Thursday, July 10, 2014

break-bone fever, bent-back fever and malaria, oh-my!

When I first came to the DR ten years ago, I was given a course in tropical diseases - it was a general "going-overseas" course, so a lot of the diseases we learned about didn't even really apply to my part of the world, and really, THANK YOU WORLD. Some of those things - worms that bore through the heels of your feet and end up in your blood stream, scorpions that sting, snakes that bite - are enough to give the most seasoned outdoorsmen nightmares.

The Dominican Republic doesn't even have a malaria problem (though occasionally you'll hear of malaria in Haiti). As far as mosquito-borne illnesses go, malaria was the scariest for me. Afterall, I had recently read The Poisonwood Bible.

I have since learned that malaria is not nearly the most painful or even the most widespread of mosquito-borne illnesses. 

Dengue Fever - often referred to as break-bone fever - is common in the DR. It is transmitted by a special, of course, type of mosquito and everyone once in awhile the country's emergency rooms fill up with infected humans. It is marked by high fevers, diarrhea and vomitting and an intense pain in the joints and bones. There is no treatment, and is often deadly - especially for small children and the elderly. 

Doesn't sound terrible, right? Some fevers, dehydration, and in the end you (probably) live? Perfect.
Except you can't take pain killers stronger than tylenol, and the only other relief is simple re-hydration by IV. And the pain can last for days and days. 

Dengue hasn't reared it's ugly head recently - at least not in epidemic status.
No, in fact, I haven't heard one story of dengue for months, but mostly that's because a new disease arrived in town about two months ago.

Chikungunya Fever.
Lovingly referred to in Africa as bent-back fever because the pain is so strong it forces your back to hunch over. Bent-over. 

Same mosquito, different disease. Pleasant.
Not as deadly, apparently, as dengue fever, but far more uncomfortable - high fever, vomitting and diarrhea, intense pain in the joints and bones and, for added drama, a bright red rash that covers the body. 

We're not really sure if it's run through our house yet, but I'm going to bet on no. We all got some intense fevers, and I was pretty uncomfortable - but no rash, no intense bone pain. Amely, we think, had strep throat and so I'm sure that's also probably what Samil had. I probably just had pregnancy-whiny-ness. Katherine, Amalio's cousin, was down for the count for three days, but also didn't have the bone-pain. Amalio, of course, was left unscathed.

The gross-ness did make it's way through school - our attendance dove into the ground in June. I had parents in the office, waiting in line to tell me that their kid was sick. And our cook, our has-never-missed-a-day cook was out for three days because she literally could not put her feet on the ground to get out of bed. 

Earlier this week, a friend called to tell me that her two month old son had the chikungunya and could I recommend an ER? (Hi, Janet!) I recommended the ER I always use. I told her that I don't really buy into any of the pediatricians there, but we've always had a decent experience (with the exception of Amely's chicken-pox visit) with the doctors in this particular one - and as an added benefit, it's just busy enough to inspire confidence but not so busy to frustrate. 

I have never waited in this particular ER. ever.
I swung by on my way home from work, to check on her and the baby because medical care can be overwhelming here. I imagined she was on a bed, getting checked or waiting to get checked. She was standing in the triage area, with a thermometer under baby's arm because there was no where else to go. There were at least 25 people waiting in line - even pregnant women were waiting in line (unheard of for preggos to wait in ANY line in this country) because there were just so many people.

She was sent home with the indication to hydrate and continue acetometophen treatment. There's not really much else to do. 

I'm hoping to avoid being a statistic this time around - it's predicted the 85% of the island will be infected, and that it will be a worldwide epidemic, not limited to tropical regions. It's worse for newborns and the elderly. If you're traveling to the Caribbean, make sure to bring mosquito repellant and apply liberally to avoid bites. The specific "breed" of mosquito is more likely to bite during the day (instead of at dawn and dusk like "normal" mosquitos) and looks different than the mosquitos that most non-tropic-natives are used to (a little bigger, front legs are higher than hind legs, and are striped like a tiger). DO NOT take any pain medication except acetometophen (I don't know how to spell that), because Advil and others can make it worse. And, if you do get sick, hydrate, hydrate, hydrate!

Tuesday, July 8, 2014

never a dull moment.

On Sunday, I took the kids to the beach with our friends, The Rousculps.

The nearest beach is only about an hour from our house, and I'm very sad to tell you that we do not visit there often enough. It is a beautiful, Caribbean beach with waters as azul as the sky, and as warm as ocean water should be. The beach sand is white and soft. And.

And we can go there in January. Or March. Or really whenever.
But we don't.
Because we apparently do not know how to take advantage of what we've got.

Nevertheless, on Sunday, we went.

The water was beautiful, the sun was out. And, of course...

thank god it's not a baby! just a dead puffer-fish!
Josh wrestled with a barracuda. At first, he thought one of the kids had rammed into his leg, but when that "kid" bit into his trunks and tried to steal them, he put his hand down and felt a long, sleek fish that was pretty big.

Rebecca and I made friends with a sweet little girl, no older than 18 months who just wanted to eat our cookies.

And then! a dead puffer fish appeared in the water, and it was like a scene out of Dominican Baywatch -- you know, the slow motion of the entire beach running toward the lifeguards pulling a drowner out of the water onto the beach -- the entire population of the beach ran toward the brave swimmers carrying a dead fish out of the ocean, including a woman who dramatically dropped to her knees and praised God when she realized that it wasn't a drowned-child.

Overall, it was a great day. Just enough drama to keep it interesting and just enough energy to knock the kids out on the way home! (well, just the boys - Zora and Amely were all about their fantasy land).

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On the way home, we pulled over to a road-side fruit stand and Josh got 5 avocadoes and a bucket of mangoes for less than three dollars. And that bucket of mangoes has SIXTEEN mangoes in it.


Friday, July 4, 2014

on reading.

Volunteer Anne Pelsser read to students
three times a week for an entire semester.
We miss you Anne (and Pierre!)
I've said - quite frequently and to anyone who would listen - that most of the problems that we've dealt with in starting and running a school are not the problems that I foresaw. I expected irresponsibility with payments, lack of concern from parents and maybe some teacher truancy and attendance issues. There are some inherent problems due to the demographic that the school serves, but overall, I guess I expected some semblance of teacher preparation and training - after all, all but one of our teachers (the 3-year old class teacher) are trained, professional educators.

I've known that there is a deeply entrenched literacy poverty in the Dominican Republic - even among the upper class - that affects how our children think and learn. There are no public libraries and most schools - again, even in the fancy private school - are lacking books. Sure, there are text books, but there is a deficiency in any other type of text: few story books, few non-fiction books, few encyclopedias.

What comes with this lack of actual physical reading resources is a lack of understanding of the real, profound importance of teaching kids not just to sound out words, but how to actually read - to comprehend, to question, to analyze the words that are on the page. But, how does one even go about switching something so ingrained culturally?

Samil was in first grade this year. He fought learning to read - he dug his heels in and absolutely refused to practice. Homework was a dreaded task - for everyone involved. The "reading" that was happening was phonetic, and from what I could decipher consisted in sounding out long lists of words.

No sentences. No pictures to describe sentences. No stories.
Lists and lists of words.

As far as technical reading goes, the method works. The student learns basic phonetic combinations of consonants and vowels (ma, me, mi, mo, mu), and then combines those sounds into simple words, building upon the previous sounds learned.

What happens when the student has to not only decode words, but decipher meaning in sentences? Or read a story and figure out the meaning?
Learning the phonetic sounds using scoops of ice-cream!

It's tragic.

One of the first teachers who worked at school - teaching three year olds - told me that she didn't have time to read stories to her students. That she needed to be focusing on far more important skills, like making sure everyone was sitting at the right table. Another told me that, after reading one story book, she just didn't have time for something the students aren't interested in. She taught four year olds.

Loving reading is an acquired skill. Loving stories is, too.
Unfortunately, there just hasn't been an emphasis on reading as a means to better educational quality. It is so hard to incorporate simple reading into the curriculum because neither the parents nor the teachers understand the importance. Sadly, I don't think this is a Dominican Republic problem. I think we're taking the joy out of reading for most kids - be it for lack of exposure, or for forcing test-based-reading, or for just not providing quality texts.
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There are some awesome organizations on the island that are working hard to enhance the culture of reading for our kids. Check them out:

Amely loves reading story books!
FUNDEBIBO - is an organization that works to train librarians and other "resource-arians" and to promote literacy in the Dominican Republic. Based in Santo Domingo.

Lleva un libro en la maleta - is a grassroots movement to motivate people to bring a book, many books and/or school supplies with them in their suitcase when they visit the island and then donate them to schools that need them.

Fundacion Mahatma Gandhi  - is located in Las Terrenas - a beautiful beach town on the Samana peninsula and offers library services with more than 7000 books to the community.

Biblioteca Comunitaria Dr. William House is, of course, my favorite literacy program on the island. Located in San Francisco de Macoris, the library offers programs ranging from story time to English classes to art hour.

Thursday, July 3, 2014

Emergency (part 3)

Last March I had a health scare. It started with just a little shortness of breath, tightness in the chest and, overnight, escalated to not being able to breathe. I got  up in the morning and even got in the concho with Jewel to go to school. Half-way there, I knew I wasn't going to make it. Could we please just go to the emergency room of that terrible public hospital by school? Surely, being located next to a burning landfill they'll have the resources necessary to deal with a respiratory issue. We got out of the car, walked down to the hill to the ER entrance and asked our way in. It looked promising, until we got to the intake "desk" and they asked if I had a mask. No, I don't have a mask. I'm dying here and you are asking me about a mask? I didn't even know what in the world a mask had to do with anything - I don't suffer from breathing problems. The intake woman told us we needed a mask; they don't have any, we'd need to buy one from the pharmacy.
you may or may not get emergency care
from this very experienced doctor

The problem? It was only 7:30 and the pharmacy doesn't open until 8. Meanwhile, I couldn't breathe and I was scared. Instead of playing the game - mostly because we had no idea what the rules were - we walked back to the avenue, paid a concho to take us to a private clinic in the city and hoped for the best. I got nebulized twice that day and even after a few minutes on the machine I felt like a new person. I didn't pay more $40USD for the treatment and emergency care, but $40USD is a week's salary for most people.

Luckily for us, we've not had any real emergencies - Amely's ear bleeding, my one-time breathing issue, a few night-time/weekend fevers, some stitches - and the emergencies we've had have not been very serious.

Emergency medical care is laughable in public centers, but it is not any better in the private clinics. There is no "emergenc-ology" - most of the docs working in ERs are the doctors who just don't cut it anywhere else. From what I understand, the "emergencies" that are generally presented are so routine that it is not necessary to have specialty doctors waiting around. The occasional car accident or burn victims call in the on-call doctors.

Emergency care is generally cheap - especially because, with insurance, it covers all of the medications that they give you, plus the bed-fee and doctor honorarium. We paid just $16USD when Amely had the chicken-pox - which included a salmonella test, blood and urine tests and an IV of saline solution plus anti-vomit and fever-reducing medicine (don't even get me started on all of that). A friend of ours spilled a pot of boiling water on her lap and the bill for all of the services she received was $60USD, for what she reports was pretty decent medical care.

A visit to the local, public hospital to get stitches
for one of our students.

I visit that tragic public hospital far more frequently than I would like to admit, but considering the lack of resources, the doctors and nurses in the ER are polite, receptive and good at what they do. I've taken numerous students for stitches and the service is quick and as painless as stitches can be. And it has never cost us one cent. (In fact, the antibiotics, triple-antibiotic cream and tylenol that we have to purchase in these situations costs less than $3USD). Now that I know most of the emergency care nurses and intake personnel, we get nice service (and a lot of our students have reaped the benefit of a good relationship with these people).

Obviously, I don't have any serious emergency experience here (and for that I'm thankful), but basic emergency care isn't terrible - and I guess it really depends what you call an emergency. Make sure to steer clear of the public centers unless you know the people who work there, but remember that just because a place is swanky or costs more, doesn't mean you'll be getting better care.

Sunday, June 29, 2014

school's out for summer!

This school year was filled with growing pains - we now have a 100% different staff than when we started imparting informal classes three school years ago, we have new resources and a completely new national curriculum to comply with. It's a lot of figuring things out and dealing with problems, and I'm really sad that I wasn't able to spend nearly as much time with the kids as I would have liked.

But! Because of my limited interaction with all of the students, I was able to form and stregthen relationships with a few that I might not otherwise have had a ton of time for. In fact, I looked forward to one kid in particular who has been with us since day one. His dad is a single father, and until very recently, if I wanted to see him, I'd have to go to his house and wait until he'd grace me with his presence.

Child-rearing is still, and not just here in the DR, very gendered - moms have their role and dads have theirs. Unfortunately, the dad role has been one of discipline and violence. Disciplining a child means spanking and beatings. Add in poverty of mind and body (and wallet!) and it is a recipe for disaster. Throw in a kid who you have been saddled with, on your own in a world where men just don't do the single-dad thing.

I met this dad before I even entered formally at school - he had come, on the last day of June to pay off the entire year of tuition. He just hadn't thought to send the money, but wanted to make sure his son "wouldn't be bothering him at home next year." I took his payment, and tried to stress the importance of paying on time, hoping that we might see more consistency in the future. 

Forget it. Last school year, I saw dad twice at school. He came in December and he came in June. His new "wife" had been checking up on the child, and we had seen definite changes in his personality - he was more open, loving and willing to receive affection. This woman was doing great things for him at home. But, she admitted, it wasn't a nice environment for anyone and she didn't know how long she'd be sticking around. 

This fall, we hit a wall with the student. He was nervous - visually shaken more than once, and his mental walls went up. We were scared to talk to the dad for fear of his punishments to the kid. Step-mom had, in fact, moved along in her life and left this boy alone with his dad. 

We talked and played and sometimes, our shy little man would  stop by my office to give me a hug before he left for home, and things got better. In March, step-mom was back in the picture and shortly after, dad was visiting me in the office to pay and just to "check-in." In May, he came and asked me for a copy of the birth certificate so he could get his son vaccinated. Three days later he brought me a copy of his new vaccination card!

No matter how much our student had changed, his mental walls and probably  a learning disability really held him back academically this year, and he'll be repeating second grade. And even with all of the change that I've seen in the dad...

I was so scared to tell his dad..

The abusiveness of old scared me. I would be much better off in my life if I hadn't heard of the "techniques" to punish this child for not being able to read or write or for wearing the wrong socks to school. I know that dad has changed - we've seen it in the kid's character as well - but failing second grade is a big, big deal.

The step-mom came to collect the report card, and I told her that I really need dad to come in so we could talk. I explained - in my best principal tone of voice - that it was best for the boy, that it will allow him to build his "base" and do better in higher grades. I told her that even if he couldn't come in, I would go there - but no matter, we needed to talk. 

Imagine my joy when dad showed up just half an hour later - leaving his little shop with an assistant - to tell me  that, yes, he understands and it is okay to leave him behind. Also, he will be attending review-weeks at school to get a little more "of that base you told my wife about." It was only more that he brought me a candy bar and told me how much he appreciates everything that the teachers have done for him and his son this year.

I had to close my door for a few minutes when he left. It's not really professional to cry in front of the parents -even if they are tears of happy.

It's hard. But slowly, step by step, we're seeing the lives of these kids change. We're growing. There are growing pains, but it seems to be working. 

Saturday, June 28, 2014

Finding a Doctor (part 2)

We began our search for a pediatrician shortly after Amely bled from her ear and the insurance coverage we had sent us on a wild-goose chase. It was difficult because most of our Dominican-friend base works in education, and therefore was either covered (and content) with the teacher's insurance program or had also just left the system and were in the same situation as us. I also have ex-pat friends, but the criteria "speaks English" is not important for me - there are few English speaking pediatricians in Santiago, and just because the Americans use them, doesn't mean that they are quality.

English not being a requirement, I have a list a million miles long of what I need in a pediatrician. I am a bit ... demanding, and, because of Amely's ear problems, we wanted someone who could deal with that and not ship us out to an ENT every time there was an issue.

to be fair, this happened on vacation in the
states. but, it's clear - amely needs a doctor.
and i'm a terrible blogger because i have no
picture evidence at all of any of our
doctor-adventures.
There are a number of private clinics in Santiago - the good, the bad and the ugly. The system is different than in the states - you don't go to a doctor's office. You go to a clinic, where the doctors have private consult areas, there is in-patient treatment, diagnostics areas (imaging, labs, etc...) all in one building.

After I chose the clinics that I could deal with, I started looking for suggestions. Oh, the suggestions came. I have a list 2 pages long of the the best and brightest and most dedicated doctors in the area.

And that's when I found out that it's not really the doctor's that are the problem.

Attempt #1. Highly recommended, Christ-loving, young(ish), female pediatrician in a favored clinic. Arrived at 8:30am, not really sure what this doctor's hours are. (very few doctors work on appointment schedules - it's first come, first served). The secretary is chatting away with the security guard. I stand at the desk for about five minutes before she even acknowledges our presence. She then tells me that the doctor arrives at 9am, on-the-dot, every day. At 10am, on-the-dot we were still waiting. When the doctor arrived, the secretary pushed two other patients up on the list. Amely threw up on the floor.
I actually really liked the doctor. Enough so that I was willing to try again last week. Bad idea. When I entered the waiting area, she was on her cell phone, talking to a friend and didn't acknowledge our presence at all until I scooped Amely up and carried her out... and even then it was to tell me that pregnant women shouldn't carry heavy things. No questions as to whether I had been waiting to see her doctor or not.

Attempt #2. Samil had a pretty persistent fever and was throwing up, so I grabbed my list and headed out to try a new doctor. I know that this inconsistency in their treatment is not helpful - but my kids are pretty healthy, so until we find a fit, I'm not that worried about it. The doctor from my list wasn't available in the morning, so I asked the secretary to put me on the list for the doctor who typically arrived the earliest. Unfortunately, that's how it works. No appointments. Just a list. And sometimes the doctors show up on time and sometimes they don't. This day, she didn't. I almost left - again because of secretarial crap. The doctor usually arrives at 9. By 10:30, she still wasn't in. When someone asked the secretary, she responded that "she's on her way, she had an emergency" and then stage whispered to her co-worker that the doctor was getting her nails done. So professional of the secretary to announce that. When she finally did arrive, and we were ushered into the office, I was told to turn my phone off. Weird. She was an older woman. I don't tend to like female doctors, but I really did like this doctor. She sent us for some tests to make sure there was no parasite, and when we returned in the afternoon she wrote a prescription for a BRAT diet and some pain relief. No unnecessary antibiotic (because it was a virus) and no crazy long list of meds. The secretary even called a few days later to make sure Samil was okay. (**this is probably the pediatrician we'll stick with)

Attempt #3. Not really an attempt to look for a pediatrician, but it fits - Amely got sick at school, threw up once and then threw up in the afternoon. She was fine, really, but her dad is reactionary and took her to the ER (which is a whole other post in and of itself). They took blood and pee samples and everything basically came back normal, except a very small amount of bacteria that the doctor called salmonella (eventhough on the lab result paper it just had some generic title). Even the ER doctor agreed that there was nothing wrong with her, if she wasn't still throwing up and wasn't dehydrated, she just needed to rest. HA! Until he called the pediatrician on call for permission to release her. The pediatrician insisted on coming in, and writing a prescription for anti-vomitting medicine (she threw up twice in the whole day), re-hydration whatevers (she just had an entire bag of saline), and some heartburn medicine (because she was obviously having so much reflux). I just kind of shook my head. Amalio got the medicine and the next day Amely was covered in chicken pox.

half-attempt (not really a pediatrician). Amely has a distended stomach. But only sometimes. So, after much complaining of snakes in her tummy, I researched out a pediatric-gasteroenterologist. She did a battery of lab tests - parasites and amoebas, blood disorders and pee testing, anemia - normal stuff in these parts. What I liked was that she prescribed on two papers - one, all of the tests that our insurance covers and on another the 2 tests it doesn't (a certain amoeba and a stomach bacteria). She was great, and had a gentle hand. I don't even want to tell you how much I loved her because it makes me sad that she doesn't do normal pediatric stuff. Also, nothing wrong with AMely's belly.

Attempt #4. And probably the final, disappointing craziness. There is a crazy illness going around town, and both of the kids got it in the past week. High fever, sore throat, sluggishness, and, apparently, mommy my shoulder hurts and mommy my eyeball hurts. It was Friday afternoon, of course, so I quick found a substitute for the uni and headed to the clinic. For some reason, I tried to go back to doctora number 1, but was reminded quickly of her secretary - and headed to the ER to take Amely's temperature - if she had a high enough fever, they'd run an IV of fluids and give her medicine right there. She didn't have a temperature (of course, not), so I asked for the doctor who arrives earliest for the afternoon shift. It was a male doctor, with 40 years of experience and not an ounce of bedside manner. I think he might have said hello and then proceeded to check out Amely. No questions about what might be wrong with her. She had no temperature, normal everything - except her throat was inflamed. He starts writing on his pad, checking a million boxes for lab tests ranging from her thyroid glands to parasite tests to blood typing and a sickle-cell analysis. "Um, sir? y todo eso?" Is there a reason that you're prescribing all that. Oh, it's just standard procedure. For a throat infection. Her blood type is A+ and she doesn't have sickle cell. To which he responded: "I can't trust your word on that, I need to see these recent lab results in order to know if it is true."
With that, I asked for the prescription of medicine he had written and went on our way. She was better the next day. (and then Samil got the bug). Considering that the doctor just assumed he'd be our new ped, but asked me zero questions, I wasn't too impressed.

I think we've found one (attempt #3) that I can deal with - and she takes our insurance. It only took two years - we'll see what happens.

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Life on the island isn't always sunshine and rainbows - we live in a developing nation. I have received numerous emails from people asking for advice. There are forums and facebook groups and other blogs. Life here is a great, but there are some realities that are very, very different and take some time. The medical thing (and education) have been my two biggest roadblocks and that's why I'm writing about it - not because I'm a Negative Nelly trying to make you feel bad for me and my family or to convince people not to come here. I have a few more posts about medical care - like how cheap medical imaging and dentistry are - that are fairly positive.


Sunday, June 22, 2014

Going to the Doctor (part 1)

If you know me, you'll know that I both love being sick (time off from work!) and hate going to the doctor. I'm never really sick enough to warrant a trip to the MD, but I blame that on taking care of myself in the early stages of illness. Luckily, though, I'm a pretty fairly healthy person with fairly healthy kids.

There are a million and one blog posts I could write about the medical care and its administrators in the DR - but it's depressing and sad, especially medical care in the public sector. A few years ago, health care was universalized and, I think, it has only gotten worse for the very large working class of the population. To be fair, though, it hasn't gotten better for the rich either.

As a family, we've benefited from the universalization of healthcare because we no longer have to use the state-run insurance for public school teachers. We have been free to choose a private ARS company (private insurance), and, in turn have a larger pool of doctors to choose from. I had positive experiences in the state-run clinic until Amely came along, and then I wanted out - the pediatricians were TERRIBLE and the care was generally just withering away to no care at all.

Two years ago, at the end of our rope with the system, Amely got sick. Except, we never really know when Amely is sick because she has the pain-threshold of my brother (who once fell out of a moving truck and had the wound cured with a metal scrub brush - and WATCHED while they did it). She had been complaining of everything except an ear ache, and then one morning she woke up covered in blood. Does it hurt? Nope. We headed to the emergency room because, well, what do you do when your daughter is bleeding profusely from her ear? We were sent to pediatrics, only to be told in pediatrics that the doctors were on strike and so we'd have to wait until the "on-turn" doc came it at 3pm. Um. Yeah, the kid is bleeding from her ear. Back to the ER.

In the ER, I found a sympathetic doctor who told me we'd have to go to another state-run clinic (for those familiar, the Seguro Social) where we'd see an ENT. I was willing to jump through those hoops, but only if the problem wasn't terribly serious. Could this kind lady just look into Amely's ear and let me know if she had, I don't know, stuck a bead or a bean or something in her ear? I wasn't going to wait for craziness of an already overcrowded clinic (who was now dealing with the overflow of our clinic) if Amely needed some real medical care. The poor ER doctor agreed - eventhough "you know we're on strike right?" - and tried to look in Amely's ear. She tried because the otoscope was so scratched that she couldn't see into the canal at all - not even to see if there was a bean or not.

I kind of spun my wheels a bit, but decided to go to the SS clinic. Wrong decision. We got there and were sent to emergency, in emergency we were sent to reception in reception they tried to send us back to emergency and finally an ex-student took us to the area where one ENT worked. A clinic serving thousands with one ENT. We get to the consult area, where the secretary in charge looks at us, asks what we need, and tells me, "the first appointment is in 8 weeks."

excuse me?
are you not seeing the blood still pouring out of my 3 and a half year old's ear? 8 weeks? lady, this is an emergency. oh, well, in that case, you'll need to come back tomorrow. the doctor is not in today.

I ended up at a private clinic, in the consultory of the son of a co-worker who is, I guess, an okay doctor. He pulled chunks of wax out of Amely's ear as big as my pinky-finger nail and prescribed some antibiotics, and for the future routine ear cleanings. Turns out her poor little ears don't spew forth wax like her brother's do (seriously? that kid's ears are nasty). We paid $2,000 pesos out of pocket (about $50USD) for the consult and wax-removal and another $500 ($12USD) for her medicine.

That was the final straw for me. It took Amalio a little longer to figure out that we needed to get into a private insurance - because even though we would have to pay a co-pay, at least we'd be getting medical care, which we were not receiving from the no-co-pay state-run insurance. We did finally switch and I have been searching for a pediatrician ever since.

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I'll be writing more on what it is like to find a doctor here - some of the cultural issues we have been dealing with as a family (like do you really take your child to the ER if she has vomited once? and is it okay to question the use of antibiotics for viral processes?) and some of the snafus we've had with doctors (like the doctor I visited yesterday who wanted to test my daughter for sickle cell because she has strep throat). stay tuned!