Friday, February 25, 2011

Medical Supplies

    The file room at my clinic is starting to look like a small pharmacy.  Andy Chiew, the pharmacist in the building, dropped by and he was impressed at our growing stock of pharmaceuticals.  
     I have not obtained enough antibiotic supplies.  I asked Andy to find out the least expensive generic source for an antibiotic in each of the basic classes and I will purchase a 1000 dose container of a half a dozen antibiotics.  Andy arranged for me to purchase these medications at cost, which is most appreciated, and then he generously offered to split the cost!  I was overwhelmed. Thank you Andy!
     Many physicians have generously donated supplies and others have been setting aside pharmaceuticals for us to pick up.  Michele Holtsbaum, my office manager, will visit half a dozen offices later today to pick up some of these supplies and she will do this again in March.   
     I purchased two very large duffel bags with wheels from MEC and expect to fill them both.  These versatile bags have shoulder straps on the back and can be carried as a pack on the shoulders, they have wheels on the bottom and can be rolled along the ground, and there are grips on three sides so they can be carried by hand.  I used one of these bags for Haiti last year and although very heavy when full, the bags were otherwise great.  

Thursday, February 10, 2011

Learning Spanish

     I know enough Spanish to roughly follow a simple conversation and even to slowly read basic passages but my spoken Spanish is inadequate, especially for a professional medical intervention. During my visit to Nicaragua last October I had a driver who served as my interpreter.

     I have used interpreters in the United Arab Emirates and Haiti. 

     In the Emirates I was the Head of Pediatrics at the Royal Tawam Hospital and my position came with a full-time interpreter. I was exposed to a number of well-meaning male interpreters and I learned that most translate what they thought I should say rather than what I said. None of the available interpreters suited my needs. Many presented as very chauvinistic and condescending in their attitudes to the mothers and this was not acceptable. During the first month in Al Ain I met a nursing assistant from Palestine who was working on an adult service. He was a good interpreter who understood my need for a literal translation, for patience, and for a professional attitude. He was happy to interpret for me but this took quite a bit of haggling because he was not a designated interpreter. You would have thought that re-assigning him to my department should have been a very straightforward matter but the nursing department would not release him to my service unless I arranged to have his salary paid through my department and to incorporate a new salary without going though the conventional budget process and at the wrong time of the year turned out to be a major problem. However, I eventually succeeded and my clinical efforts were definitely better for my trouble.

     In Haiti the need for a good interpreter was painfully clear. On my third day a new interpreter arrived and he turned a difficult morning into an impossible morning. I might not speak Creole, but I can certainly read people. I would ask a question and the interpreter would provide an answer to another question. This happened so repeatedly that I started to speak very slowly and purposefully with him, the kindest and most preliminary way for me to let him know that I would try my best if he would try his; he was clearly impatient with the mothers and increasingly with me; I guess he felt that the failure to translate, his job, was either the mother’s problem or mine. After an hour or so, and with an increasing sense that he was just not interested in trying to connect with the mothers, I started to get impatient with him. “Is anything wrong,” I asked? “No,” he replied, but he laughed at me when he said this. His mind was clearly somewhere else and finally, when another translator became available, I asked him to leave. The new interpreter turned my morning around. The histories took a quarter of the time, the mother’s had the light of understanding in their eyes, and I was confident that I was offering good care.

     The clinic in Nicaragua does not have an interpreter who will routinely be available. I have offered to hire a local person with fluency in both languages but there are none available in this rural community. So, I need to learn Spanish.

     I researched the various methods to learn Spanish and I decided on The Rosetta Stone, a computer-learning program that incorporates audio with visual images. Last week I ordered the Spanish, Latin America version, Levels 1 to 5. I also ordered a well-known Medical Spanish textbook.  For the last two mornings I set my alarm for an hour earlier and I spent the time working on my Spanish. 

     My goal is to arrive in Nicaragua with rudimentary Spanish.