Pocket Change

Last Thursday Miss Fanor and I headed out on or first Mobile Clinic as a team of two. We drove outside the city to a tiny and very poor town along a busy stretch of road. As has become custom, we walked into a church that had transformed into a makeshift clinic. The pastor had arranged for a bed to be brought in, sheets hung for privacy, desks set up for consultation and for a pharmacy as well as chairs lined up for waiting. As we unpacked our supplies, members of the community slowly filtered in.

During the day we saw patients young and hold, relatively healthy and those near death. One such sickly man was our second patient of the day. He came shuffling up to my desk, skin stretched taught over bones, a hollow look in his eyes. He had all the signs of immunodeficiency without an official diagnosis: extreme weight loss, oral thrush, many fungal and bacterial skin rashes, shingles, a chronic cough and persistent nagging fever. He had spent most of his life in the Dominican Republic working, but had come home to live with his sister when he got sick. After examining him, I told him of my fears about his health. He pretended not to know, but there was no surprise that danced across his face. Instead, a quiet resolve was all I could read in his eyes leading me to believe he suspected more about what was causing his decline than he admitted. Often I’ve found that people usually know when they are dying.

We made a plan for him to go for diagnostics at GHESKIO, the local research center that does a lot of work with HIV and TB. I sent him home with some medicines to help treat his symptoms, but our little pharmacy is nowhere nearly capable of bringing him back to full health at this point.

After he staggered away, Miss Fanor came up to me and asked if I had another thermometer. I did, and handed it to her, confused. She wanted a replacement since the (presumed) HIV patient had used it.

Inside I fumed. I made a mental note to have a little educational talk with her after clinic.

On the ride home, Miss Fanor beat me to the punch. "That man has AIDS. You knew it, I knew it, and everyone in the room knew it. There was whispering, gossiping already going on. The people were watching our every move. I needed to change thermometers so they wouldn't be scared to get care because they all don’t yet understand how the disease is transferred. There is still a lot of ignorance." Once again, Miss Fanor proved to me her infinite wisdom and insider-knowledge that helps me stay afloat in a community where I’m still in many ways just getting my feet wet. My annoyance dissolved into gratitude for having such an observant and capable teammate.

The last patient of our mobile clinic day was similarly dramatic. After strings of children with runny noses, coughs and symptoms of poor nutrition, old men with "acid" and "gas" and women with headaches and back pain, a pregnant woman sat down before me. She was 43 years old and on her 11th pregnancy. She came to see me because of a headache, back pain and stomach upset. I looked at this woman who was 9 months pregnant with 10 kids at home, and was not surprised to see immense fatigue in her eyes. Her husband accompanied her looking equally as tired. I started with my history and evaluation, noting that her blood pressure was sky high--a very ominous sign in the end of pregnancy, worrisome for preeclampsia. My exam showed a kicking and active baby, but her stomach was sore in all the wrong places, and given her headache, red flags started waving in my mind. I discussed that I wanted them to immediately travel the short distance into town to the free maternity hospital to get evaluated. I discussed my concern honestly and frankly in hopes that I could convey this was a matter to be taken seriously. We could even find a ride if needed.

The husband--clearly concerned about his wife-- let his eyes fall to the floor in apparent embarrassment as he said, "tomorrow we'll go, if God wants." When I pressed him that tomorrow might be waiting too long, he informed me that his brother had recently been in a motorcycle accident and was in the city’s general hospital. The family was pooling all their resources to get him the care he needed, and there was nothing left, no money. Pockets were empty, and those who weren’t helping at the hospital were trying to work to make up for the funds lost; no one was available to help get them in to town, much less watch over their house full of children. He needed his wife to help at home. While trying to come up with strong, calm, diplomatic words in Creole to persuade him otherwise, I thought of the looming disaster in this man’s life if his wife’s symptoms turned into a worse-case-scenario in their home in the middle of the night. What would this man do if suddenly left without his partner to raise 10 kids by himself?

We slipped the couple a little tap-tap money hoping they'd use it for a ride into town. I instructed the mother that under no circumstances was she to work or to walk; if she insisted on returning home, she needed to be lying down. She looked at me like I was an alien, but mouthed agreement.

They left our clinic hand in hand. I could only hope they took to heart what I was trying to convey, were convinced that maybe this blan doctor venturing out to the countryside was there to help and knew a thing or two. I now can only pray she has had the baby by this time and both are well.

Today in the CONASPEH clinic, a couple of patients from our mobile clinic came in with their pastor for follow up visits. The walking skeleton-of-a-man was one of the faces waiting on my bench. He had come in to see if there was anything that we could do to help him, for he had nothing, nothing to buy food, nothing to buy a tap-tap ride to the hospital, absolutely nothing.

In general we don't give money to people. It is not our role, nor the best way to empower people, and there are those that argue hand-outs encourage dependency. But some days it is impossible to look death and suffering in the eye without offering at very least the change you have in your pocket if it can offer a little hope. And for an unprecedented second time in a week, Miss Fanor and I reached into our pockets. After consultation with Francois, we three females decided that we'd offer this gentle man enough money to send him to a special hospital for patients with HIV and AIDS where he'd receive not only HIV medicines, but food, potentially a job when he was strong enough, and a heaping plate full of hope. When we slipped him the envelop with hushed whispers, his eyes gleamed. He started to cry. He wrapped his bony arms around our necks and whispered a choked thank you.

Tonight I have new patients to pray for. I pray for the woman who was anticipating birthing a new life amid a clinically dangerous, life-threatening circumstance. I pray that her husband isn't now left alone with no one to help raise his huge family. I pray that the man with hollow eyes finds his way, pray that at the very least he finds comfort in his final days of life. For all I pray that its not too late, that just this once or twice, pocket change can make a difference.