Learning Foundations in Clinical Care by Rachel Black

            During our stay at the Palo Verde OTS research station in the national park we had the opportunity to visit a CAIS, or Centro de Atención Integral en Salud, which is kind of like an intermediate step between a local EBAIS (Equipos Básicos de Atención Integral en Salud) and a hospital. We were lead through the facilities by a physician, seeing each of the specialties and talking about the different health services and care the patients can receive there. We walked through the premises fairly quickly, but ended up spending a lot of time in the room where patients with CKD, chronic kidney disease, can receive peritoneal dialysis.

We learned that chronic kidney disease has reached epidemic proportions in plantation workers in Mesoamerica, and therefore it is often referred to as Mesoamerican nephropathy. Patients with this disease are often impaired from work and rely on peritoneal dialysis or hemodialysis for survival. Peritoneal dialysis uses the peritoneal membrane of the cavity as a filter to transport a form of saline fluid across the membrane, removing the waste from the cavity as the clean solution is pumped in. Fortunately, this treatment can be done in a nearby CAIS or in the comfort of the patient’s own home, but the membrane is under a considerable amount of stress and usually only lasts for around five years.

Hearing the statistics and odds of surviving this disease was shocking to me; until coming to Palo Verde, I had never heard about this disease, much less its prevalence and impact on the lives and families of these workers. I’m definitely a ‘fix-it’ type of person, so initially it was frustrating to me that there are very little preventive programs in place and the causes seem unclear or underrepresented. However, something so little was comforting to me: while the physician was describing the patients and the dialysis treatment he said something to the effect of, “It’s hard, but I really like spending time with the patients here”. Over the semester we have toured a handful of clinics and hospitals, both private and public, but this was the first time one of the doctors mentioned what it was like to interact with and care for actual patients.

While it is still heartbreaking that thousands of people are suffering from this disease and many other neglected diseases, his simple statement reminded me that medical care is often more than a curative treatment or medication. I love other people and obviously want to see them at their healthiest, but sometimes caring for others, even in a clinical setting, can be as simple as being there and spending time with them.