Biopsies and Philosophizing

This morning I discovered that Dan was taking a little girl from one of the VivaKids centers to the capital to see a dermatologist for a rash/tumor that she has on both sides of her face and on her leg. Being the medical nerd that I am, I asked to come along to the consult and got to see the private side of Dominican medicine in practice. I admit that my perception of Dominican public medicine has been colored negatively based on horror stories that I've heard, but in a visit to a private physician, I wasn't entirely sure what to expect--Dan and Shana love their private doctors here, but they had never been to a dermatologist, so this was just one on the list recommended by the U.S. embassy.
My immediate reaction to the doctor was not a positive one. First of all, she had drawn on eyebrows--something that freaks me out. Secondly, the receptionist had written the wrong name on a form and rather harshly sent be back out to get the little girl's name written on the form instead. In the five minutes that it took to rectify the situation, the doctor had done a cursory examination of the little girl's face and bluntly pronounced it to be a genetic non-curable disease that would continue to take over the girl's face and body. If it had been caught earlier, she explained, they could have surgically removed the lesions and they would have stopped spreading. The mother, understandably in shock, told of her experience with another doctor in San Pedro who had told her that it was simply a rash and had given her creams to put on it. While in all likelihood, this dermatologist is correct and the other doctor was wrong, she didn't sympathize with the fact that this poor mom had done the right thing--gone to a doctor, paid for the creams that were supposed to help her daughter--and was now being told that it was all wrong and that it was too late.

When Dan and I began to question her about which disease specifically she thought it was, she offered to do a biopsy to prove that she was right (for RD$2000 more, about $50). Dan agreed to the biopsy and we went back to a little surgery room where the girl's mom and I held her down while the doctor administered local anesthesia. Here the doctor became a little more compassionate and assured the little girl that the worst was over and that the next part wouldn't hurt. After a quick biopsy (during which the mother looked away nervously and I watched closely), she cauterized the wound and put on a very sloppy bandage that took over the entire side of the girls face. She then very casually handed me the container with the biopsy in it and told me that we would have to take it to a lab several miles away. It's not every day that you get handed a skin biopsy. 

We went back into the consultorio and talked with the doctor a little more, got directions to the lab and the names of some possible diseases that it could be. Being the pre-med nerd that I am, I've spent the last hour and half looking up the possible diagnoses she gave us and find myself wondering if she couldn't have done a few more preliminary checks to properly diagnose this--for instance, one disease is associate with scoliosis, something relatively easy to test for--the kid just has to bend over. The other possible diagnosis seems ludicrous to me as it involves vericosities and birth marks, neither of which this girl has. While I don't doubt that the doctor is a qualified professional, and I would guess that the test results in a week will prove her right as to the disease being genetic, my overall impression of the visit was not positive. Maybe that's just her personality, and I need to be mindful of my own bias against medical practice here in the DR, but I came away with the impression that the doctor was there to do her job and make her money, but that she didn't really care about the patient or the effect that the facial deformity the disease causes could have on the rest of this two-year-old's life.

I came away from today wondering a lot of things about the medical training system here in the DR. I have appointments to talk to doctors tomorrow evening, so I'm trying to wait to reserve my judgement until after interviewing them, but my overall impression is that there's something fundamentally flawed (or to be more academically correct, different) about the mindset of healthcare professionals here. Maybe I'm naive in thinking that doctors should truly care about their patients or at least attempt to empathize with them and value their experiences, but that's how I think medical professionals should operate. Our car ride back from the capital was filled with discussions about exactly this--about the short training period for doctors, the young age at which they can start practicing, the overall education system that relies heavily on rote memorization and doesn't develop critical thinking skills or deductive reasoning, the cycle of poor education and poverty that develops when the teachers aren't trained properly--lots of uplifting things. At the same time though, we talked about the need to meet a community on its terms in order to be effective in creating change--the need to work with existing structures, rather than tearing them down.  

Sometimes I see things changing for the better, people who feel listened to by their local doctors, good teachers who are willing to go against the usual style of teaching because they know it's better for their kids. And then sometimes, like today, I'm left with an overwhelming desire to just come fix everything and make it work in the way that seems best to me--and when I realize that's not possible, I want to draw a circle on the wall and write "bang head here."

But enough philosophizing for today--here is something that I have learned for sure: No matter what country I'm in, no matter what I order, my digestive system will always feel crappy after eating McDonald's.