Monday, March 31, 2008

Medical Systems

Tom and I have gained a little more insight into Belize’s medical system over the past few weeks and have had a chance to directly compare how some things are done in the US and how they’re done here. A little over a month ago, I found a lump in my breast. This happened twice before while we were living in NY. In NY, I’d waited a week or so to make sure it wasn’t something that would disappear, then called my doctor. The doctor in NY always had me come in immediately, and then I’d start the rounds of “we don’t think it’s anything, but because you’re in the high risk group, we’d better do a mammogram.” Then the mammogram people would say they didn’t think it was anything but I’d better get an ultrasound. Then the ultrasound people would say they didn’t think it was anything, but I’d better get a needle biopsy. Then the surgeon would say he didn’t think it was anything, but it would really be best if he just took it out. So then, in both cases four to six weeks after finding the lump, it was gone and that was that.

Here, I found the lump and waited a week or so, then walked into the local hospital, told the receptionist what was happening, and asked if I could either see a doctor or make an appointment for a mammogram. She told me that the mammogram machine they used to have at that hospital broke a few months ago and they couldn’t get the parts to fix it, so if I wanted a mammogram I’d have to go to Belize City. I asked if they had an ultrasound machine. They do, but I said I guessed I’d like to see a doctor first. So, she had me sign in and I had to wait for the doctor. Before seeing the doctor, a nurse takes your vital signs. We were chatting and she was looking at my chart (which only had that visit since I’d never gone there as a patient), and she suddenly looked at me and said “YOU found a lump?” I said yes, and she asked how often I checked, and I told her once a month or so, and she asked how I found it. I told her that because I know I’m in a high risk group since my mother had breast cancer and I’m in my 40s with no kids, not to mention all the carcinogenic chemicals I’ve had my hands in because of the horses, I do monthly self exams. She couldn’t get over the fact that I found it, no matter what I told her.

The doctor, a Russian woman, was also surprised that I found it. I pointed out to her that it’s really pretty big, and if I did any sort of self exam, it would be hard not to find it. She agreed that it should be checked, and asked if I minded getting an ultrasound. I figured I’d have to make an appointment and come back in a week, but she took me out of her office to the cashier where I had to prepay $55BZ for the ultrasound, and then took me to the ultrasound technician. He found and measured the lump in the ultrasound, and also registered surprise that I’d found it myself. He then walked me back to the doctor’s office, then went and developed the film, and then met with the doctor, and they called me into the office. This all happened on a Tuesday afternoon, and the doctor was a little upset that I wasn’t there in the morning, because she thought I needed to talk to the surgeon, and he’s only at that hospital on Tuesday and Thursday mornings, so I had to go home and come back Thursday morning to see him. I had waited about 45 minutes to get in to see the doctor, but once I was in her office, the rest of this happened within about another 45 minutes – an hour and a half for what would have been a couple of weeks of running around in the US. The only unfortunate part of the whole visit was that while I was waiting I was trapped in front of a TV tuned to CNN and broadcasting one of President Bush’s press conferences. Fortunately, they’d already taken my blood pressure before I was subjected that stress.

I went back to the hospital on Thursday morning and met with both the doctor I had originally talked to, and the surgeon. The surgeon said that I could go to Belize City for a mammogram, but he felt that he’d end up doing a biopsy anyway, so he recommended that we just do it then. So, with both doctors and a couple of nurses, they got out their biopsy tool – a thing that looks like a sparky that pokes in and grabs a piece of tissue – and did the biopsy right there. The surgeon, who went to school, trained, and practiced in the US before moving to Belize, was then full of apologies because the biopsy results take two weeks, and he was sure I was used to much faster turnaround in the US. I told him that the biopsy results might be faster in the US, although not definitely, but that so far I’d found the Belize process to be a whole lot more efficient than in the US.

Those two weeks were a fairly long two weeks. In the US, I was always more aggravated than worried with the US habit of saying “we’re pretty sure everything is okay, but…” However, I apparently found that more reassuring than I’d realized, because the doctors here didn’t do that, and I was more than a little worried. The doctors here said exactly what they thought – it felt like a fibroadenoma, but was more attached. It also felt like a cyst, but the ultrasound showed that it was solid. It’s in a spot where over 70% of all breast cancers occur. And, I’m in that damned high risk group. Plus, between the surgeon and the doctor, they’d spent about four hours with me, which has not been my experience in the US, so I was worried that they were spending so much time talking to me.

Despite my worries, it’s benign, another fibroadenoma. However, the talk with the surgeon here was very different than with the surgeon in the US. In the US, he’d asked if I wanted a needle biopsy or to have it removed. I said a needle biopsy would be fine, and he said no, he’d rather remove it. When I mentioned this to the surgeon here, he sort of grimaced, and said something to the effect that even removing a smallish lump is surgery, and elective surgeries in Belize generally aren’t a good idea. He also suggested a different long term plan since we’re living in Belize. When we left the US, I figured I’d schedule an exam and a mammogram for whenever we were in the US. The surgeon here suggested that in addition to that, I should think about the genetic test and find out what kind of cancer my mother had so that if this happens here in the future, they’ll know if I’m in the high risk category, or the really high risk category, and if I’m in the really high risk category they may handle it more aggressively. And, he said, I may want to do an MRI rather than a mammogram in the US, just to be more thorough when I am checked.

I’m not quite sure how I feel about all of this. I can get all this stuff done in the US, but because our insurance is just catastrophic coverage, and because all this stuff in the US is so expensive, it could cost me a fortune to do what the Belize surgeon recommends. Here, the ultra sound, the biopsy, and the hours with the doctors cost me just a little over $100US, probably less than I would have paid in co-payments even when we had good insurance in the US. I also got the impression (although we didn’t directly discuss it) that if the lump had been malignant, the surgeon would have recommended shipping me back to the US for treatment, even though he remarked numerous times how seldom he saw women who found their own lumps, and that Belizean women could learn from me. Tom and I also spent a lot of time talking about what we would do if…and didn’t really decide anything, so I guess it’s a really good thing that it’s just another benign lump.

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