Tag: medical

Where There Is No Doctor (That You Can Trust?)

I moved to Indonesia fifteen years ago, before the age of smartphones in our pockets to help find advice on medical issues. Other missionary friends recommended a long-trusted book, Where There Is No Doctor. Perhaps you know it or even have it on your bookshelf.

First published in Spanish in 1970 by Hesperian Health Guides, it has since been revised and translated into almost 100 different languages — providing community workers with easy to understand, practical health information. The book was intended to help those working in rural areas, with limited access to medical care. I have read the book cover-to-cover and found it very helpful over the years — even in a large city, where there are medical clinics nearby. 

But these past fifteen years our problem has not been that there are no doctors. The problem has been knowing whether we could trust the doctors.   

Or whether the doctors care at all.

This has been the case while helping neighbors try to receive medical care. Too often they wait for hours and hours, only to see a doctor for a literal minute (I am not exaggerating here). A doctor might not even touch the patient, listening to the litany of symptoms while scribbling a prescription. Transaction complete, now go wait for the medicine another couple of hours. 

Is it any wonder that many of our friends prefer the local midwife as the front-line of medical care for any illness for women or children? At least a midwife will look them in the eyes.

A few months after moving to Indonesia, my teammate was hospitalized. She texted me the names of the medicines they were giving her, so that I could look them up on the internet (again, this was before smartphones). “Don’t take any medicine before you look up what they are giving you,” she taught me. Which is great advice — except often our neighbors return home from the doctor with unidentified pills in plastic bags. Not helpful.

I like following instructions. My personality is one that does not like going against the flow or standing out or causing problems. But I have had to learn to advocate for medical things. Sometimes this is challenging because I do not want to be the “ugly foreigner” or act like a “know-it-all.” I have not gone to medical school and the doctor has spent years studying and practicing. But I have found that the guidance provided by Where There is No Doctor has been very useful to help know what type of care to advocate for — or what tests to ask for.

Perhaps my angst with the medical system increased when I was pregnant with my first son. My blood is rhesus negative, and I needed a shot of Rhogam to protect my baby and future babies. This medicine was not even available in most hospitals, and we had to find it privately, take it to the hospital where I was getting prenatal care, and explain to the doctor what the shot was and why I needed her to inject me with it. 

We also had to hide the fact that I wore glasses — because then I would have been recommended for a C-section. Many doctors in Indonesia tell their patients that if you have poor eyesight, it is necessary to do a C-section (I am not making this up!). 

I have observed different levels of care in government clinics, public hospitals, and a variety of different private hospitals. More recently, we took our coughing son to see a pediatric specialist in a very fancy clinic. Walking into the clinic felt like stepping into another country: beautiful fish tanks, shelves with toys in the waiting room, and even a free library! 

Yet even at this expensive clinic, I was not sure the doctor was giving my son the care he needed. I explained how I thought my son was allergic to one nasal spray he was taking. The doctor dismissed my observations and prescribed a double dose of the nasal spray. We followed the doctor’s orders for only two days, and after a massive coughing episode we stopped that medicine.

My encounters with doctors in Indonesia have not all been stressful, however. More recently, we are very grateful for partnering with a Christian doctor to help address medical concerns in the slum community where we live. This lovely Christian friend works full time but is giving selflessly of her “free time” to help serve our neighbors and friends. I am so grateful!

The medical advancements over the past one hundred years are astounding. One hundred years ago there were no antibiotics. Let that sentence sink in. Penicillin was discovered in 1928 but was not produced affordably until the 1940s. Before antibiotics, any simple infection could turn deadly. In the 20th century, humanity has seen the development of vaccines, CT scans, the MRI, and successful organ transplants. All of this used to be impossible. 

As expats living overseas, we have choices that did not exist for missionaries a hundred years ago. We could go to the local government hospital. Or we could pay ten times the price at an elite hospital. Or we could hop on a plane and go to another country in search of better health care. 

I don’t judge the medical choices that any expat makes, but I do wrestle with the reality of disparity between the rich and the poor. Between the type of medical care available to some but denied others. What do we do with the disparity? What do we do with finding ourselves on the wealthy side? How do we make responsible choices — stewarding our money well, yet also advocating and seeking health for ourselves and our families? 

I think there are some idols surrounding this issue that I need to lay down. Seeking hope and security in a trusted medical system can be an idol. I have to acknowledge that the medical system is not where my hope should be placed. While I am all for healthcare, I also have to acknowledge that there is only One True Healer. 

He is the Great Physician who can be trusted. 

I think of Jesus stopping for the one. Jesus taking children on his knees. I imagine Jesus looking people in the eye, asking them where their pain is, taking the time to really hear what is going on. Jesus touched those ostracized by leprosy. Jesus healed the crippled, the blind, the lame, the deaf, the hopeless. In these stories, Jesus offers a foretaste of the kingdom coming. Where there will be no more sickness or dying or tears or pain. 

Our bodies are finite. A few gray hairs appearing on my head are a mocking reminder that I am getting older. Life is fleeting, we are only a mist. And yet we have the joy of using our short lives in service of our King.  

I still have a lot of questions. Questions about doctors, access to medical care, the gap between rich and poor. Perhaps you do too. 

My prayer is that as you journey out of your passport country, you will be held in the hands of our Good Physician. And as you encounter the suffering masses of humanity — many without access to the standard of care you are used to — may God touch your heart to be a compassionate presence to those whom you may meet. 

And when you are at the end of yourself — since we are all finite and can only do so much in a day — may you learn to surrender it all into the hands of the One Good Doctor.

Photo by Patty Brito on Unsplash

When my child is sick: Missing the promise and illusion of safety

On Friday my fifteen-month old baby, Dominic, started running a fever for the first time in his life. We live in Northern Laos. The hospital beds here are full of dengue fever patients at the moment, and fevers of any kind aren’t to be taken lightly.

I did what any worried mama living out of reach of good medical care does nowadays … I googled. And after 24 hours of fever and fussiness, my husband and I put Dominic in his stroller and set out for the doctor who runs an after-hours clinic out of her house down at the end of the little dirt lane we live on.

Going to the doctor here is a little different than going to a doctor at home. There is no such thing as an appointment. The clinic opens when the doctor comes home from her work at the hospital at about 5:30pm, and she sees patients on a first come first served basis.

When you arrive at the clinic you take off your shoes and pick up a number outside the door. Then you wait your turn on a bench in the front of the room while Dr Payang sees people in the back of the room where she has set up a desk, a chair and a camp bed. Only a large dresser that acts as a partial screen separates the waiting room and the consultation area.

We waited our turn with half a dozen other families, and exhaled in relief when the tired doctor peered into Dominic’s mouth with a small flashlight and then showed us the source of all that heat – a throat infection. She handed over some antibiotics, wrote down the dosage instructions on a sheet of paper to make sure that we had the details right, and we headed home.

Living outside the reach of carpeted, colorful pediatricians’ offices is possibly my least favorite aspect of our life in Laos. I miss ambulances with their purposeful sirens and English speaking paramedics. I miss emergency hotlines. I miss gleaming hospitals with their bright lights and shiny instruments and reliable X-ray machines. I look at my baby when he’s running a fever and I really miss the promise and illusion of safety that all provides.

I say promise because, let’s face it, medically-speaking, Dominic would be safer if we were living in the more developed world. Malaria, dengue fever, and the tropical parasites that thrive in our garden here don’t even exist in most of Australia. And some of the more globally equitable childhood maladies, like meningitis, you really want to catch and address fast. As we learned the hard way when Dominic broke his femur at five months of age, you can’t address things fast when you live in a small town in Northern Laos.

But I say illusion because living right next door to the best hospital in the world can’t guarantee you safety or grant you total control. It just can’t. No matter how much we might want to shield our children from catastrophic injury or illness, we never erase those risks entirely. In fact, Dominic would be more at risk of experiencing something like a car accident in that situation. We don’t own a car here in Laos, so he rarely rides in one. The same could not be said if we were still living in our previous home, Los Angeles.

So the questions that I must continually confront are these: How do we calculate risk? How much risk are we willing to tolerate, and to what end? What do I do about fear? We are living in Laos because my husband is doing work we both believe makes an important, tangible difference in the lives of people poorer and much more vulnerable to the vicissitudes of life than we are. Is that a good enough reason to have my baby risk dengue fever? On average, the answer to that question so far has been yes. On average.

Now, three days after starting antibiotics, Dominic’s fever is gone. He had seemed to be much improved, but two hours after going to bed last night we woke to the sounds of retching and screaming. It heralded the start of Dominic’s first all-night vomiting marathon. This morning has brought more vomiting for him and more questions for me.

So now I’m off to consult google again, this time about oral rehydration. If only I could search out answers to all of my questions so easily.

Do you feel any tension over how your choices impact your children?
How do you resolve that tension?

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Lisa McKay – author, psychologist, sojourner in Laos

Blog: www.lisamckaywriting.com      Books: Love At The Speed Of Email and My Hands Came Away Red