Days here are a mixture of emotional highs and lows. So many things can turn the tide. An improving patient and happy family -- a high. A sick patient and no way to get the evaluation or meds we need -- a low. Health promoters eagerly learning and advocating for their patients -- a high. Visiting doctors talking about locals as if they are stupid or conniving and acting as judge, jury, and executer (in the assassin sense of the word) of the current health care systems -- a low.
Today was a real high for both of the above reasons and finished up as a low for the last reason. I am so frustrated with much of what I see medical volunteers doing when they come through here. Maybe because I’m in medicine and am paying more attention to what medical volunteers do, I find them to be the biggest troublemakers of all the volunteers. (And it does strike me as ironic and sad that the very people who are trying so hard to help are the ones causing some of the biggest damage).
Just to give a bit of background, the health promoters are community volunteers, typically overworked (farming, caring for 10+ kids) and impoverished but willing to give of themselves for others. They undergo three years of training to be able to provide basic, safe
, essential care and medications to patients in their communities who can’t access a physician (due to distance and cost). They purchase their own medications and sell them at cost, allowing the purchase of more medications to keep their supply going. On very rare occasions, there have been reports of some health promoters selling medications at a mark-up to earn some money. The vast majority of the health promoters do not do this and, despite their utter poverty, work for free performing and honest and selfless service.
One of the visiting doctors who has made many trips to SLT over the last 15 years brought up the concern tonight that health promoters have access to medications at all given the risk of them selling them for a profit. As evidence to support his concern, he sites that patients are receiving vitamin shots and gentamicin injections and also reports the story of one program of health promoters in Guatemala City in the 70’s that, after 20 years fell apart because of medications being sold for profit (he reluctantly admits that the program later came back together with some modifications that have allowed it to function well). My objections to his concerns, and implicit desire to take away from health promoters their privilege to provide medications to outlying communities and therefore deprive destitute patients much-needed medical care, are multiple. One, in all his years volunteering in SLT, he’s never once worked with the health promoters who manage these medications (much less introduced himself to them and learned about their program) yet he stands in judgment of them and their program. Two, he hasn’t educated himself as to their role well enough to recognize that they don’t actually have access to vitamin shots or gentamicin and that these meds are instead being supplied to patients by pharmacists who have even less training than health promoters. That health promoters likely protect patients from seeking care from pharmacists by providing them with informed assessments and reasonable treatments. Three, he aims to dismantle a working system without regard to the consequences for patients in the interest of heading off and theoretical future abuses. Four, as a foreign physician he acts as if he believes he has the right to decide for a community what their needs are and police systems they, themselves, have put into place.
I have worked closely with the health promoters and I believe they absolutely must continue to have the ability to distribute medications to the communities that don’t have physicians. And it infuriates me that this visiting doctor would act with such arrogance, paternalism, and callousness. I believe that despite is good intentions and high quality medical training, the patients here would be better off without his “help”.
Today was a real high for both of the above reasons and finished up as a low for the last reason. I am so frustrated with much of what I see medical volunteers doing when they come through here. Maybe because I’m in medicine and am paying more attention to what medical volunteers do, I find them to be the biggest troublemakers of all the volunteers. (And it does strike me as ironic and sad that the very people who are trying so hard to help are the ones causing some of the biggest damage).
Just to give a bit of background, the health promoters are community volunteers, typically overworked (farming, caring for 10+ kids) and impoverished but willing to give of themselves for others. They undergo three years of training to be able to provide basic, safe
, essential care and medications to patients in their communities who can’t access a physician (due to distance and cost). They purchase their own medications and sell them at cost, allowing the purchase of more medications to keep their supply going. On very rare occasions, there have been reports of some health promoters selling medications at a mark-up to earn some money. The vast majority of the health promoters do not do this and, despite their utter poverty, work for free performing and honest and selfless service.One of the visiting doctors who has made many trips to SLT over the last 15 years brought up the concern tonight that health promoters have access to medications at all given the risk of them selling them for a profit. As evidence to support his concern, he sites that patients are receiving vitamin shots and gentamicin injections and also reports the story of one program of health promoters in Guatemala City in the 70’s that, after 20 years fell apart because of medications being sold for profit (he reluctantly admits that the program later came back together with some modifications that have allowed it to function well). My objections to his concerns, and implicit desire to take away from health promoters their privilege to provide medications to outlying communities and therefore deprive destitute patients much-needed medical care, are multiple. One, in all his years volunteering in SLT, he’s never once worked with the health promoters who manage these medications (much less introduced himself to them and learned about their program) yet he stands in judgment of them and their program. Two, he hasn’t educated himself as to their role well enough to recognize that they don’t actually have access to vitamin shots or gentamicin and that these meds are instead being supplied to patients by pharmacists who have even less training than health promoters. That health promoters likely protect patients from seeking care from pharmacists by providing them with informed assessments and reasonable treatments. Three, he aims to dismantle a working system without regard to the consequences for patients in the interest of heading off and theoretical future abuses. Four, as a foreign physician he acts as if he believes he has the right to decide for a community what their needs are and police systems they, themselves, have put into place.
I have worked closely with the health promoters and I believe they absolutely must continue to have the ability to distribute medications to the communities that don’t have physicians. And it infuriates me that this visiting doctor would act with such arrogance, paternalism, and callousness. I believe that despite is good intentions and high quality medical training, the patients here would be better off without his “help”.
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