Annina Lux - A Definition of Snow

Chamuela (Bolivia)

I started working at the Hospital ********* 5in 2011. I work as a Medico General . In rural Bolivia, there are no GP practices, so anyone ill or injured has to come and see a medic at the hospital. I treat patients with all illnesses and injuries, from just after birth to more than 90 years of age: anyone who comes to the hospital. The hospital has remained small for the number of people living in and around *********, and it lacks specialist doctors like traumatologists, internal specialists, paediatricians, endocrinologists and gastroenterologists. The Director of the hospital also made me responsible for the Accident and Emergency department (A & E), so I have to write weekly and monthly reports and do 24-hour shifts there at least six times a month while continuing with my other work.

When you work on 24-hour shifts, you see patients with all sorts of problems: patients with tropical diseases and viruses; patients with acute abdomen problems, like appendicitis and cholecystitis; patients with light or severe burns; patients with urinary infections, with hernias; patients with different types of tumours; patients with cancer; patients suffering from polytraumatic injuries. You have to deal with everything from fractures to wounds, from pregnancies and births to self-performed incomplete abortions – you see it all. As a medic, you have to treat all of these patients. The hospital does not have enough, or sometimes any, specialist doctors. Neither does it have advanced technology for diagnosis or treatment, so a lot of the treatment is done by meticulous clinical work with the help of the patient’s own account of their medical history. After assessing the patient, we write a detailed medical history and fill in the many forms needed to solicit the available laboratory work, ultrasounds, X-rays and ECGs, as well as prescription forms and, of course, a diagnosis sheet. In recent months, we have been able to call our available off-duty specialists in the areas of paediatrics, internal medicine, surgery, traumatology and gynaecology to come to the hospital and assess patients if needed. For this we have a communal telephone to contact those specialists. However, as medic on duty you will often have to attend these complicated cases by yourself, if you can stabilise the patient. When we do call specialists on the phone, patients often complain or denounce us to the press or the director of the hospital, saying we only talk on the phone all the time. It is difficult calling specialists at night, because sometimes we do not have credit on the phone. It’s incredible and very alarming. Sadly, the medics in the hospital do the work of doctors, secretaries, statisticians, and sometimes nurses. Its impressive how they deal with all the pressure and stress. In Bolivia, Medicos Generales are truly the worst paid and least privileged and appreciated. They are not valued. Many admirable people do not get the respect they deserve.

There are so many challenges in A & E and often you have to fight tough battles. You have to endure ill-mannered, drunk people that shout at you and insult you. They have no manners and believe the medics are their own special employees. I believe you should not even treat your own personal employees like this. You see fights, physical aggression, sexual aggression … In the hospital, we do not have security guards. Because of this, I had many very stressful shifts between 2011 and today.

Once, a couple came into A & E after attacking each other. The man had a slanting cut near the right eyebrow, the woman a deep round contusion on the forehead after suffering a blow to the head. I dealt with the wounds and put in stitches. This couple had been brought in by the police but the police had just left the couple in A & E and gone. The woman had a sharp blade with a cutting edge to attack her partner. In that moment, my heart was racing, and I felt so desperate when I saw this happening. I felt powerless, and I had to call the police again. When I heard the siren approaching, the aggressor ran away. When there are tough cases like this one – murder, accidents or situations where people lack respect towards us – we do not have the police close by. When we call them, we lose time, and they always arrive too late. Sometimes they also come with patients. There are only a few policemen in the town. When the police come, they often come to ask the medic on duty to register how many patients there are in each ward, rather than to help.

In A & E, I have had so many patients intoxicated with alcohol, illicit substances, and poisons. Sometimes you also get bold patients that make you compliments in their intoxicated state. Sometimes the patients tell you, ‘My darling, how beautiful you are. Doctora , you can touch me wherever you want, doctora .’ One patient that came to see me told me his stomach hurt. I examined him, and he told me it hurt further down and that he would show me where. He lowered his trousers and showed me his erect penis. He covered his face and asked me what I thought. I examined him seriously, but something seemed strange to me, and when I looked more closely, he grabbed me. Another patient lowered his trousers and told me he wanted me to give him an injection, instead of the nurse, and hit himself on his buttocks. Another patient suffering from schizophrenia came to A & E armed with knives, grenades, handcuffs and guns, and only during my shifts, so that I specifically would attend to him. To tell the truth, I had shifts full of terror. When I handed the Director of the hospital a complaint, he only laughed. This is a problem for female medics, not for male doctors. Women do not do these things to them. I had all these bad experiences in my shifts. It makes me so scared of these situations.

Some hospital staff also used to leave the hospital to visit prisoners every Thursday. The prison in the town is a very sad, desolate, and truly disastrous place with bad conditions for the detainees. We discovered this when three staff members went there to give medical attention to the prisoners. There were people who were involved in drug trafficking, murder, robbery and assault. Initially, you do feel a lot of adrenaline when you are inside the prison room, out of fear of the reaction of the people there … But I can confirm that they were friendly and treated us with respect. Once, however, a young man approached us to ask us to treat him for Chagas disease 6. After we had explained the possible side effects of the drug Benznidazole to him, he agreed to start and finish treatment. Another female colleague and I left the hospital to go to the prison to treat him every five, eight, or sometimes ten days for two months. Whenever possible, I gave him fruit, cereals, cookies and bread, which he shared with his friends. Sadly, when he was going to finish treatment, he started to tell me, ‘Doctor, I am in love with you. I love you, you are my favourite doctor, thank you for doing all the follow-up checks on me. But I am in love with you, I want to kiss you. I want you to be my girlfriend, my love.’ So, when he was released, he came searching for me … This situation I didn’t like. I felt worried and surprised that a patient would say this to me. To be honest, I was very scared. Because a man had asked me to treat him for Chagas, of course I did, and did all the follow-up checks for two months. But this man knew everything about my life. He knew where my family was from, he knew I was single and that I did not have children. He told me to save money for when he came to find me after his release. He said that he was in love with me, and if he had met me earlier, he would not have committed the crime of murdering his wife. This situation made me shudder. After that, I stopped my visits to the prison.