December in Bolivia is summer time. It also marks the end of the school year, so there are now no classes in schools and colleges until February. Taking advantage of this, a local NGO is funding a scheme to enable all children and teenagers under the age of 16 to have a free medical check up. The small rural hospital close to where I live is in the thick of this programme. This small medical outpost has a couple of consulting rooms and a larger room with 4 beds (optimistically called the delivery suite). It normally deals with 10-20 patients each day. However, in the 2 weeks before Christmas, over 2000 people will pass through the doors. I helped out yesterday, bringing the number of doctors up to 3. By the time I had to leave at 1pm (to head straight to the old people’s home) I had seen 46 children and teenagers, averaging less than 4 minutes per patient. It was an incredible experience.
The whole building was crammed full of people and they were queuing up outside. In the small office that I was using, I had an auxiliary helping with weighing and measuring the children, a queue of 5 or 6 patients to be seen next and heaven knows how many waiting outside. Add in their parents, plus other doctors/nurses coming in and out, asking if I had any spare Fluconazole or ear drops or if I could just have a quick look at something or other and the result was something I have never experienced (and am sure will never experience) in the UK. In this situation I had to deal with a number of children with fungal skin infections, a teenage girl with menstrual pain, an infant with diarrhoea, a youngster with bed wetting problems and a plethora of ENT infections. Privacy is quite simply an alien concept here.
The director of the clinic had given me a large tub of Mebendazole at the start of the day. She told me to give every child one tablet. I innocently asked how I would know if they had worm infections or not. She raised an eyebrow and gave me a look that told me I still have a lot to learn about health problems in the campo. When she gave me a tub of multi vitamins and said to do the same thing, I didn’t ask any more daft questions.
So above the din and picking my way around the bags, bikes (!!!) and bodies, I managed to listen to hearts, check ears, examine skin lesions and tried my best to ask sensitive questions and give the best advice I could with some semblance of confidentiality. It was medicine en masse and was far from ideal. However, for many of these children it was the only time they would see a doctor this year and quite possibly for several years to come. It was crazy. I loved it.