By B. Michael Rubin
Feburary 18, 2015
I recently had a medical exam called an echografia in Brazil. Im not sure of the English term for it, but by way of visualization, it resembled a pregnant womans ultrasound test.
Step One: The anorexic diet plan. I am required to maintain total abstinence from all food and drink, except water, for six hours prior to the test. It should be noted that asking me not to eat for six hours is like suggesting an alcoholic skip Happy Hour.
As an aside, my pre-occupation with food began in infancy when, my mother claims, I was so voracious she needed to supplement her milk with bottled formula. As I have no recollection of this, I choose not to question the validity of a mother running out of milk. Suffice it to say my interest in food has been a lifelong affair.
For people like me who love to eat, hearing todays nutrition experts declare that consuming food every 3-4 hours is the most healthy diet was more exciting than the first time I heard the Beatles. In Brazil, grandmothers are ahead of the experts; they have been offering this advice for centuries. Brazilians eat frequently, five or six small meals a day.
Step Two: My wife, who is Brazilian, drives me to the clinic for the test. After six hours of fasting, I am so light-headed I feel like George Clooney weightless in Gravity. I am in good hands with my wife, who is not only a careful driver, but adept at finding reliable clinics that accept my health insurance card in full payment.
Once we arrive, I discover the clinic requires no forms whatsoever. Instead, there is a 5-minute digital interview with a young lady whose fingers move so quickly over her keyboard she appears to be typing nonsense. Nevertheless, she soon prints out a document, has me sign it, and the writing-free interview is complete.
As we have arrived early for the exam, my wife and I wait in the reception area, where I eye the free coffee and candy like the wolf in Little Red Riding Hood. At the scheduled test time, a clinic worker calls my name simply to inform us the doctor is running late. I consider the last time a doctors delay was announced openly in the US.
While I continue reading my book, my wife fills out a customer satisfaction survey, where she reports that the doctor is late for the test that we scheduled last week. A few days later, we will receive an email apology from the clinic.
Well-accustomed to waiting for doctors in the US, I am content to read. As opposed to being annoyed by the delay, I am relieved to learn a doctor will be doing the test, rather than a clinic technician.
In Brazil, most tests – blood tests, MRI scans – are performed in specialized clinics and labs, not in doctors offices. Once, when a Brazilian physician wrote me a prescription for a shot of Vitamin B12, I took the prescription to the local pharmacy, where a girl just out of grade school lead me into a back room, addressed my bare buttocks, and administered the shot herself.
At the time, the experience of exhibiting my ass to a young female in a pharmacy caught me by surprise, but Ive now come to appreciate the value of doctor-free procedures here. As a result, doctors have more time to listen and talk to their patients. Often they have no choice, as Brazilians can be verbose, but American doctors could take a lesson in bedside manner from this developing country.
Step Three: My name is called. Unlike medical privacy protocol in the US, no one in Brazil is asked to do anything alone – CAT scans, root canals at the dentist – all allow room for guests. Similarly, there are no visiting hours in Brazilian hospitals: everyone is permitted and encouraged to stay as long as possible, including sleeping overnight in the patients room. If the patient is a senior citizen, he is required to have someone with him in the hospital room at all times.
Like Brazilian doctors advanced degree in beside manner, I find the non-private approach to health care in Brazil comforting. Its difficult enough to be sick, but deciphering a doctors diagnosis alone can be tricky. Not always in the clearest state of mind while sick, its easy to misunderstand a physicians instructions.
I always feel like Im six years old when I visit a doctor or dentist, and having someone with me is an emotional luxury. I had an MRI scan on a sore shoulder last year, and the doctor allowed my wife to hold my foot, which was sticking out from the scanner, as a comfort to claustrophobia. She had to remove every particle of jewelry or risk being sucked across the room like a dust grain into the MRI magnets.
As the clinic clerk leads us through the locked doors of the lab entrance, my wife assures me that the echografia will be simple and painless – nothing more than the spreading of a gooey jelly over my abdomen and a doctor rubbing a camera to see more than is decent.
The clerk then hands me off to a woman in her 20s in a white lab coat holding a clipboard. She leads me into the exam room and asks me to lie down on a table, fully clothed including my shoes. She pulls up my t-shirt and tucks a piece of paper into the elastic of my shorts.
What role the paper plays is a mystery, but I know Brazilians are famous for their cleanliness. I conclude its purpose is to keep the gel off my clothes. It seems the technicians most important function is to keep my clothes clean, and I consider her service with a smile exemplary.
With deft dexterity, the young ladys fingers dance across my lower abdomen, tucking in the paper. As she does this, she quietly says, “Com licena” (excuse me). Although formality is common in Brazil, I am impressed with the politeness of the situation, having a medical worker apologize before touching me. It reminds me of Brazilian waiters who will say “Com licena” before placing items on the table, as if the food needs an excuse for interrupting a conversation.
Thanks to my wifes translation, the technician or Miss Lab Coat as I think of her, informs us the doctor will be arriving shortly and proceeds to busy herself in the exam room. Besides the short table on which I lie, the room has only a computer, plus a chair for my wife. Directly in front of me is a flat-screen TV pitched near the ceiling, perfectly angled to watch while lying down.
A few minutes later, a female doctor in blue jeans young enough to be my daughter enters. She speaks no English, but what do I care, as her bedside manner insists she cradle me alongside her. To be within reach of her camera connected to the computer, my head is touching her leg, my face nearly in her lap.
As the blonde doctor turns on the computer, the assistant jumps to attention with the stomach gel, which she has been dutifully warming. She squeezes it onto my torso with another “Com licena.” The doctor perches the plastic camera on my abdomen, and an image jumps onto the TV. I am watching an ultrasound exam performed on a man. I ask, “Is it a boy or a girl?”
As the entertaining test proceeds, the camera gazing through the gelatinous goo at my liver, kidneys, and stomach, the nurturing doctor and my wife discuss essential topics, such as how I met my wife.
In 15 minutes or so, the test is finished. I am disappointed it has ended so quickly. As the raven-haired Miss Lab Coat carefully wipes the gel from my exposed body, I feel ill-equipped to handle this much maternal warmth in a sterile health clinic.
Heres a lesson from Brazilian health care: Conduct all tests in small rooms surrounded by young, smiling females. The only thing missing from this exam is nervous tension, the trauma that American doctors seem to bring into every meeting.
How warm, transparent jelly allows a plastic camera to see through layers of skin and fat is a mystery. However, I do know that when I came to Brazil, I was terrified of inadequate medical care in a poor country; I was wrong. The comforts of the bedside manner in Brazil are not easy to forget.
For a stalling maneuver, I deem it appropriate to ask questions. I insist the doctor hit me with the cold, hard facts – the full prognosis. Through my wife, the doctor explains that the two kidney stones which had been diagnosed by a US doctor have disappeared. She suggests that perhaps what my American doctor had observed were mere calcium deposits. In calming neutral tones, rather than calling the American diagnosis incorrect, she states there was simply nothing big enough that she could see to call a kidney stone.
Im so surprised to learn of the vanishing stones that I forget all my other questions. As the soothing doctor turns away and leaves the room, I shout, Obrigado (thank you), one of the few words in Portuguese I can pronounce. At hearing Portuguese, the doctor giggles and mimics the word back in a ticklishly high voice. Then she glides out the door with a bright smile and obliges me with her English: “Bye bye.”
The following day, for 10 reais, my exam negatives and written evaluation from the doctor are delivered to my apartment by motorcycle messenger. Another lab sends me a text message that the results of my 25 different blood tests are available on their website, secured by a password. Its all so easy.
Thus, my American kidney stones waltz out the door, going bye bye with the sweet Brazilian doctor. For the first time in my life, Im eager for another medical situation to arise, where Ill be soothed by young women in white lab coats who look more like TV doctors than the real thing.
B. Michael Rubin is an American living in Curitiba, Brazil. He is the editor of the online magazine, Curitiba in English.
Previous articles by Michael:
Brazil: An Expats View
Brazil: Joao Pessoa – A Quiet Gem
Brazil: Communication for Foreigners