What??? No Germ-X?...

No pictures for this one. For those of you who don’t know, I’ve been dealing with some serious gastrointestinal problems the last 8 days. It hit me hard the day after we did the clinic and even after daily doses of Imodium and a round of Cipro, I’m still not much better than I was at the onset. So, after much discussion, and a 2 to 1 vote, it was decided that I needed to go visit the doctor this morning.

We had met this doctor once before when we were here last summer. There is a lady here in Managua named Miss Ruby who lives down by the dump. Many of the groups that come here go to visit Miss Ruby. She’s actually from Bluefields which is over on the Atlantic side and she’s Miskit Indian. Miss Ruby was ill last summer and could not (or would not) go to see the doctor. We went with Susanna to pick up Dr. Diaz to make a house call at Miss Ruby’s. She has little regard for physicians but she loved sparring and quizzing him on the Bible…as she does with everyone who enters her colorful little house.

Well, today was my turn to be treated by Dr. Diaz. Susanna picked us up about 8:30 this morning and we got to his place close to 9:00. He runs his practice out of what would have been the living room of his very modest little house and he and his family live in the rest of it, in a typical little neighborhood. It’s first come, first serve and the waiting room is his front porch. There were chairs set out on the porch and thankfully, it was shady. When we arrived, Susanna commented on how unusual it was that there wasn’t a group of people waiting, that he’s a very good doctor and is exceptionally good at tropical medicine. Sounded like my kind of doctor. The only other people there were the lady in seeing the doctor and a young woman waiting with her little girl, probably about 3-4 years old .

Although Dr. Diaz is a Minsa certified physician and surgeon, he does not work in a clinic or a hospital, choosing instead to be somewhat like a general practitioner of days gone by. There was no check-in window. No paperwork to fill out. No request for id or proof of insurance. No music in the background. No magazines. No television mounted up in the corner on the wall. No Norman Rockwell prints to smile about. Nothing other than 8 wooden chairs, a slight breeze, a wall of bougainvillea and the daily street business for entertainment. It was one of the most relaxing times I’ve ever had in a doctor’s “waiting room”.

When it was our turn to go in, Jim and Susanna accompanied me - Susanna to translate…Jim to worry. There wasn’t going to be anything private about this doctor’s visit, that was for sure. And honestly, the way I felt, it didn’t matter…I just wanted “fixed”. After being ushered in to the room, the door was double locked. The room, which had a working window air conditioner, was actually nice sized but it was packed. The walls had all kinds of anatomy charts posted on them along with scriptures that had been printed out from a computer; there was a cluttered bookcase on one wall which was filled with aged medical journals, magazines and an assortment of books that all looked like they had seen some wear and tear; a small sink was loosely attached to one wall; a very basic, old cantankerous examining table…sans protective paper took up another; shelves which held all kinds of emergency type items – bandages, alcohol, sprays, etc. were behind the doctor’s desk…none of the items were sealed – hermetically or otherwise; a small bathroom had been built in one corner and right in the middle of the room was Dr. Diaz’s desk with two chairs in front (topped with little upholstered cushions), his chair and his little examining stool to the side. There was a small older laptop on one corner of the desk and behind him, on a portable desk/table, was an old typewriter.

But the desk was the focal point without question. Piled high on it were mounds and mounds of medications…of all sorts. Because of the heat and humidity here, most medications come in little sealed packages vs. bottles containing loose tablets. Otherwise, the meds would mold…yes, it really does happen. I’ve seen vitamins that were only a few months old that had not been kept sealed up and they were beginning to be a bit furry. Bulk packaging is much more economical in the States, but here, it just translates in to waste. Back to the desk…it was amazing. I wondered how on earth he even knew what he had and if he did, how could he ever find it. If my dad were still living, he would have had a fit seeing medications just heaped up like that in total disarray. Obviously, Dr. Diaz doesn’t know that they are to be neatly lined on shelving in alphabetical order. I kept thinking to myself that this poor man needed a locked cabinet to keep his drugs in.
Somehow, in spite of obsessing about the mess on the desk, (the thought did cross my mind as to how I could manage to just tidy things up a bit without causing a great cultural offense…obviously, I couldn’t so I tried to avert my eyes), I also managed to notice there was no sanitizing soap dispenser on the wall and no sight of disposable gloves. As a matter of fact, I was beginning to notice just how dingy this little office was. It obviously needed a fresh coat of paint, there wasn’t even the faintest smell of antiseptic and I doubted seriously whether any hard surface had been wiped down prior to our coming in. There wasn’t even a sign of a single Germ-X bottle. For a moment, I wondered about just what kind of exam I was going to be given. But my thoughts were soon interrupted. The doctor was struggling trying to pronounce my name…he opted to go straight to his computer and start entering the info there.

After getting all my vital information via Susanna, including my formal education (I guess living to this age feeling the way I’ve felt the last week wasn’t that impressive). He then listened intently as Susanna told him of the week’s issues and unsuccessful course of treatment. Dr. Diaz asked question after question in rapid-fire succession. He talked a mile a minute and had a very busy manner about him. Reviewing all the info he had just entered in to his computer, he sat and looked at me for a few seconds and then jumped up, having Jim and me change seats so he could take my blood pressure.

He pulled out an old blood pressure cuff and very gently, placed it on my arm. Taking my blood pressure wasn’t remarkable…the gentleness of his touch surprised me. He listened to my heart, took my pulse and then escorted me to the examining table. He tapped on my kidneys for a few seconds, asked if I had pain and then gently laid me back on the table. I totally forgot there wasn’t any protective paper under me or even a pillow…with or without a disposable covering. Dr. Diaz gently and thoroughly pushed, prodded and poked on all parts of my stomach area. He then listened very intently with his stethoscope. Of course, all the rumblings and grumblings of protest that my stomach has been making for the last 8 days were non-existent…figures. Just like when you take the car to the mechanic, the mystery noise disappears. Or so I thought…seems he must have heard something because he immediately went back to his computer and began typing once again. Those same hands that had handled me so gently and carefully were now pecking furiously away.

He told us that I MUST promise not to drink any alcohol since he was putting me on a medication that would not mix well. We assured him that wouldn’t be an issue. Not good enough. He made me promise that I wouldn’t even eat any cakes or anything that had been made with alcohol. Again, we gave our word…oh fiddle…guess that rules out that oh, so yummy, frozen concoction, Rum Raisin Ice Cream. Not a problem.

Spinning around to his typewriter, he typed out my prescriptions and his instructions all on the same sheet…additional Imodium, a weeks’ worth of another antibiotic, a medication to hopefully take care of any nasty little amoebas that have opted to take up residence in my digestive tract and a 3 day course of rehydration fluid. Plus, the directive to call him tonight to let him know how I’m doing and again on Friday…he will be in Honduras until then at a conference on cardiology. He even typed in English in all capitals…CALL ME.

Then it came time to pay up. No statement, no billing, no credit card. Just hard, cold cordobas…40 of them. That equates to about $2.10…no wonder he couldn't afford a drug cabinet. He thanked us, reminded us to call him to let him know my progress or lack of and then he walked us to the door, unlocked both locks and gently but firmly ushered us out on the porch, oops – in to the waiting room, and called in his next patient. When we left, all 8 chairs were filled and it was obvious the wait was going to be lengthy for some of them. I remembered our monthly Saturday morning clinic and the inordinate patience we see exhibited there…and I was very, very thankful that my earlier wait had been so brief.

Obviously, medical care here is much different than in the States but there are similarities. There were no cultures taken, no lab work ordered and certainly not a sterile environment. There was a gentle, caring physician who had a very hurried manner but did anything but in his examination, understanding “sick” transcends all language barriers. And thirty minutes after entering an area I had viewed with such a critical eye, I left feeling very blessed to have been entrusted to this gentle man’s care…even the messy desk didn’t seem to matter anymore…I think I’m beginning to acclimate.