Following up

I had the cutest 3 year old little patient the other week. Perhaps I shouldn't use little to describe him, as he was higher percentile for his age in both size and language acquisition. I basically conducted the entire follow up consultation with him directly. At the end, with mom's suggestion yet minimal encouragement required, I pulled him up onto my lap for a picture. Cute. Afterwards I was sharing a few words with mom and dad before sending them on their way, and I looked up to see his baby sister reaching for me from her papa's arms. Big brother had gotten a picture, she wanted one too. I was very happy to oblige! My only regret is that I didn't ask for a photo on my camera as well.

A little while later that day I glimpsed Carolina walking down the hallway through my cracked office door. On making eye contact she veered in my direction. Based on the pile of papers she was carrying, I guessed she needed me to fill out a form or two. Carolina is in charge of patient relations and caja (payments), and she most likely was on a mission to obtain some sort of document. I had assumed. Instead, she handed me a copy of a hand-written note from a patient's wife. She had moved on again before I realized what it actually was, so I have no idea how a letter made it to Loma de Luz in a country with no mail service. The letter was dated March, so if I had to guess, the couple waited until a neighbor or someone from their community was making the trek and hitch-hiked the letter via them. In the letter they commented on the love and professionalism that they witnessed and received here at Loma de Luz.

"Following up" is not really culturally performed here on the edge of the jungle in Honduras. I give every patient I operate on a follow up appointment to come see me, but on average only about 25% actually present to be seen again. The largest reasons for this are time and money. Most of our patient's do not have their own vehicle and so have hired transportation to and from the hospital. This is a huge expense already. Then, even though I make sure that none of my follow up patient's are charged to see me, this is also not culturally expected, so they assume they will need to pay for a consultation on top of paying for the transport. And when all is said and done, traveling hours for an appointment, then hours back home again, means they miss a whole day of work. So all in all, if they are feeling well enough and improving, they skip the whole "follow up" all together.

I am thankful for each patient that comes for a follow up, and do not take the effort they put forth to present for granted. It is especially meaningful when the whole family has packed up, with bows in baby sister's hair, to come see me. Or when they can't come in person, they still think enough to send a rare written word to let us know that they are well and appreciative. I will keep having my follow up surgical clinic, and it will be interesting to see how it evolves with time.

Much Love.