Trabajando Con Los Promotores

Health promoters brainstorming "How to Use a Pediatrician for the Year"

Clinic visits with patients in Nueva Providencia
Fluoride applications in Totolya

A few weeks ago, I started spending less time in the Parrochia clinic and more time with the health promoters. My Stanford mentor, Paul Wise, had told me that he felt my greatest contribution this year would be in supporting the efforts of the health promoters and helping to strengthen their three-year training program that was established 4 years ago. I was excited at that prospect but also excited about working in the clinic seeing ambulatory patients and caring for hospitalized patients. I spent the first month mainly in the clinic learning what conditions are most commonly seen here, how they are typically approached by other local physicians, especially Rafael Tun, what the local beliefs are about health and illness, and what medications are available. This experience was very valuable. It gave me a solid base of understanding and I think helped me make sure that my approach, when I'm out in the community, would harmonize with the approach of local providers and patients.


But I also started to realize that my daily work in the clinic was probably not making the impact I had hoped. While I think it unloaded Rafael's incredibly challenging schedule and may have positively impacted some individual patients, most of these patients would be seen even if I weren't there and I found myself very frustrated by the limits on workups we could do in clinic and the hospital, nursing care that wasn't as thorough or informed as I'd hope for, and medications that really didn't let me treat things as well as I felt they should be treated.
So, happily, I've started working just two days per week in the clinic and hospital and three days per week with the health promoters on program from nutrition to fluoride treatments to family planning to care of chronic patients with diabetes, asthma, hypertension, and epilepsy. It is wonderfully rewarding work.