reproductive health clinic

i returned to my volunteer post at the reproductive health clinic this past monday. at first i was dreading going back to work and still had a bad taste in my mouth from an incident that happened right before i left for vietnam. that incident revolved around EVERYONE going into a meeting (and not really telling me about it) around 3 pm and leaving me to man clinic by myself for an hour. this was frustrating on many fronts, including:

1) it was my second or third week volunteering and my main role there is to do paps/pelvics/breast exams. id sat in on some counseling sessions up to that point but that's about it. leaving me to man clinic meant that i was supposed to greet patients, figure out what they wanted/needed, do paperwork, etc.

2) the day that they left me was a day that a local brothel's physician hadn't come in to do pelvic exams. at this brothel, all the women who are working there need to have pelvic exams twice weekly by a physician/nurse to be able to work. because the doc didn't come into the brothel that day, there were tons (maybe thirty-forty?) women who came in from the establishment. some of them were really rude to me because they thought i was young and didn't know what i was doing. when everyone was gone, a group of about ten came in, but half of them didn't have their patient registration cards (and i have no idea on how to make them) so i just did pelvics on the four that were available.

3) women (some of them with their significant other) were waiting for abortions. they were told to come at 3 pm but since everyone was in the meeting, no one was helping them and they started to get restless as time went by (i didn't blame them). i couldn't do anything about it and just kept apologizing and saying the doctor would be in soon. i talked to one white guy (probably early 20's) that i had seen the day before with his thai gf in a counseling session. the guy approached me, apologized for wearing an OSU sweatshirt, and basically poured out his heart to me.

he stated that he was pro-life but accepted his gf's decision; that he didn't have a good job now but was sure his parents would help out (he grew up in chiang mai and spoke perfect thai), that he was worried about his gf being able to conceive in the future, and that she was pretty much on her own and didn't think she could handle a kid right now. i asked him if he'd tried to talk to her about his feelings (since i feel that a lot of abortions are done because the woman doesn't feel like she has her partner's support) and he said a little, but she had her mind pretty much made up already. im not sure if she went through with the procedure (although im pretty sure she did), but it was somewhat heartening to see a young guy in Thailand want to accept responsibility for his part in the pregnancy. The day before (during counseling) he was really interested in the ultrasound and seeing the fetus on the fuzzy screen. I think he's the only guy that I've seen that's really been interested in that part of it, but I feel like it would probably be much harder to go through with a decision that most people have already made when they come in if you're actually confronted with a picture face-to-face.

anyway, it was a semi-traumatic experience overall and i left without really voicing my concerns to anyone because i was so angry.

when i returned this past monday, it was ok, and i did some Paps, pelvics, and STI exams (swabbing the cervix, vagina, and urethra). i learned that there was a new executive director (the guy i met to arrange my volunteering had been the interim director, but no one had told me that before) and one of the nurses encouraged me to go and introduce myself. when i approached the head admin person about it, she said just to 'wait until tomorrow', so i did and attended the meeting where he introduced himself and talked about his vision for the future. originally some people didn't want me to come to the meeting but i was determined not to be left on the floor again by myself and wanted to meet the new ED, so with the support of some nurses, i went anyway.

the meeting was very thai, meaning, you all sit in this somewhat dark room around a table. one person talks the whole time into a microphone, at the end he/she asks for feedback/suggestions/whatever but leaves like 2 minutes for them (nobody will give any, anyway) and then when no one speaks up, the meeting is over. this ran pretty much the same way, with the new ED talking about how he wanted to collaborate with all the ppl who had been working at PP for over twenty years, blah blah blah, but then really saying that he was the boss and things were going to change. i wasn't introduced (not a surprise) but i WAS surprised when one of the nursing assistants totally raised her hand and was like, you need to introduce tanya. i introduced myself a little bit and then suggested that they get into research and apply for grants outside the planned parenthood federation. the ED was like, yeah, that's nice, whatever, but the interim director approached me afterwards and said he thought it would be cool to write up something on the characteristics of women who seek abortions. i had gotten in trouble a little before because i had observed an abortion (and the doc who was providing them that day didnt know me, and got mad because he didn't know what i was doing there) so i haven't had a lot of experience since then, but that same doc talked to me about american medical education briefly when he stopped in that day. anyway, good news: i can likely do a project at planned parenthood and get access to their data.

some other clinic stories. on tuesdays, these master degree students (all nurses) from chiang mai university come as part of a practicum for one of their classes in community health. they have all been really friendly to me and im really happy when they're around because they're fun to talk to and they include me in things (like counseling). this past tuesday, i was able to be involved in two pretty involved counseling sessions:

1) Pre-conception counseling. The woman was 33 and her husband was around the same age. They had been trying to conceive since July but came into get blood tests. Most people in Thailand have heard about/know someone with thalassemia so this couple was mainly concerned about that. This nurse and I also encouraged them to get tested for HIV, VDRL, and Hep B. I convinced the woman to get an annual exam as well as she hadn't gotten one in a couple years, and she talked to me while she was waiting. Both the nurse and I had disclosed that we were recently married, so she felt comfortable talking to me about her concerns, not getting blood drawn before, and asking me if I had gone to get tested with my husband. I said that we both had been tested for STD's (and were already vaccinated against HepB). and told her regardless of the results, it would work out, and it would be better to know before starting a family. She had half-joked earlier that her husband had a lot of risk behavior, but I wasn't able to sit in on the individual HIV counseling sessions so didn't know the full extent of it. It was fun to talk about conceiving, pregnancy, and repro health issues with the other nurses there, and it was nice to see someone planning for the future rather than just dealing with the consequences after something has already happened.


2) HIV case. I was pulled into the case by one of the nurses, who stated that I should go see this girl just to see her eyes. The girl was 16 y/o and blind in one eye; she had an eye patch over the other eye and was accompanied by her sister (maybe 20 y/o). The 20 y/o told us that both her parents had passed away and her younger sister had been transferred to CMU Hospital from Chiang Rai (where they lived) because she had started to go blind. She ended up being hospitalized for almost a month, where she received some treatment for her eye problems , caused by zoster and CMV (surgery, meds, etc), discovered she had other ENT problems (abscess in her ears?), and also tested positive for HIV. The older sister (now head of the family) said this was the first they'd known about the diagnosis and wanted to be retested at the clinic just to be sure. She was frustrated at the hospital and had missed an appointment the previous day with HIV docs because she was charged for ENT care and was afraid that she would have to pay out-of-pocket again. I understood where she was coming from, but was frustrated because she *shouldn't* have had to pay for anything (she has a 'gold' insurance card). It seemed that she had just gotten lost in the health care bureaucracy and didn't have an advocate or someone to explain to her what was going on. The CMU nurse and I tried to talk to her about what she should do next, how to transfer care back to Chiang Rai, and I attempted to stress that her sister really needed to take her ARV on time and that they couldn't run out. After they left, the CMU nurse said she would call and follow-up with the older sister and also try to find out exactly what happened at the hospital. I felt better, but it was still a difficult situation to see, especially because ARV is made available (free) by the Thai government to those with CD4<200.

there's still so much work left to do.