results
must be positive. They must. Death doesn’t scare me. I am ready to die. I can’t
take the pain any longer. I have had men die in my arms from this disease; I
want to die, too.”
The
councilor from the peer-to-peer program offered him a tissue and ushered us out
to the patio tables. Through his tears he told me about his life. My Spanish
isn’t great, and its even worse when its through a mouth blubbering with snot
and tears, deformed by countless knife wounds. From what I gathered he killed his
first victim when he was 12.5 years old. There was something about a mother and
her 7 year old daughter. Maybe he raped one of them, maybe he killed them both,
maybe the mother had to watch her child die, I was iffy on the details. But it
was bad news bears. As he rounded the corner he ran smack into a police officer
that arrested him for the first time. Since then he had killed un montón de gente (a bunch of people). He
worked as a prostitute “dando el amor a gente que me pagaba y a gente que no
(me) querría” Because of the aforementioned blubbering I’m not sure exactly
what he said. The “me” in parenthesis changes the sentence from “Giving love to
people who paid me for it and to people who didn’t want it” to “Giving love to
people to paid for it and to people who didn’t love me). From the rest of the
conversation though, I’m fairly certain he has rapped many people, though. He
said he had an anal infection that almost killed him, indicating that he was
either raped or had consensual sex with men. Afterwards, the doctor and I
decided that it was probably consensual. At one point in his life he was shot
in the leg and the bullet cut his femoral artery. “If you weren’t such a lady,
I’d show you my groin” he boasted. When he was in the hospital he didn’t think
he would be able to walk again. He prayed to his patron saint and promised her
that if she would allow him to walk again that he would walk the 500 km to
visit her shrine-thingy-ma-bob. He kept talking about his “dolor tan grande que
no me aguanto más” (his great pain that he
couldn’t take any longer).
Throughout
the conversation he brought up God. “Why would God do this to me? Why wouldn’t
he take me from this earth?”
I
swallowed the atheist rhetoric that was bubbling up inside me and for some
reason decided to play along. I don’t know if it was that I had no idea how to
say any of the big words associated with my atheist schpeal and that I had
heard the religious words in Spanish a million times over, or if it was that I
knew I would instantly lose any connection I had with him and might as well
have just gotten up and walked away. Whatever it was, I told him that, “God has
bigger plans for you. This is why he didn’t make your result positive. God
never gives us more than we can handle. You can handle this life.” He would
protest and list another atrocity he had committed, another murder.
When his
results came back from today he said a prayer, asking for them to be positive.
(Up until now we had just been revising the results from January, which were all
negative. He took the test in January and never came back for the results
because he was taken to jail again. But during his time in the clinic, he had
gotten another quick HIV antibody test done.) The doctor showed me the result
and pointed to the date, the type of test, and the result. Showing me the (-)
symbol and then pointing to the word “negative” on another sheet of paper. He
asked me if I would like to give him the news. I nodded and the man began to
whimper again. He asked, “Are they positive?”
“No”, I
responded. “You’re clean.” The man began to sob. Not just a tear here and
there, table-shaking, nose-dripping, body-quivering sobs. I spoke of his second
chance, of an opportunity to start over. An opportunity to pay back all of the
people who have helped you by helping others. There is so much good you can do
with your life still – go do it.
He
grabbed my hand.
He began
to pray. I could smell the alcohol on his breath as he thanked God for putting
the doctor and me in his path. We were angles, he said. (Oh if he only knew. I
almost protested at this point that God was certainly not pleased with me, but
I swallowed me cynicism.) After he had exhausted all of the prayers he knew and
he had complimented every part of us. Our hair was suddenly sacred. The
doctor’s physique was that of a knight. I had beautiful eyes. The doctors hands
were magical curing machines. I was a princess of medicine. I knew he had lost
it when he said he liked my nose. Proof positive of complete intoxication.
Finally when there was a lull in the conversation and the doctor got up to
leave, he protested and grabbed both my hands, which were holding his hand,
with his other hand. “Tell me a wonderful story,” he asked.
I said I
didn’t know any stories. “Why don’t you tell me your favorite story instead” I
suggested. Lo and behold he asked me if I knew the story of Stone Soup. Did I
know the story of stone soup? Of course I did! But I wanted to see how the
story had changed from when my mother told it to me. The basic premise is that
a wandering traveler boasts to a village that he can make stone soup. The town
is incredulous. He traveler asks for a big pot for the soup. Into it he lowers
a huge stone. Of course, for the soup he will need water to boil it. And
perhaps some onions to flavor it. He stirs it and tastes it. Of course he will
need carrots as well. On and on it goes until he has asked for everything one
could need for a soup. He doles it out and it is delicious because its real
soup that the villagers gave him with some stones in the bottom. The end.
Our
favorite suicidal murderer, rapist, and prostitute didn’t quite reach the end.
In fact he got to onions and then started praying again. But the premise was
the same. It was really cool to see how stories have migrated across boarders and
inspired all types of people.
Eventually
the man’s friends came over and all got negative results, too. They were all
happy as clams, he praised God for the beautiful results, thanked us, promised
he would come visit me at the clinic tomorrow and left. He won’t be back.
After
that, my day was significantly less interesting. I filed forms 1100 through
1800. It was a ball.
I got
home at about 4:45 and washed my hands about 100 times. I don’t know if it was
the pound and a half of hand sanitizer that I put on, or the residue from the
hundreds of penciled-in forms that I filed, but I just felt covered in ick.
Eventually I went out for dinner and picked up canned vegetables and peaches,
and yogurt at the corner store. Plus peaches. Did I mention the peaches? It
looks like I’ll be set for a while. And it’s a good thing that I left when I
did as it just started raining cats and dogs. Huge thunder and lightning. Good
thing I have an umbrella for tomorrow morning.
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