The title of this entry, "Health is not everything but without it, everything else is nothing," was one of the many signs hanging in
front of the hospital yesterday morning. Since last week, the number of flyers,
posters and T-shirts have been growing all over the hospital, all in
anticipation of protest day. At 9 am
yesterday, roughly 5,000 doctors, medical students and hospital personnel from
multiple hospitals in Cali marched down the main road in town and then held a
protest. The same thing occurred
simultaneously in numerous other cities around Colombia. They were protesting
planned health reforms by the government. These reforms, from what I can
gather, involve outsourcing of management of the public hospitals, and
decreased pay for doctors and other hospital employees. There is a lot of fear
that if the public hospitals are no longer truly public, that many people will
lose access to care. In a local news article I read today, the government seems
to be denying that any of these things will happen with the proposed reforms,
and that the public are misunderstanding the legislation. Regardless of what the truth is, the
residents are currently in strike mode. That’s right folks, residents are
actually walking off the job. Imagine that. All of the residents currently on
consult services are not consulting. The residents and interns on the medicine
wards saw their patients and wrote their notes very rapidly this morning,
checked in with the attending briefly, and then left to go to the protest. The
attending was kind enough to stay on the ward and watch the patients while
everyone else went.
Unlike everyone else, the emergency room
doctors were working. Working in the
emergency room’s medicine ward two days
in a row means seeing many of the same patients. The medicine ward in the ED is somewhat of a
transitional medicine ward, and some patients stay there for days. It seems that the patients are at two
extremes. Those who are incredibly sick and unstable, awaiting an ICU bed, and
those who require just a bit of intervention and can then go home. The 19 year
old boy with the asthma exacerbation requiring steroids and frequent albuterol
was sitting on the same stretcher, wearing the same albuterol mask and the same
clothes, 24 hours later, as if he hadn’t moved at all. His mother gave me a
little smile, I’m not sure that she had moved either. Next door, in the critical room, the woman in
heart failure with a ruptured chorda tendineae of her mitral valve continued to
wait patiently for the cardiothoracic surgery consult to come. Were they
running behind because of the protest? It’s unclear to me. Her daughter saw me
walk in, and introduced me to another family member as her doctor from the
United States. While honored, I also felt shy, and sad. I had also seen her
once briefly the day before, and I had no news for them, and no control over
when the surgeons might come. I certainly did not feel like her doctor. But I
smiled and checked in with them all. I
looked over at the jaundiced, emaciated man on the stretcher across from her.
He has been sitting there every day for the past week, looking tired, ill,
miserable, and near death. According to his chart he has end stage AIDS,
chronic diarrhea, and malnutrition. I am not sure what he is waiting for, what is
keeping him in the ED. I imagine he would be more comfortable on the medicine
ward but perhaps there are no beds.
Suddenly, paramedics roll in to the middle
of the room. On the stretcher is an overweight, well-groomed, middle aged woman
who appears to be non-responsive. They start talking quickly to one of the
nurses. A family member holding the woman’s hand is bawling. It seems that this
woman may have ingested something, and when her family found her she would not
wake up. Over the phone, another family member at home read off the name of a
bottle of some chemical, an insecticide, that had been next to her.
Impressively, the ED attending was immediately on the phone with a
toxicologist, and five minutes later, that very same toxicologist appeared in
the ED to see the patient. There is 24 hour toxicology consult available, in
person or over the phone, with a poison control line too that anybody can call.
Our consultant did not seem overly worried about this woman, as her vital signs
and physical exam were all within normal limits, but it was a good opportunity
to discuss organophosphate poisoning and treatment. She soon regained
consciousness and seemed back to herself. I’m not sure how much longer she had
to sit before being worked up and discharged.
As the day went on, more patients arrived
with the paramedics, others are wheeled off to the ICU, portable ventilators
and heart monitors in tow, and others continue to just sit. All around them,
the hospital thought it would be a good time to start taking down the curtains
between the beds for washing, drilling other unidentifiable objects into the
walls, and polishing the floors. It was a very active place for a place that
sometimes feels like very little happens.
I sent a text to David, the Colombian resident
who is on the infectious disease service with us, to ask him what time we would
be starting today. He wrote me back in
English, “Hola, please call Dr. Segura for going to Hospital Uribe , ‘cause we
are in strike.” I had not realized this
would be a multi-day strike, I thought it was just the protest. So this morning, together with the other
visiting resident from Ecuador, we made our way to the Hospital Uribe
ourselves, without David, to meet up with Dr. Segura the ID attending, who was
not on strike today. When we arrived in the ED there, I could tell something
was different. The rooms, waiting rooms and hallways were overflowing with
patients, much more than usual. While there did seem to be large gaggles of
residents and interns there, I think there was a back log from everyone having
been at the protest the day before. This
hospital is semi-private, unlike the hospital where I normally work, Hospital
Universitario del Valle, which is entirely public. I think the resident
staffing there is going to continue to be very bare bones today. While
hopefully nobody will die because of it, I think patients will continue to
wait. I’m also not sure how long this strike is expected to last.
Would we as residents in the US ever
strike? I can’t imagine it. We have lobby days where we can go to Hartford or
Washington. We have the AMA and the NPA to make our voices heard. But the idea
of walking off the job, saying, I am not going to go to work at the hospital
today, and coming up with a system of bare bones coverage for the wards, with
the full support of our attendings, is something I cannot fathom. Let alone the
potential harm to the patient, but what health or labor issue would make us mad
enough, and brave enough, to do something like that? As the Ecuadorian resident
said to me over lunch today, You guys don’t celebrate Labor Day do you? By
Labor Day you mean the long weekend where we go away to the beach and wear
white for the last time?
They may not have beach homes here in Cali,
but it seems that most wealthy people from Cali, which includes many doctors,
do have country home. I was fortunate enough to be invited to Jaime and Clara’s
country home last Sunday. Only one hour out of the city, it is truly a welcome
retreat from the rush of Cali. The small, usually sleepy town of Ginebra is
actually well known for its annual music festival. One week per year, all of
Colombia descends on the town to celebrate classic Colombian music, “the music
of our grandparents” as Jaime said, “before people listened to Salsa and Rhumba”
(kind of make me think of Dirty Dancing). They have so many friends that want
to come that often, people will be camping in their front yard. The amazing thing
about living in a tropical county is that you can build your house to be
partially outside. In their case, the entire middle part of the house is a big
courtyard, some of it covered but some of it entirely exposed. Shrubbery, small
trees and flowers grow freely upwards toward the sun, fed by rain that falls
directly upon them. As we were eating lunch at the dining room table, protected
by a ceiling, a hummingbird flew directly up to the shrubbery beside us to sip
from the flowers. What a peaceful and tranquil
retreat, something so special to be able to enjoy for so many years.
Nearby their house is Hacienda El Paraíso,
known as one of the most romantic places in Colombia. The story is a true one,
and was made famous by the Colombian writer Jorge Isaacs. In fact, you can see
a picture of him and the hacienda on the 50,000 peso bill. When he was young, a
girl named Maria came to stay at his family’s hacienda. He fell in love with
her, but she soon became ill and died. Jaime told me that every teenager in
Colombia read this book and feels the romance of the story. There is something
even more magical about being able to walk the very hallways and courtyards of
this estate, of seeing the actual rose bushes where he offered her a flower, of
sitting beneath the tree where they sat. The hacienda itself is situated on the
cusp between valley and mountain, in a shaded, impossibly green and flower
filled spot, with endless sugar cane fields in the distance. You can definitely
feel the romance in the air.
Photo of Maria on the wall at the Hacienda del Paraiso. 50,000 peso bill shows the writer and his inspiration
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