Today, Dr. Karla, our new assistant Patricia, and I went to the school in La Concha. It is the most rural school that we work in. The school and much of the community does not have running water or clean bathrooms. We attended to many coughs and tummy aches, and then followed-up on the case of Julia who had been having convulsions and bleeding from her ears, nose, and mouth.
Julia’s lab work had confirmed gastritis and that seemed to be gone along with the bleeding from her mouth. However, the neurologist said after testing that her convulsions were not from her epilepsy but in fact pseudo-crisis from some psychological trauma.
When Dr. Karla began talking about this to the school director, she did not talk about how psychological trauma can cuase changes in your brain if it is not coped with well and how a psychologist could help find and treat the cause of the convulsions. Instead, the conversation was about how Julia is possessed by demons. We didn’t talk about what could have been happening in her life around the time she started having convulsions except for that fact that she had been playing Wikki board with friends and the devil must have captured her. To help her, they talked about finding a Pastor to cast out her demons. Dr. Karla has a Pastor in mind that is also a Psychologist.
Similarly, a little boy named Ismael was diagnosed with leukemia the week before Easter. His parents then, after Ismael received a complete blood transfusion and one dose of chemotherapy, took Ismael out of the hospital and stopped all medical treatment saying that God was going to cure their child. When Dr. Karla and I went to check on the boy for the first time since he had left the hospital after Easter, Ismael had his color back, was talking, and could move his legs….relatively better. However, this was interpreted as a miracle of God healing the boy. Not once was the possibility of this change being due to his replenished blood and one dose of chemo that if not cured would come back like before. We rejoiced with the family and prayed with them about the miracle that God had preformed. We will diligently check on this child, pray with the family, and be there as a trusted person to call if things start to go wrong or get miraculously better.
Additionally, there is a young girl named Guadalupe who has Tuberculosis whose parents decided to stop treatment and let God heal their child. Well, if you do not know, Tuberculosis (TB) is an extremely infectious disease that eats the lungs and can be fatal/dangerous to populations if not treated properly. The public threat of this case made managing cultural sensitivity and clinical care more difficult and urgent. However, again we did not force the mother to start the treatment again or argue with her about the necessity of medical treatment. We simply scheduled more appointments with lung/throat doctors for her to be able to follow-up and re-assess her daughter’s condition. (after visiting with these specialists the mother decided to begin treating the TB again)
In all of these situations, I listened, and watched and resisted the urge to discuss the scientific/clinical view of the situation that I was thinking. I was evaluating my automatic reactions to these beliefs/care plans and learning how to respect their beliefs and culture while still attending to their clinical needs. Who am I to contradict their beliefs when quality of life, trust, faith, hope, family unity and peace were all variables? Trust, understanding the mental and spiritual aspect of patients, an open-mind, faith, and love are all critical parts of any patient/caregiver relationship.
Also, as a side note here in Nicaragua, there are lizards that sound like birds, birds that sound like monkeys and monkeys that sound like dogs. And Nicaraguans are the hardest working people that I have ever encountered.
Love,
Ayla Landry
“Assumptions in foreign countries are a bad thing.”
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