For Bolivia Trip in 2007, we were asked if we would accompany a nurse (a young woman trained by the non-profit to administer vaccines, dispense medications, and do certain wellness checks) around the neighborhood for home visits. I have no medical training and was wondering what purpose I would serve, but agreed to go.
At one house we were not allowed entrance – the household consisted of a mother with yellow fever and 2-3 young children. She refused the medication and the nurse expressed sadness in being unable to offer assistance; she indicated this was the norm for this house. We remained in the car while the nurse spoke with the daughter who was 10-12 years old through a fence. (On a side note, yellow fever is transmitted through mosquitoes, so I wasn’t concerned about my presence.)
One house we were not allowed entrance – the baby had received a vaccine previously, had a fever and was sick/fussy afterwards. We discussed the safety of vaccines, she indicated she understood but was scared for further vaccines. We stood in the courtyard outside the house. Her husband came home during our discussion and also expressed concern that the vaccine caused the infant’s illness. We provided testimony about receiving vaccines throughout our childhood and before traveling to Bolivia, that the injection site was sometimes sore, that I sometimes feel “icky” afterwards, and that symptoms from the vaccine are milder than the disease. The couple seemed to consider the information, but understandably seemed scared and skeptical.
One house we entered a “breezeway” area between an outer wall and the inner living area of the home. It had a dirt floor. The teenage mother was alone with her younger sister and her infant. The younger sister brought wooden chairs for myself and Tara. (Seemed rude to refuse although my comfort was not really important.) She indicated her father was away at work, her mother was deceased, her younger sister was not attending school to stay home and help her, the father of the baby had not seen him since birth, was not providing assistance, and was at work with his father. The infant seemed listless and unresponsive. We removed the stocking cap to discover what appeared to be hydrocephalus. The infant had been feverish and sick. She was advised to bring the baby to the clinic to see the doctor as soon as possible. Later that afternoon, we saw her arrive at the clinic, then leave about 15 minutes later in tears.
One house we stood outside but allowed to peer inside (no breezeway.) It was about the size of a U.S. hotel room with a dirt floor. The nurse weighed the infant using what reminded me of a produce scale from the grocery store. She then used charts in her backpack to compare the infant age with the weight, then advised the mother that the infant was slightly underweight and should increase number of feedings. Mother was friendly and about 35 years old. The courtyard of these homes is often shared with others, strewed with clotheslines, an outdoor tub for laundry, other debris. Others were around and watched us with curiosity.
The last home: about the size of a U.S. hotel room and shared with three teenage girls (16-17) and their husbands (17-18 years old) and three infants. One of the boys was home, the others were at work which was walking distance away. Two of the girls were sisters. The sisters’ mother was seated in the corner of the room and coughing. One of the infants was coughing. All three infants were weighed and (I think) neither underweight nor overweight. The information from the charts was shared as to how many feedings per day were recommended. The girls were very friendly, a bit shy at first, and eager to please us and take direction from us and the nurse. They had a hammock strung from the ceiling over the only bed in the home where the babies slept and swung. They had some kind of outdoor kitchen with an oven they were excited to tell us about. They could make their own bread. We expressed concern about the coughing and recommended mom and infant be taken to the clinic to see the doctor soon because it will spread. They seemed to understand the problem, however mom had mobility problems and was unable to walk. Because we had seen horse-drawn (or mule-drawn) carts in the street, we asked if there was a cart they could borrow from a friend. They were also concerned about paying the doctor, as they had limited funds. We recommended a payment plan and talked about what could happen if medical care was delayed while they saved funds… could be too late. This was a new concept for them. We also talked about vaccines, how we had all received them as children, and had received several before traveling. We told them we had a yellow card with a stamp from the doctor’s office showing we had the yellow fever vaccine, and that we would need to show it at the airport in Miami or we would not be allowed to return home until we received one. They were receptive to the vaccine info. Later that day or the next, we saw them bring mom to the clinic on a cart, and leave money with the nurses. The nurses didn’t know what to do with it, as it was a partial payment and they didn’t really have any record keeping system. I think later I heard mom was taken to the hospital with possible pneumonia.
Ron can tell you about the home visit where they had some kind of pox that was spreading. The translator, who was the English teacher from the high school, said it was chicken pox, but it sounded like scabies to me. Ron said there was much discussion about using separate water for cooking, laundry and bathing. He also washed his hands and used the hand sanitizer repeatedly when he got back to the clinic!
Overall, I felt like our presence at the home visits was wanted by the nurses. The locals were shy at first, but warmed up quickly after we oohed and aaahed over the infants. Afterwards, I felt like sharing our own experience with vaccines was helpful to the community. Hopefully the introduction of a payment system will be helpful, even if they have difficulty implementing it for cultural reasons.
In Guatemala 2012: the clinic was mainly a birthing center with a traveling doctor. The woman in charge had midwife training from either Red Cross or Catholic church, or both. They asked us to leave for the day on Wednesday because they had wellness appointments and they thought the patients wouldn’t arrive if we were there. (We traveled to the other village to see the clinic that had been built by our club in 2004.) They indicated they were giving pre-natal care, post-natal care, and Depo-Provera shots. Early one morning, I was already awake pre-dawn and heard shouting in the native language and a vehicle drive up. At breakfast, there was a pick-up still parked between our dorm and the birthing center. We learned that a teenaged girl from a village about an hour away was driven there, gave birth in the back of the pickup, and received post-birthing care in the center. She and baby were resting and doing well. She wanted to go home, and was assisted in walking from the center to the pick-up while we were eating breakfast.