Medical Care in this Place.

Sheesh. That’s all I have to say.

But I lied. Because of course that’s not ALL I have to say. I actually have quite a bit to say.

I’ve learned a lot about medical care in this country over the past several days. I mean, I already knew it was pretty rough. Especially around my town. They wash and re-use rubber gloves in the hospital here. And a doctor recently diagnosed a 22 year old friend of mine with cancer when really, it was only bronchitis.

So when Sani, a close friend of mine, went to the doctor last Friday after a week of severe stomach pain and was diagnosed with appendicitis and sent home with Amoxicillin, I was skeptical, to say the least. I mean, I’m not doctor, but I’m pretty sure that no amount of medicine can cure an inflamed appendix. And I was very worried about her appendix bursting. However, the doctor had said that surgery to remove the appendix would cost $1000 (an OUTRAGEOUS sum in this country), so Sani wanted to try the medicine first. When I found all of this out on Saturday, I immediately emailed a fellow teacher who is also a certified nurse, just to check. She confirmed what I was thinking and recommended a second opinion.

But it was the weekend. Doctor’s offices wouldn’t be open again until Monday, and that could be too late. I remembered someone mentioning something about a white Dr. from Kalimantan visiting town for the weekend, and I managed to get ahold of him. He was willing to see Sani right away. So we went to the home where he was staying. He asked her many questions about her pain and other doctor-patient type things, and then he felt her stomach to see where the pain was. He concluded that it didn’t seem like appendicitis, more like some type of infection. He said that if she had had appendicitis for a week, the pain should be far more intense. But she was up and walking around and we had, in fact, just returned from spending all day out of town visiting some friends. He gave her the name of a stronger medicine that he recommended and also told her to get a blood and urine test. He also prayed over her, which I’m pretty sure nobody has ever done for her in her entire life. I can’t say enough about this doctor and how thankful I am for his willingness to see her (he was on vacation!) and to speak love into her life.

She got her labs back later that night, and they showed an elevated level of leukocytes and also a presence of bacteria in her urine. I hand delivered the results to the doctor, and he said that it looked like a kidney infection coupled with extreme dehydration. He strongly suggested that we take her to the hospital to be on IV fluids for a day or two. By that time, it was already late in the evening. I got a bunch of beverages, took them to Sani’s house, and told her what the doctor said. She agreed to drink as much water as possible that night and check herself into the hospital the following morning (Sunday).

I was at church on Sunday morning when Sani SMSed to tell me that she had tried to check herself in. But in order to have any kind of procedure done (including IV fluids), you have to have a letter from a doctor. And since it was Sunday, there was no doctor on call at the hospital and also no doctors offices open, so she would have to wait another day.

Monday morning, Sani returned to the hospital. This time, a doctor was available, and after the doctor inspected her, he told her, “You have appendicitis”. And he ordered her to go and see yet another doctor at a clinic in town to get checked out further. So at 7:30 last night – a full 72 hours after going to the first doctor – we all gathered at the clinic. She was in the examination room for a grand total of 10 minutes, and when she came out, she looked like she’d seen a ghost. Atik, who had accompanied her, explained that the doctor basically had no bedside manner and told her that he had no idea what was wrong with her and the only way to find out would be to cut her open and look inside.

That seemed a little drastic given that she had all the same symptoms I did when I had a kidney infection and that her pain level had been going down, not up (as it should if it were appendicitis) since Saturday. I immediately got on the phone with my nurse friend who agreed and suggested that maybe an ultrasound would be a better Plan A.

I reported back to the group. I think Sani felt overwhelmed by everything, and at that point, burst into uncontrollable sobs. After awhile, she managed to choke out that she wanted to talk to her sister, so we all loaded up on 8 motorbikes and went across town to her sister’s house.

We all huddled around the front room of her house and discussed our options. The dilemma we had was that a surgery is pretty scary and honestly, a little sketchy. There are much better/cleaner/reputable hospitals in the next town, but the doctor she saw was also the surgeon who would be doing the operation and would most likely not write her a letter to go to a different hospital. Also, since he said surgery was the only option, he wouldn’t write a letter for her to get an ultrasound. And without a letter, you can’t do anything, which is the thing that frustrates me the most about this situation.

After many tears and all of us going around and saying our piece, it was decided that the choices were a) have a surgery and know once and for all what is wrong and be able to treat it or b) do nothing and potentially die of a burst appendix. Sani was too emotional to do or say anything, so option A was picked for her. We took her to the ER and checked her in. For some reason she was afraid to give the doctor’s letter to the nurse herself, so it was my job to accompany her and arrange the letter and talk for her.

I’ve never been in an ER here. And being there did nothing to soothe my fears about her being operated on there. I mean, this is the entire ER.

That’s it. That’s all of it. The last bed in the ER is reserved for emergency deliveries. It looks like this.

Here is our brave patient.

And here is the entirety of the medical equipment in her “room”.

Sani’s sister and Mas Yo ordered a room for Sani. There are several different levels of room to choose from, all at varying costs. There is everything from VIP and VVIP, which cost $50 and $70, respectively, per day, all the way down to rooms that cost $6 per day. They chose a medium priced room for her. So after about 45 minutes in the ER, an orderly got a wheelchair, and we headed off to get her settled in.

Beyond the ER were the observations rooms, which looked like this.

That pile of blankets is a person sleeping on the floor. I don’t know if it’s the same in all hospitals, but here in our town, if relatives want to stay, they bring blankets and pillows and camp out on the floor. For extended stays, relatives pretty much set up camp in the hospital room. They even cook food on gas burners in there.

We went up a floor and found ourselves in this waiting room, which just seemed so dark and sad to me.

Pushing her down the hallway…

And finally, we arrived in her medium priced room. It looked like this.

      I’m thankful that we were able to get her her own room. Down the hall were the cheaper rooms, and they had SIX beds in a room the same size as this. And she has a TV and her own bathroom. Granted, they are both small and dirty. But they are amenities that not everyone gets.

We left her there last night – I, reluctantly – to rest in preparation for surgery today. As we were leaving, her nephew pulled up with bags of clothes, blankets, and pillows – because the hospital here doesn’t even supply those things.

She should be in surgery right now as I type this.

 

I’m trying to figure out if my frustration over this situation is because it’s different or because it’s wrong. I could be feeling this way just because it’s not what I’m used to. I’m used to a much higher standard of healthcare. I’m used to people being able to tell the doctor, “I would like to have an ultrasound done”. I am used to doctors who actually went to med school (sorry, that was mean, but it is really how I sometimes feel in this country). Does it mean that it’s WRONG to have a lower standard of healthcare or that it’s wrong for doctors, rather than patients, to have the ultimate authority over one’s medical decisions or that it’s wrong for me to know more than the actual doctor (though that’s probably me just being a prideful know-it-all)? I don’t know. Different or wrong? Different or wrong? Sometimes it’s hard to distinguish between the two.

Either way, I really am very frustrated and exasperated by all of this. And I’m worried for Sani’s health. I am very worried about something going wrong during the surgery. People die during routine procedures all the time here. But I’m also praying a lot and trying to trust that God is going to work for good in this situation.