Sunday, July 25, 2010

The Doctor

We have had a number of discussions about the role of "students' working
along with professionals in a country where we have limited language and
knowledge of customs. How much of this experience is "taking" so that
our work with Latino patients in the future will be competent and how
much is "contributing" in any way. It is a challenging subject and one
that I won't presume to have a final word; it is for our program to
continually process.

However, in meeting an Ecuadorian doctor who runs a public health clinic
where our students will be for a week, it is clear that we can be
helpful. He sees hundreds of families and he sees them over and over,
like the family doctor. On any given moment he is pediatrician,
gynecologist, pulmonologist, neurologist, and cardiologist for this
community of very poor people. This is a cinderblock neighborhood that
is an iteration ahead of the bamboo shacks that stood in the same place
a few years ago. It has no sewage and there is trash in the unpaved and
unleveled streets. It is a place that is quite similar to those in
which I worked in Jamaica, but it is overwhelming if you haven't been
exposed to it. This doctor needs us to do some histories. Since he,
like his American primary care counterparts, has only a short time to
visit with patients, it will be very helpful to hear from our students
about the living situations, family challenges and emotional issues that
his patients are experiencing.

He spent a good deal of time on the orientation visit giving us an
introduction to his work and his community's needs. The fact that he
travelled to a welcoming reception and to a lecture that I gave at the
Blue Hill College spoke to me of the value that he anticipates that we
will provide to his work in only the few days of our visit. At the risk
of seeming overly impressed with heroic figures, this is another unusual
figure; he is a man from the mountains, he can work anywhere as a public
health doctor, his office and his examining rooms are a far cry from
those of the Harvard teaching hospitals.

One is forced to ask: "Why does he work here?" One is forced to
challenge Miss Freud's concept of Altruism as merely a defense against
libidinal instincts or her father's ideas about sublimation, reaction
formation, etc. He stands as a counterpoint to personal profit. What
is there to learn from his commitment to this community? Even with only
being able to contribute some good psychosocial histories there seems to
be value to the students' presence with this man and his team.
Incidentally, we did have a good discussion about the potential that the
young people whom he observes compulsively texting: so much that they do
not eat, sleep much and become deconditioned due to inactivity might be
depressed. These are adolescents whose parents have immigrated to find
work and they are now living with neighbors, not necessarily family
members. I promised to send him some information when I can speak with
some addictions people to get their impressions.

Nick Covino

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