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a culture where doctors traditionally have not questioned female
patients about their sex lives, let alone their husbands', it was
difficult to ask about such matters. It was harder yet to help these
women connect the dots and explain how they contracted these ailments.
proper treatment, sexually transmitted diseases can cause scarring
and other harm to the reproductive organs and leave women infertile.
We saw many patients with long-term infections that had done permanent
damage. In Kosovo, where many women's greatest ambition is to have
children, an infertility diagnosis is especially devastating.
many women who had tried, unsuccessfully, to have children. They
came to the clinic desperate for hope. They came in crying, asking
if we could do something for them, asking what treatments we have
in America. How do you answer such a question? Should you explain
in vitro fertilization to someone who doesn't even have enough money
to repair her house, who doesn't have a telephone?
and technical challenges like this came up on almost a daily basis.
Faced with a patient with an obvious gynecological infection, but
no microscope with which to determine exactly what kind, I had to
make an educated guess about what to prescribe. My decision, I realized,
could have incredible consequences.
I often wished for more access to technology - the lab tests and
machines we take for granted in the United States - I also came
to appreciate the value of clinical abilities. Take anemia, for
instance. At home, it's routine to run a simple blood test. But
it's also possible to diagnose it by examining a patient's eyes
and skin and performing other physical checks. And if you can make
a determination this way, the money you would have spent on that
lab test can be used for something else, like tetanus shots or vaccines.