Bonus Post: Extended Interview with Esther

Hello, it´s Lauren once again.  To make up for being late with Tuesday´s post, and because I´m on a blogging roll that may never be replicated, we´ve decided to offer you yet another bonus post!  This time, we´re going back and filling in the blanks  in our initial interview with Esther, as promised in last Friday´s post, Callao, Here We Come!  To refresh your memory, here are the topics we promised to cover:

(1) A discussion of the make-up of the staff at Hospital Carrion’s TB Ward

(2) Esther’s guide to overcoming a sense of impotence at the enormity of the problems that TB poses

(3) The difficulties of performing triage

(4) How the lack of mental health facilities impacts TB patients

(5) The role of ‘indifference’ on the part of doctors, patients, and families

So without further ado, let´s dive right in.

Point 1.  A discussion of the make-up of the staff at Hospital Carrion’s TB Ward

The TB Ward at Hospital Carrion boasts 6 staff members: (1) doctor, (1) nurse, and (4) technicians.  These 6 people have a caseload of about 30-40 people, making the staff to patient ratio about 1:5 or 1:6.5.  This is not the worst ratio that exists in Peru, (sometimes there are only 2 nurses for 500 patients), but even so it´s not a particularly good ratio.

There are only 12 total TB Wards / health clinics in Callao.  2 are for children, and the other 10 are for adults (2 each in Ventanilla, Bepeca, and Bonilla, 2 in San Jose, and 2 in Hospital Carrion).  At least twice as many clinics are needed to adequately house all of the patients.

(2) Esther’s guide to overcoming a sense of impotence at the enormity of the problems that TB poses

Obviously, because resources are so limited and there is a real lack of staff, Esther often feels impotent and unable to help.  She has learned to focus on the impact that she does make so that she doesn´t feel overwhelmed by the enormity of the problems.  By focusing on the small and the specific (individual triumphs and stories), she is able to get through the bigger problems one step at a time.

(3) The difficulties of performing triage

Because the money and resources only go so far, Esther is always having to perform triage.  The hospital mainly takes those who can be cured, of course, but even so, many times Esther knows that certain patients could really benefit from different treatments or diagnostic tests that they´ll never receive because other patients have a greater need.

(4) How the lack of mental health facilities impacts TB patients

Many of the patients that Esther sees have been abandoned by their families.  As a result, they feel worthless and dirty.  It is also fairly common for these patients to have been mistreated at other health clinics.  Upon their admission to Hospital Carrion, they are often very angry at the world in general, and unwilling to comply with the doctors´orders.  They have no one to really talk to who can help them come to terms with their situations or their diagnoses.  Of course, this lack of mental support makes it difficult for the doctors to help the patients recover physically, and so the cycle continues.

(5) The role of ‘indifference’ on the part of doctors, patients, and families

No one wants TB, and there is a  huge fear of being infected.  These are understandable, but unfortunately, have resulted in situations where families abandon the sick, doctors have no respect for their patients, and patients themselves feel like they must have done something to deserve the disease.  Because so many people consider TB a poor person´s illness, doctors and patients alike can consider it an inevitable result of poverty…with the implication that those who have it are somehow unclean (whether simply due to their poverty or due to associated HIV infections, drug use, alcholism, etc.)  Patients are on the defensive (I don´t have HIV/I`m not a drug user) but they too believe that they must have done something wrong to contract TB.  With all this negativity surrounding the disease, no one makes a real effort to help the patient get better, and so, once again, the TB spreads.

Well, this was just a quick expansion of our interview with Esther.  I´m sure you can see some recurring themes throughout the blog posts.  Hopefully, you understand more how devastating the social attitudes have been to the recognition of TB as a threat, and you have enjoyed reading this bonus blog post as well as our newest post, Making Friends and Influencing People.  Until tomorrow!

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Posted on June 21, 2012, in GROW Trip 2012 Blog. Bookmark the permalink. Leave a comment.

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