The blog silence for the last few days is largely a result of us not being sure what to say about beginning work. Our own processing is so much still in process that it's hard to articulate anything to share. It's a lot to take in, and one could slice it on any plane. So I'll pick one aspect, not because it gives a comprehensive perspective, but because it might be adequately bite-size. The good news is that we're not going anywhere, so if you keep reading the blog long enough, a holistic picture of life at the hospital ought to emerge sooner or later.
Taking care of patients here is hard. We understand limitations, but we are all hit by a whole new level of limitations. One of the largest of these is poverty. This is not new, but it is at a whole new level. According to GDP, Burundians on average make about 1/3 of what Kenyans take home.
Example: Rounding on the medical service yesterday, and we see a man in his 50's with urinary obstruction. We can determine that it's due to his large prostate. That part doesn't cost anything (ask your neighborhood urologist why). Jason can take his prostate out. Great! We can help this one. Let's do it!
Problem. There's a decent chance his urinary obstruction has made his kidneys function poorly enough to be dangerous for his surgery. And actually hospital policy means he needs a few labs before going to the OR. OK. Our lab can check those! Let's do it!
Problem. It's too expensive. It's probably at least $8 to get all those lab tests and he doesn't have the money. His family is coming tomorrow. Maybe they will have something…
This is an illustration. In most other cases, the problem of the grinding poverty here comes into play right at the beginning, so they wouldn't make a very interesting illustration.
Poverty calls everything into question. "Standards of Care" are almost always income-dependent. Everything we know of such standards is therefore subject to drastic reevaluation. This test for this problem. This medicine for this benefit. Is it worth it? Well, what does this cost mean to you? There is often no straight answer to this question, so it gives us a great sense of "shooting in the dark". Was that the right decision? I think so, but how can I know?
And this, of course, is humbling. Or maybe humiliating. Sometimes the difference is hard to tell. And maybe not all that important in the end. Humility (or maybe humiliation) seems to be one of the hallmarks of our clinical beginning here in Burundi, as it has been throughout our time of language learning.
It's not a new thing. It's certainly not a bad thing. But it's hard. Pray for us as we go.