Customer Service in a War Zone

In August, just before I reached the limits of my cultural relativism and flew back to the States, I went to a San Pedro pharmacy to fill a prescription. It was a Farmacia Kielsa, which I didn't realize at the time is part of Grupo FICOHSA, which is Camilo Atala's bank, and one of the biggest sponsors of the coup both openly and in much more nefarious, clandestine ways. I made the purchase, and only 20 minutes later upon sorting through my purchases realized that I had been given an oral suspension, rather than the injectable solution I had been prescribed. I returned to the pharmacy to exchange the unopened bottle (worth around USD20, if I recall correctly), armed with my entitled gringa "customer is always right" habitus. I imagined it would involve an argument of sorts, because in Honduran chain stores the customer is rarely right, but I can generally hold my own. I hadn't anticipated the response, however. I explained the problem to the pharmacist who had given me the solution, and she told me that the drug in question only came in a drinkable version, and the doctor's prescription had been sort of vague, and she had altered the indicated dosage on the Rx to correspond to the suggested dosage for the oral solution (a common practice there). At first I performed indignant, saying that it may be the case that the pharmacy didn't have the right form of the drug, but that she should have consulted me about the substitution. But then her boss, an arrogant young man, came over. The story was repeated, and he defended the pharmacist's approach, and then told me he would exchange it...if I really wanted her to have to pay for it. I was taken aback. No, I said, I don't want her to pay for it- it was an honest mistake. Why should she have to pay for it? The pharmacist looked on the verge of tears. That's the policy of the company, her boss told me, with a particularly gendered condescension. If an order is messed up, the person who made the sale has to pay for it.

"Well that's a messed up policy!" I said "No one is at fault here- a mistake was made, and all you have to do is exchange the unopened bottle. You can sell it again. You don't have to penalize your workers for no good reason." As we continued arguing, me angrily insisting she shouldn't be punished and that I just wanted my money back, I could see the pharmacist relax. When her boss went momentarily to the back of the store, she leaned closer and whispered, "the worst thing is even if I were to pay for it, they'll still sell it again."

So I ended up with an expensive (for Honduras) bottle of medicine I didn't need. And I got the injectable solution at another pharmacy (where it did exist) and called a nurse, a cousin of the friends with whom I was staying, to come give me the first of the series of shots. But on seeing the medication she told me it was intravenous and that I should double check with the doctor, to make sure I shouldn't have the shots instead in his office or a hospital. The doc had said it was intramuscular, but the packaging did state very clearly that intravenous injection was indicated. Having just suffered through a few days of poorly administered and (as I later found out) totally unnecessary intravenous medication during an involuntary ICU stay the Hospital Catarino Rivas that had left much of my right arm black and blue, I was eager to make sure things were done properly. But the doc didn't return my calls. When he finally left a message with his office manager for me days later, regarding a supposedly urgent medication (which, as it turned out, was also medically unnecessary), it was to tell me the drug was intramuscular.

A colleague said upon my return to the States (and this isn't an exact quote) "That's how they'll get you- in a hospital. They won't kill you on the street, it'd be too obvious." I didn't actually think that the doctors or pharmacists were trying to kill me (although the nurse was certainly trying to save me)--at least not for political reasons--but I did witness a murder in the Catarino ICU the previous week. Here's what happened:

The patient next to me was a young woman, probably in her teens. She was in a late stage of pregnancy. Because of a particular drug I was receiving (intramuscular injections), I spent the night awake. About 3am, I heard voices from her gurney. Cooperate! shouted a nurse. "Cooperate!" She continued sternly, "If you don't cooperate, we can't help you!" As far as I could tell, the patient was completely non-responsive. The nurse shoved the patient into a position that she had apparently failed to cooperate herself into. It struck me as abusive. "We'll have to operate her," someone said, which in that context meant a Cesarian.

The patient was rolled out past me through the ICU exit. I continued reading Said's Representations of the Intellectual, which was keeping me sane. Some hours later she was rolled back in, placed this time in the far corner of the room where all the patients could have been, but were not, separated by curtains that hung from the stained and crumbling ceiling. I wondered what had become of her baby. Immediately I heard the moans. They were moans of death, sounds so deeply disturbing they made me shudder and cry. They went on, and on, and on. I had never heard anything like them. The numerous young residents, mostly men, who had been hanging out playing video games all night, ignored her. The nurses ignored her. Being a gringa, I got more (though certainly not better) attention than other patients. When a resident came by my bed, I asked about the patient's moans and asked him, "is that was a Cesarian feels like? Is that what she had?" He said yes, but then added that the patient had other complications. He didn't seem concerned about it and shrugged when I said that shouldn't somebody go look in on her.

The patient was hooked up to a machine, a heart monitor straight out of hospital drama tv shows (from the 70s). An hour or two into the moans--I don't know how long really, I was trying to dissociate--she had a code. It was unmistakable, "beep...beep...beep...beeeeeeeeeeeeeeeeeeeeeeeeeeeeeeep." You don't have to be a doctor, or even play one on TV, to know that one. A nurse shouted "Code! I need doctors over here!" The residents walked over. Just as they arrived, the same nurse gasped.

"My earring!" she exclaimed. "I lost my earring!"

"Where do you think it fell?" one of the residents asked.

"I don't know! Help me look!"

As the residents and the nurse scoured the floor, that horrible noise continued in the background. "beeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeep"

"This is terrible," she lamented loudly as their search went on, "terrible! I lost the other one this morning, and now this one too! Now I don't have any earrings at all!"

I felt my intestines turning themselves inside out, my head pounding. At least a minute, possibly two, went by. Whatever it was, it was an eternity. Connected to machines and bags of various fluids by at least three tubes, in pain and unable to move, I chanted silently to myself. "Sleep, sleep, this isn't happening, go to sleep." I tried to force myself not to look. I put in the earplugs I'd thankfully brought with me. I noticed that they eventually moved on to paying attention to the patient, earrings or not, but managed to force myself to nod off through sheer force of will.

A while later, through my groggy half-sleep, I heard the doctors and nurse talking about the patient again. "Call the orderly. We need to transfer the patient." I felt relieved- they were going to take her to surgery, fix that horrible pain behind the death moans, something. The orderly came, and chatted pleasantly with the doctors and nurse, who I heard shout "Wow! Thank you! You found both my earrings! What a relief- this is wonderful!" I opened my eyes and tried to focus. The patient was being rolled out past me, again through the exit, and I wondered why the orderly was moving so slowly. Still, it was clear from the mood in the room that everything was going fine. I turned my head to look at her. My first sleep-deprived thought was, "what an odd way to drape a patient." She was wrapped like a mummy. It only dawned on me after a few seconds that she was dead.

Later, I was transferred to a non-urgent ward. I should never have been hospitalized in the first place; there was nothing wrong with me, but that's a longer story. My intake doctor happened by and cheerily asked how I was doing. I told her, "At least I'm not in the ICU." She seemed surprised. "Why?" she asked, "What was wrong with the ICU?" "Well..." I said, choosing my words carefully, "for one thing, a patient died in front of me this morning." I avoided ascribing agency to the death, for fear that it would motivate the doctors to turn their malpracticing gaze in my direction.

She shook her head with a smile to calm my worries, and responded: "That patient had AIDS."

...

El Catarino does not provide drinking water. Only patients who are lucky enough to have someone bring them water from the outside during the two hours of visiting time per day are lucky enough to drink. Every person who saw my crappy little mini-laptop told me it'd get stolen (I ended up devising a way to attach myself to it when I slept). The women sharing my room told me their own stories, horrible stories, of previous victimization at the hospital, but said they had come back for treatment because it was their only option.

Finally getting up the courage to flee was terrifying. I actually didn't think they would let me go. The doors at the ends of the hallway were locked and guarded by security guards dressed like police. The actual term for leaving "AMA" (against medical advice, as it's termed in the US) in Honduras is "going fugitive." Darse de fuga. I wasn't on a mental ward, but it felt like I was. Or a prison. Total institution, same thing. I was angrily berated by the head doctor doing rounds when I mustered up my indignant gringa performance to tell him I planned to leave, while the residents shook their heads in disgust at my non-compliance. The funny thing was, they were so angry at me, they wouldn't even allow me to pay for any of the treatment, which I offered to do. The offer, in fact, was taken as an insult.

There's a lot more of that story to write down, but I didn't even mean to get into it here. It was actually a tangent in the topic of this note, which was meant to be post-coup customer service--a note inspired, in part, by waking up terrified on a train in the northeast United States last night.

Yesterday I got word from one of two friends I'd left in charge of overseeing some contractors while I was gone, that don Joaquín the carpenter had finally finished the pricey loft I'd hired him to build in my little one-room cottage. He'd stalled for months after I gave him the deposit, scheduling the work and then standing my friends up time and again. He then began demanding they pay him a second large deposit to begin work. At that point I called him from the States to demand he honor our contract, which was clear and in writing. He responded, as my friends told me, and did indeed go and build a loft. But it was a slipshod job that did not employ the quality materials or workmanship that Joaquín and I had agreed upon.

I was pissed off. My friend asked what he should do- Joaquín was demanding the rest of the money. "Tell the pendejo he knows that's not what we had agreed to, and I'll pay him when he does the job right. Tell him I'll be there soon, and that when I arrive, he can fight it out with me. Tell him I refused to send you the money." My friend sounded hesitant, but agreed.

In the middle of the night I awoke in a panic. I was furious about having been taken advantage of, but at the same time, what if I really didn't pay him? I imagined numerous scenarios. At 3am, the most probable of those was that he would take a hit out on me, or on one of the friends who had been helping me out. I couldn't sleep. I lay there, furious, terrified, cursing myself for bringing my bourgeois gringa habitus to a business transaction where it had no place, cursing myself for having put my friends in danger.

Around four hours later I managed to fall back to sleep. Shortly thereafter the phone rang. It was the friend with whom I'd spoken the previous night. "I was wondering," he said through poorly masked sobs, "if you would want to call Joaquín instead."

"Sure," I said, half asleep, "I can call him tomorrow. I can't call out from here."

"But...I had told him yesterday I would call him at eight, and he thinks I'm going to give him the money. And [my other friend] says it's a bad idea to not pay him."

"Pay him then," I said, quickly reliving the hours I'd just spent in terror, and this time feeling utterly relieved to have allowed myself get so screwed over. "Just pay him, it's fine. Don't cry, it's fine."

"I'm not crying," he told me. He added, "I think paying him is for the best."

Now I'm thinking, why did I hire the carpenter in the first place? I could have built the damn loft myself. It's a weird world where you can't demand good customer service because you are afraid that doing so will get killed.

It's also difficult trying to tell stories like my hospital ordeal (which is nothing compared to the stories my roommates on the ward told me) while firmly supporting public healthcare and opposing privatization. Ultimately, the expensive private care I got in Honduras was just as incompetent as the public care, although it was wrapped in a much prettier package. The violence of most Honduran healthcare is not located along the public-private divide because one sector is public and the other private; rather it is integrated with the many other expressions of extreme structural and symbolic violence that pervade Honduran society, and that make life (but especially poor life) so cheap. [It is also of course related to the neoliberal process of privatization (rather than the static idea of a public-private divide), which is responsible also for so much of the violence of U.S. healthcare, but that explanation alone is insufficient.] A U.S.-trained physician friend who spent a year practicing in Central America observed to me on hearing of my experience that "they practice 1950s medicine in Central America." While this statement could fit with the dangerous idea that Hondurans are behind on the linear time line of development, what she meant was that not only is medical practice not informed by the findings of current research, but also the doctor-patient relationship is one of complete patriarchal authority. This is more pronounced in hospitals serving the poor, not because those hospitals are public, but because they serve the poor. In Honduras, whether it is through zero tolerance policing in poor neighborhoods or locked-down hospital wards, the poor are treated as needing greater discipline. When I complained in the Catarino ICU about a medicine I did not believe (correctly) that I needed, and which was causing me considerable pain, the resident--a man in his early 20s--responded sternly with no explanation: "Señora, es por su bien." While my treatment in a private clinic was ultimately just as medically useless as the "care" I received in the Catarino, the doctor's bedside manner was far more attuned to my habitus. He provided explanations and gave me (poorly informed) choices, patronizing me in a much kinder, gentler fashion.

Comments

That's quite a tale...

That's quite a tale, Adrienne. Having experienced actual 1950s style medicine in Latin America, it was a lot nicer than that, both in the attitude of medical staff and in basic quality of care and, while I enjoyed the privileged status of being a guest, the care wasn't noticeably different than what I saw local people receiving.

Sorry you haven't been well. Please take good care of yourself.