Miriam (Barbara’s foreign nurse friend) runs a free clinic out of her home one day a week, so Barbara and I were able to go a couple times when we were in the Valley. The clinic is a pure act of charity; Miriam’s resources to treat the many people who sit on her front porch each week are limited, and people are often seeking help for complex illnesses and injuries. Sometimes frustration runs high because people are clearly looking for a miracle cure – but in order to know why this is reasonable, you have to understand the mysterious circumstances under which healthcare is sometimes provided here.
As in many places in China, tuberculosis is endemic to the Valley. Cases here are often allowed to progress to a stage rarely seen elsewhere; permanent lung damage, disabilities from TB that has spread to and destroyed skeletal joints, and deaths are not uncommon. The government, however, does provide a certain amount of TB medication for free if you test positive, and Miriam is often able to arrange for a patient to receive this treatment. That can, indeed, seem miraculous – one day you have a cough and a fever, the next day you’re diagnosed with TB, and then this foreign lady makes sure that you get free medication and home visits so that you’re not going to die! From that perspective, why shouldn’t people turn up expecting to be cured of all manner of diseases?
Clinic days are long; the first patients have shown up by 8:30am, and we often weren’t finished until 5pm. At a desk job, that’s just a regular day – but when you’re seeing an endless stream of patients who often cannot be helped, you want to go home and go to bed without dinner at 6 o’clock.
What complicates matters is that many of the patients we saw had actually already been seen by a physician in one place or another – the Valley hospital or a village clinic – and simply did not like or did not understand the answers they received.
Some of these patients face deeply serious problems: one young mother brought her 2-month old baby girl to the clinic for intractable chest congestion. I have never seen a baby that looked like this before – she cried endlessly in a way that seemed to choke her every five minutes. She was clearly unable to breathe properly, and turned blue several times. At the Valley hospital the mother had been told that the baby did not have pneumonia, and they didn’t know what to do for her.
Fearing that perhaps the baby had cystic fibrosis, which would be tantamount to a quick death sentence in a place like the Valley, Barbara and Miriam advised the mother to take the baby immediately to the city hospital four hours away for further tests. Unfortunately, the young mother was living alone with the baby at home for the next few days, with her husband off working and in possession of all of the money. There was a discussion of scraping together enough money to lend her so that she could get to the city, but someone who spoke Azu and Mandarin would have to accompany her, since she did not speak Mandarin and the city hospital staff do not speak Azu. No such person could be found on such short notice.
Then there are other patients who have been told what to do to fix their health problems and are simply being stubborn about it. One amazingly wizened Azu woman presented herself on Miriam’s front porch complaining of eye troubles, eventually revealing that she had been diagnosed at the hospital with cataracts in both eyes. The woman was a serious character: at 75 years old, she stood perhaps two and half feet tall, a consequence of her dwarfism. She was dressed as if she had been plucked from her village and drafted into the Cultural Revolution-era military; she wore the traditional Azu women’s patterned skirt and embroidered vest, strung from neck to knees in beads and large shells, and had paired them with a camouflage green Mao hat and combat boots of the kind favored by the People’s Liberation Army.
Despite the fact that she had been correctly diagnosed, and that her problem was fixable with a very simple surgery that would be provided for free by a hospital right down the road, she refused to go, claiming that the doctors there would kill her. She quickly announced that she would only have her eyes operated on by a foreigner, and demanded to be sent to Kunming for said mythical foreigner to schedule her surgery.
We explained to her, in the nicest possible terms, that she was being a huge pain in the ass, and that if she wanted her sight back she should go get her free surgery down the road, where they were not going to kill her.
“You people aren’t helping me!” she companied, adding, “Plus my knees and hips are sore.”
Lady, you are a 75-year old with dwarfism who has done manual labor in the fields her whole life. My joints would hurt too.
One of the strangest problems we’ve encountered at the clinic is infertility. Barbara and I were meant to be focusing on any OB/GYN patients, and apart from a few women with minor infections, they all seemed to be having trouble getting pregnant.
Infertility can be difficult to cure even if you have lots of money and all of the latest technology available to you. So what do you do when women show up at a free clinic halfway up a mountain side, with no lab technology, no samples of or understanding of any medications they’ve previously been given, and tell you that they can’t seem to get pregnant?
These are not 40-year old women who put off having children because they were busy with their careers or because they couldn’t find a suitable mate. Azu girls often start marrying by age 16, and everyone seems to be married by age 20. Marriage and childbearing and extremely culturally important, and therefore nearly universal. So again: what do you say to a 26-year old in seemingly good health, who had one still birth when she was 8 months pregnant seven years ago, who has been trying to get pregnant ever since, but who doesn’t quite understand the mechanics of how pregnancy actually happens?
Pesticide use on crops in the Valley is ubiquitous, and women often apply it with their bare hands – perhaps that’s the problem? Perhaps it’s their husbands who are infertile, having contracted sexually transmitted infections? Perhaps this incidence of infertility is no higher than normal in a population of this size, but because it’s so embarrassing for Azu women to discuss it they will only come to this free clinic, making it seem like we’re seeing unreasonably large numbers of infertile women? Who knows.
We drew lots of pictures, and explained in simple terms about the ovum traveling down the fallopian tube. We went over the possible causes of infertility, and even tried to explain how to monitor your temperature and other symptoms daily to determine whether or not ovulation is occurring. Even as I was explaining these things, I could see how hopeless the situation probably was for most of these women. They seemed to understand what we were saying, but were quiet; perhaps they knew how hopeless it was as well.
If we could help everyone who came to the clinic, the days would simply have been exhausting. But because we couldn’t help many of them, the days were not only physically tiring but full of anguish. Azu people are often happy to explain their health problems in front of other Azu, presumably because they are used to the very public nature of village life – so when one 36-year old woman approached me speaking so quietly that she was almost inaudible, I knew her problem must be very serious. Barbara and I took her into an inside room, where she presented us with a CT scan of her uterus. I don’t have any training in reading CT films, but even I could see that her uterus had some sort of mass in it, and what looked like only one fallopian tube. She said she had been trying to get pregnant for six years, and then dissolved into sobbing. She lifted her shirt to show the thick, dark scars lacing her abdomen from previous gynecological surgeries.
It was certainly not my place to give this woman a possibly faulty reading of her CT films, nor to pretend to understand how much pressure she must be receiving from her family to have a child at age 36. What was clear was that no one had ever sat with her for half an hour and allowed her to say how scared and upset she was about her infertility. We gave her advice as best we could, and she cried, “It’s hopeless, isn’t it? Isn’t it hopeless?”
It’s at times like these that I find myself wishing away the next few years, so that I can be done with my nurse-midwifery training and actually help a woman like this. Did we do anything to help any of these women in the Valley? Did we offer them hope, simply with our presence, that we then dashed by being unable to fix their problems?
How do you know when you’ve done a good enough job?