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.

The next patient was another pregnant mother. She was an extremely joyous, slightly older woman who seemed to have the “pregnancy glow”. Her animated smile and bubbly personality shined through as she answered questions. We measured her stomach with a numbered tape and listened to the fetal heartbeat. We used a fetal heartbeat monitor, a device that looked like a stethoscope with a display screen numbers. Everyone in the room went silent so that the rhythmic thuds of the growing, little human filled the room. The sound was so marvelous, breathtaking, and entrancing—a miracle. It was a sound that gave me hope for my future and that made me want to work as a physician for future generations. It was a sound that caused me to think about much more than myself. It made me think more globally, more focused: I wanted to stay with this soon-to-be mother and help this tiny human survive and overcome the odds already waiting to greet him.

I looked at the mother, who was trying to keep a straight face while the sound of her child’s heartbeat captivated the room. The corners of her mouth kept rising upwards, and her forehead furrowed as she focused on some invisible point on the ceiling. Soon though, she gave in and a smile overtook her face. Her eyes lit up with a bright shine and an even more magical feeling seemed to permeate the room.

It is for both of these types of mothers that I’m driven to volunteer and work toward becoming a physician. I want to better the lives of entire families. The hardships that they are bound to face will be difficult, but instead of deterring me, the challenge inspires me. These babies are already at a disadvantage due to the lack of access to nutrition, technology, and supplies where their families live. They should receive extra attention during their gestation and when they are born, but I’m not sure they will receive it. Before coming here, I never envisioned conditions this rudimentary. Here in this hospital, helping with something as basic, yet important as prenatal care, the medical team is not only helping to improve the health of each human being who walks through our doors or is born here, but helping to improve their overall quality of life as well. Good healthcare at the start of a life helps to ensure good health throughout of the entirety of life.

This experience gave me a preview of disparities present not only in Latin America, but also in the United States. Inadequate access to affordable and reliable healthcare in areas around the world is heartbreaking, yet fixable. This motivates me to work with under-served communities, whether in the United States or elsewhere. I hope to use the Spanish skills I acquired in my future career to increase the public health of varying communities.