You have $10 to work-up your patient. What tests do you order?
This question is never posed in Canadian hospitals, but is an everyday reality for most physicians and patients worldwide.
How can you deliver the appropriate treatment if you don’t know exactly what you’re dealing with? Should you ask your patient to sell their house to arrive at the correct diagnosis?
Part of our course tuition goes towards something called the “Gorgas Patient Fund” so we can do more a more complete work-up for more complicated patients that we see on rounds, and provide treatment they might not otherwise be able to afford.
The Cayetano Heredia National Hospital where we are based is one of three major referral centers of north Lima, and is among the most reputable institutions in Peru. It’s radiology department and microbiologic facilities offer the possibility of a very high standard of care, if you can afford it.
The hospital serves a population mainly from lower socioeconomic classes, including the districts of of San Martin de Porres, Rímac, Independencia, Carabayllo, and Comas. Although most of these areas have access to basic sanitation (tap water, sewage and electricity), approximately 20% of them live in shanty towns (“barriada” in Spanish), where none of these facilities are available.
The only thing equally as wonderful as the Gorgas patient fund, is witnessing the stewards of this fund in action: our Peruvian preceptors. We are continually amazed at their ability to correctly empirically diagnose in the absence of what we would consider “standard” investigations. And when they do have all the tools available, they put it to use with outstanding clinical excellence.
We are privileged to be welcomed into their hospitals and clinics: so this post is dedicated to them. Provide cutting-edge care and skillfully navigating both the 10-dollar and 10-dollar-plus work-up.
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Truly delightful!!!