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Winter 2000
Doctor Without Borders
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In 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.

Without 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.

I saw 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?

Ethical 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.

While 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.

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