Taiwanese Medical Brigade

After a tiring yet rewarding week of working with the optometry brigade I decided to take it easy Monday and do a little “community entry”. I went to the local hospital to meet a woman who I may work with in the future. She organizes trainings for community health workers and may be starting an support group for people living with HIV/AIDS. So I gave her my information and she said she would call me when they figured out the date of the next training. Then I headed down to Ashonplafa, an organization that does family planning and prenatal care to see if I could work with them in any way. While I was waiting to talk to their director I got a call from the hospital asking if I could come back that afternoon and translate for another medical brigade that only speaks Taiwanese and English. It seems like I just keep ending up in the right place (or wrong place depending on how you look at it) at the right time. So I returned that afternoon at 1 and met the team of doctors from Taiwan from ICDF (International Corporation and Development Fund). They brought a generalist, a pediatrician, a surgeon, an internist, a dentist, a gynecologist, nurses and organizers. Obviously they speak Taiwanese and a little bit of English and also some speak a little bit of Spanish (which I find incredibly funny, although I really shouldn’t).
They decided I would translate for the pediatrician so they put me in a room with her and she started to explain what vitamins and formulas she had brought. Then the Honduran nurses started coming in and asking me how they should organize all the people they had on their lists and that had been waiting since the morning. I told them to organize them according to their number and that their help would be great. Then the Taiwanese people came in and said they weren’t going to us the Honduran nurses’ lists and they had their own way of doing it. I started to get a little frustrated because I didn’t know what to tell the nurses and the nurses didn’t know what to tell the people that had been waiting since the morning. So I tried to explain the problem to the Taiwanese doctors and they just kept saying they had their own way of doing it but were to busy hanging signs up to explain their own way to the Honduran nurses who were responsible for dealing with the people. So after a while of going between the two sides I went to find some answers and walked into the “opening ceremonies”. All the Taiwanese doctors, the hospital staff, the mayor, people from the ministry of health and other important people were together to welcome the group and each in turn had to give his own praise. I have noticed that Hondurans are big on ceremony, they will have five important people get up and say the same thing, like thank you so much for coming, we really appreciate it, etc. It drives me crazy because everybody says the same thing and it takes forever. Also, everything had to be translated from Mandarin to Spanish or Spanish to English, or English to Mandarin because everybody spoke some combination of the two or three. This whole time that they were all praising each other all I could think about were the patients waiting outside since morning and the nurses not having a clue what to do because nobody bothered to explain anything to them. Finally we finished the flattery and began to work at 3 pm and planned to go until 5 pm. That is another thing I don’t understand. Why in the world would you start seeing patients at 3 for only 2 hours? Well we didn’t actually begin to see patients until 3:30 because they had to be pre-screened. It turns out that the Taiwanese had a very organized way to pre-screen the patients waiting in line and make sure they got to the right place, but it would have been better if they would have communicated that and started earlier. We didn’t finish until 6:30 pm because there were so many people.
Once I got over my initial frustration we got to work translating. In total we saw about 200 kids with malnutrition, coughs, fungal infections, scabies, anemia, allergies, headaches, sore throats and some random other stuff. The doctor mostly gives prescriptions for allergy medicine, parasite medicine and vitamins and formula to help with malnutrition. The whole process was very frustrating to be part of because giving a short term supply of vitamins or allergy medicine is not going to fix anything. As soon as they finish the bottle the problem will come back. Most of the problems that come in are completely preventable with education. As the translator I was able to give some preventive advice regarding hydration, hygiene and nutrition, but it is hardly enough to cause long term change. Also, some of the advice that the doctors gave wasn’t exactly appropriate for the people. An odd case involved a young girl with only one nipple. The doctor said it wouldn’t cause any harm now but later she may want to have cosmetic surgery to construct a nipple. I told the doctor that plastic surgery wasn’t really available. She said that maybe in ten years when the girl was older they would have it. I said maybe, but she still won’t be able to afford it. The doctor told me to tell her anyway and I said no. It makes me feel horrible to give advice that is completely inappropriate and I know will never be followed.
It is amazing how different this week is from last week. I feel like last week the optometry brigade was able to give a more lasting service by giving people glasses that they can use for much longer than a bottle of vitamins. This week so many of the cases made me want to cry. A 14 year old give came in with a severely malnourished 2 month old and it just ripped my heart out and made me so mad at Honduran men for taking advantage of young girls and mad at parents for not teaching their children about sex and mad at everybody whose fault it was. The whole experience is depressing and exhausting. This week the translating is also much more difficult. Last week all I had to say was blurry or clear, this week it is a million things.
Another particularly hard case involved a few month old baby with extremely high intra cranial pressure (think about those babies with huge heads and tiny bodies). Her mother brought her in and she could barely breathe. I worried that she may die right in front of me. I tried to explain that she needed surgery immediately to relieve the pressure on her brain and that she needed to be admitted to the hospital because she could barely breathe. The mom kept saying that she didn’t have enough money and she had other children to take care of. Finally I got a nurse to come and get the mother and make her admit the child. I don’t know what happened after that, but as soon as she left I broke down in tears. Granted the US health care system has its problems but situations like this make me appreciate the level of care we receive in the US.
The whole experience makes me question the worth of these brigades. How much good can they actually do in a few days? How could money be better spent? Is it appropriate to go another county where you don’t speak the language or know the culture and give advice? Would it be more helpful for foreign doctors to come and train local doctors to make a lasting change? It makes me feel better about being a Peace Corps volunteer because I know I am here for more than I few days and I am going to learn the language and the culture and get to know the people and try to do more than a quick fix.

Although this experience has been difficult there are a few redeeming qualities. First, I am learning a whole lot of new vocabulary words and improving my Spanish. Second, I am working with other Honduran translators and nurses and administrators from the hospital which allows me to make good contacts. Third, there may be some longer lasting education going on. One of the Honduran nurses told me she was watching how well they organized everything and how efficient the Taiwanese doctors were and she was learning from them. This made me so happy!

The hospital The line outside the hospital
From left: The organizing doctor, Karla (daughter of Honduran doctor helped me translate all week, what a huge help!), me, Dr. Sun (the pediatrician I translated for)