L a N o r i a.

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Yesterday was my first day at the hospital, and it’s taken me until now to form articulate thoughts about the experience. It was just so different from anything I’ve ever experienced!

When I arrived, they assigned me to the Emergency Room. I recently spent some time shadowing in an Emergency Room in Waco, so I was excited to have a direct comparison readily available. When I walked in, I realized it was literally an Emergency Room — a single room with a metal desk, an observation table, a stethoscope, and a sink. There was a doctor and a medical student, and a bunch of people outside the doorway waiting to come in.

La Noria is a hospital that specifically works with uninsured patients, or patients who have a government-sponsored insurance called SIS. If you come to the ER, you must purchase or bring your own thermometer, latex gloves, sutures, or whatever they will need for your visit. If you don’t have what the doctor needs, you must go to the pharmacy located at the hospital entrance and buy what is needed, and then return to the group of people and wait again. On one hand, it seemed strange that the doctors didn’t have latex gloves and other basic necessities available as a part of the visit. On the other hand, I think it’s a solid compromise between the hospital and the people who don’t have health insurance. Here, medical supplies aren’t catastrophically overpriced like in the US. I needed medication from the pharmacy yesterday and it was 1.80 soles, which is about 60 cents in the US. If someone doesn’t want to buy health insurance, I think this is a fair way to compromise, as long as it is justly followed through. All in all, it was very interesting to see the different approach to health insurance here!

When a patient arrives to the ER, they just walk in the open door and see if the doctor is already with someone. All of the HIPAA policies that have been indoctrinated into my brain were freaking out all day, and I had to continually remind myself that HIPAA isn’t applicable here. I’m starting to understand some of the ethical reasoning behind HIPAA, especially in regards to patient privacy and respect. Just another interesting part of the day. Anyway, so when the patient arrives, the doctor asks them for their name, age, address, and reason for visiting, and then they record it in a book that resembles how I imagine Santa Claus would keep tabs on little kids. Then they describe their problem, and the doctor either refers them to another part of the hospital or has them lay down for a physical exam. The examination table has no hygienic paper on it, so one minute it could have a sick baby on it, the next it could be a woman with typhoid. Occassionally the doctor would use hand sanitizer in between patients, but it was not as consistent and strictly followed as it is in the US. That was the most surprising aspect of the day for sure.

Friends, I had no idea that medicine looked like this in a developing country. Someone recently responded to a social media post and asked why I have been so surprised by what I’ve seen in Peru. I certainly was expecting poverty, but not to this degree. Not in a developing country. Not in a major metropolitan city. Basic hygiene, basic patient privacy, and basic safety precautions are not applicable here. From now on when I hear that an area is medically underserved, I’ll be thinking about this single Emergency room with a mass of people outside waiting to see the single doctor.

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