Eminent Physicians

Care Network

Disparities start at Gestation

As I walk past the ever growing line of pregnant mothers and young children, I see a sign marked “Obstetricia” and open the door. I find the doctor sitting at a desk with a nurse and introduce myself. They’re going through the patient files for the day, and she invites me to sit down. I listen to them converse in Spanish, and eventually they open the door to let the first patient in. I’d been in Peru volunteering, shadowing doctors, and taking Spanish classes for three weeks, and today I was visiting the government run hospital that attends to very basic ailments to shadow an obstetrician. This hospital is on the far side of the city in a migrant section. The patients are mostly people from rural areas who have either moved to the city or visited specifically to be seen at the hospital. Its services are limited to pediatrics, obstetrics, topical consultations, and it has a basic laboratory. As the line outside the door decreased, I struggled to understand the fast Spanish words and medical terms. Another patient, a young woman, walked through the door supported by her boyfriend. She was thirty two weeks pregnant but had not yet seen a doctor during the pregnancy. Her huge stomach seemed to overwhelm her small frame. Her boyfriend answered most of the doctor’s questions, but when she did speak, her voice was quiet, hushed. To me, she seemed to exude exhaustion and unease. In the end, the doctor advised the expectant mother to watch her diet and eat certain foods to avoid becoming anemic, which she most likely already was. It would stop her headaches as well, she added, as she filled out a patient file. With only diet advice and a signature on a piece of paper, the young couple left promptly and a new woman came through the door and took her turn on the chair. The lack of prenatal care shocked me. The young pregnant woman was just sent home when she clearly struggled to care for herself. The amount of poverty in this Peruvian city is astounding. Malnutrition is a major problem: when helping in the pediatric unit the day before, many of the children I weighed had lost weight since previous visits. The mothers would shake their heads ruefully when told. And this is a more developed, relatively affluent area of Peru. Many surrounding cities lack much more than this city, so I cannot even imagine what the state of healthcare is like in those places.

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