A Cross Necklace

Being a Christian refugee in this part of the world is a dangerous affair.

Unlike in America, where counting oneself a Christian is increasingly perceived as a designation that affords privilege, sometimes to an unfair degree (I have my doubts on that one), there is no question that the opposite is true in much of the Middle East.

It is easy to see that militant Islamists are actively focused on the eradication of Christianity in at least “Muslim” lands, if not the whole world. This is true to some degree in the refugee camps as well.

Even still, many of the refugees we worked with this week are either committed Christians, or are actively exploring the faith.

The stories of how these people came to their decisions for Christianity vary widely, but most are eye-opening. Few in the Middle East can come to Christ as easily and risk-free as nearly every American can if they wish. Apostasy from Islam is often regarded as an offense punishable by death.

One man I saw this week was openly wearing a prominent silver and gold cross around his neck. I didn’t notice it at first, but as I was listening to his heart with my stethoscope the bright golden object swinging in front of me was suddenly hard to miss.

crossRealizing I wasn’t in America, where crosses are so ubiquitous they’ve become a little trite to me, I exclaimed, “You’re wearing a cross!”

“Yes,” he nodded.

I pondered the implications of wearing that specific symbol in the Islamic world. A cross is better described as cross-hairs for a man like him. Yet he wore the symbol proudly, unapologetically. Should our roles be reversed, would I have the same courage?

“You are a Christian then.” I said, continuing in my new role of Dr. Redundant.

“Yes.” He nodded again, smiling.

Through my translator, I learned that a few months ago in Iran he was awoken in the night by the figure of a man calling him to follow Christ. He said he was convinced that the man speaking to him was Jesus, the Son of God. He knew almost nothing of the Christian faith, as he was raised a Muslim.

Still, upon waking the next day, my patient committed himself for following Christ. He felt he had to do this. It was an inner compulsion; he had been called to a new faith, a new life, no matter the cost to him.

But it was indeed a ‘costly’ decision. Read anything about the Islamic regime of Iran (I recommend the the wonderful autobiography Persepolis as a cursory intro if interested), and you will know that the government of Iran is itself a religious organization. Along with typical functions of any secular government, like providing running water, working roads, electricity and health care (which in many instances, the Iranian government does quite well), it also enforces a highly conservative interpretation of Shia Islam.

How do they enforce such a thing, you ask? How do you get a nation of 77.5 million people to follow extremely strict religious rules? How can you enforce an entire nation to put every woman in robes and headcoverings, to allow no music, no dancing and to enforce frequent observance of Islamic practices like 5x daily prayer?

With “religious police” of course!

As a kid from the suburbs of America, following a Christian faith I was always free to reject, it took some reading and imagination for me to even comprehend such a notion.

It was only in 1979 that the Iranian Revolution took place. Prior to that, Iran probably looked much more like America than it does today. But in ’78-’79, things changed dramatically, as that was the year of the Iranian Revolution. It was then that the Pahlavi dynasty, led by Mohammed Reza Shah Pahlavi was overthrown by the Islamic Republic.

revolution
Supporters of the Revolution. Didn’t Turn Out Like Many Expected.

The Republic was initially a political movement, comprised of a collection of leftist thinkers, activist students and numerous Islamic movements. It was led by a powerful Islamic leader named Ruhollah Khomeini, a scholar, author, politician and political revolutionary.

After the Shah was forced from power, to the surprise of nobody, Khomeini was designated as the Supreme Leader of Iran. However, TO the surprise of many, Khomeini was given final authority on both political and religious matters.

The irony of this transformation is hard to miss. Criticism of the Shah centered around how difficult it was for the commoner to be heard. The Shah’s rulership was a dynastic monarchy, with power passing from father to child generation after generation. This meant that nobody could rise from, say, a community organizer and member of a minority comprising 13% of a nation’s population, like Barack Obama, to the highest position of power in the land (Huzzah! Huzzah! Democracy!).

Yet the solution to this problem that emerged in Iran was the Islamic Republic, which consolidated both political and religious power in one man. The power of the rulers of Iran was, effectively, broadened as a result of the revolution. The “little people” never got their say. And, I suspect, many of those who supported the Revolution experienced colossal disappointment. Power just went from one ruling class to another. To this day, a Khomeini rules Iran.

Some version of the above rushed through my mind as I stared at the cross hanging from my patient’s neck. An Iranian, 4 months in Greece, wearing a bright silver and gold cross. Wow.

As it turns out, the father of this man was a member of this religious police force. This patient had chosen to convert from Islam to Christianity as the son of a man who is tasked with enforcing and promulgating Islam in the country. More irony.

Imagine the shame on their family for such an act! Aside from endangering himself, my patient was possibly even endangering his own father (and mother).

Many immigrants come to Europe because they think it is rich, with jobs and money flowing like wine at a wedding party. Increasingly, they are finding that Europe is no utopia. Millions are unemployed. Millions are poor. Upward mobility is rare.

But one reality of Europe is that it does remain a place where you can follow a religion in nearly any any way you choose, to include no religion at all. Say what you will about the EU, but it remains a place of tremendous religious freedom, rivaled perhaps by only the U.S.

So it is understandable that this man left Iran. But it is still amazing that he was willing to do it. He left with nothing. No family, no friends. He slunk away in the night, alone. As the son of an important man, his life had no doubt been comfortable and safe. He upended all of that.

port
Pireaus Port. Lucky you if you have a tent.

My patient arrived at the Pireaus Port of Athens after crossing the Agean Sea from Turkey. He arrived nearly destitute, having given most of his money to a trafficker to get him to Greece. I think he slept on the concrete sidewalk the first night.

The next morning, he says he prayed that the God of his new faith would spare him, and shortly thereafter was approached by members of a Christian church in Athens who offered him a bottle of water. It was through this church that I met him.

ellenikoGreek authorities soon placed this man in the Elliniko refugee camp, where he made no secret of his faith, sharing it with any around him who would listen. Not long after his arrival, a riot broke out in the camp with Muslims targeting Christians.

The violence carried on for quite some time, as Greek police made no move to stop it, one even pointing out that if some of the refugees died, “there will be fewer of them for us to deal with.” My patient was beaten severely in the melee.

It is inhumane, of course, for anyone to think as these police did. But their attitude is understandable nonetheless. Would you wade into the middle of that mess?

Somewhere in this story, my patient picked up his cross. I don’t know if it was in Iran or somewhere in Athens. But he wears it daily. It is not merely jewelry to him, given at some Christmas party. It wasn’t bought from one of the ubiquitous Christian Book Stores in America, with every possible permutation of “cross trinkets” available for sale. It was bought for a price; worn for a higher one.

This isn’t necessarily a Christian story, although as a Christian I find it inspiring. But from this anyone can recognize the deep human desire to worship in freedom. This man’s life story is a reminder that people are willing to die for the right to think and act honestly in relation to their understanding of the divine.

The cross symbolizes the reality of this man’s beliefs, even if that symbol marks him for suffering or even death. Would that all Christendom be so committed. Would that all who cherish freedom be so as well.

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Headed Back to Athens

 

The Acropolis in Athens, Greece.
Athens, looking pretty. A rarity, IMHO.

For the second time in less than a year, I’m on my way back to Athens. This will be a short trip with virtually no team. My colleague organizing things in Athens has stated that she “feels sorry” for me, as the number of people signed up for the clinic appears to be quite large.

From what I can tell, the situation in Greece has only gotten worse since I was last there. Many borders and routes into Europe have closed, and migrants are being turned away at far greater numbers than they were last year. But by “turned away,” I’m not describing from Greece itself. Nope. Thousands continue to arrive on the shores of Greece every day. I’m talking about further into Europe. So, the migrant population continues to swell in Greece, especially Athens. Although authorities have begun shipping back some migrants (numbering in the hundreds) in the past few days, this is a small small number.

I say I’m bringing ‘no team’ this time, but in reality this isn’t accurate. Aside from what sounds like a great number of willing helpers in Athens, I also will bring my 14 and 16 year old daughters with me this time. I don’t know what sort of role they will be able to play in the work we do this time. It could be simply watching the children of the patients while they’re waiting the doc.

migrantsHopefully, they can learn a bit about medical care in a refugee and/or underserved situation. As their lives are largely consumed with cheerleading, skinny jeans, teen-lit, French horn, Cello, soccer and boyfriends (ex…EX boyfriends), this might be quite an eye-opening experience for them. I hope so.

My biggest concern is that we will successfully collect accurate data on the patients we see. Last time we did a fair job, under the circumstances, but in my spare time I’m STILL working through the XL spreadsheet and trying to come up with data summaries that will be of some use to the wider medical world.

This time, I hope to have time to ask better questions, and to formalize how we input the data. It is well known among those who do medical research that 80% of the study is done before the study begins. Developing a means to collect data, to college USEFUL data, and to do it in a way that is searchable and accessible at a later date is difficult. It is especially difficult when at that later date, you are dealing with hundreds, maybe thousands of data points.

I’ve had enough training in this element of the medical world to feel a gnawing sense of anxiety as I approach the issue. My medical school heavily emphasizes epidemiology and biostatistics, and I was part-way through an Master’s in Public Health degree until I ran out of money. So I have a sense for how easy it is to do this stuff badly. But I wish I had a collaborator or better skills to know I could do it well.

Still, I’ve had some help from a colleague at work who maintains a quizzical affection for XL (I can’t judge, I was once in a steady relationship with Photoshop), and he has helped me clean up our data from October. And I have a much better sense for what I need to do this time around.

14_athens_imgIt should be mentioned that most relief agencies don’t actually do any of this, even the good agencies who actually help people (lots of them are there for the photo-op and little else, it seems). I received some generous help from a professor at the London School for Hygiene and Tropical Medicine prior to my last trip, and he noted only a small number of agencies who provide care AND do good, statistical research on the populations they serve.

So, it makes sense that I’m somewhat on my own here. It’s not easy to focus on research and practical care at the same time, as one is more empathy-driven, the other much more analytical and “cold.”

Example: if someone comes in coughing up blood, you can either turn and enter “hemoptysis” into your spreadsheet (and then get the heck out of there because…ew), or you can throw on some gloves, hopefully a mask, get them on a bed and start working them up for any of the many many possible reasons for that symptom (most of those reasons being prit-TEE bad).

So, we will see how this goes. We leave tomorrow (Sunday) afternoon.

 

Ambushed!

International work, medical or otherwise, is dangerous. Maybe only a little more dangerous than normal American life, maybe quite a lot. A long-term Christian missionary doing really, really good work was gunned down in Haiti just today.

noyau-goat-3
About as remote as it gets.

I myself have done relief work in Haiti. One of the places I worked is located in the hills of a village-esque area called Noyau. This place is about as remote from civilized life as I can recall being in my life.

After an hour of 4WD driving on extremely-rough dirt switchbacks up a mountainside, we pulled on packs and hiked for another hour+ to reach the area of our clinic. If something went wrong out there, the time required to receive aid would exceed 4 hours easily. Assuming emergency crews had access to a 4WD vehicle, which is doubtful.

I recall thinking, as well over 100 Hatians stared at us zipping ourselves into our expensive tents and sleeping bags at the end of a clinic day, how honorable they were as a people. They had hiked for many hours to find our clinic, and often the only thing we had to offer them upon their arrival was a few TUMS tablets. Frequently their medical problems were either too complex for us to help with, or, more commonly, we simply didn’t have the medicine or procedural ability they needed.

But they could have robbed us. Selling our nice North Face and Sierra Designs gear would have fetched an impressive price in Port au Prince. Furthermore, they could have kidnapped us and held us for ransom. Now we’re talking real money. Until they talked to my wife, who would probably say something like, “Take ‘im. Never does the dishes anyway.”

We were totally vulnerable in that village. But the reason, I believe, nothing bad happened was simply because most Hatians are good people. Honorable people. Honorable, even, by my wealthy American standards, where respect for property and life is alive and well. They let me keep my nice tent, even though they couldn’t be sure of their next meal.

Similarly, while working in the Galatsia camp on our 3rd day in Athens, I ended up in an extremely vulnerable position. Again, we came out unscathed largely because most people are, quite simply, good.

Prior to entering the camp, I asked one of my team members with military training to effectively serve as our “security.” He took his role seriously: identifying sight-lines, exits, areas of risk, areas of relative safety. He developed rudimentary emergency plans, identified key leaders in the facility and communicated escape plans to our team.

But for some reason, when I was asked to leave our clinic to go see a patient reportedly too sick to walk to us, I didn’t think to ask our security guy to come with us. In “medical mode,” it’s difficult to think in “safety mode” too. Our task is to meet needs, not protect ourselves, and the thinking between the two is often very different.

wpid-wp-1444825879926.jpeg
See all the people? That lady in blue is an aide worker. Behind me was a large room, a courtyard, and a line of police. I thought we were going here.

I also believed we would be going to one of the large rooms with lots of people, located near the entrances, near the police, organizers, aides and managers.

That’s not where we went.

Led by the sick woman’s husband, we walked down corridor after corridor. Branching off from each of the primary hallways were other halls, down which I saw a half-dozen young Middle Eastern men, crouched against the wall, all looking at me. The halls were strewn with trash, cell phones hanging by cords from every available outlet. I heard yelling, some laughing, but mostly saw numerous drawn, emotionless, bored faces. There was no joy.

I went with our clinic organizer (a Persian woman who organized the whole medical clinic, speaks numerous languages, and knows what she’s doing) and, as luck would have it, the pastor of the local Calvary Chapel we’re working with who saw us wandering away and followed. So at least I wasn’t alone.

hostages
This happened in the Philippines just last month. However improbable, we could have rounded the corner and found guns and flags, not a patient.

But after the 3rd corridor, and up a large flight of stairs, then outside the building and then back into it and around a corner, I knew that if someone wanted to do us harm, they would have succeeded. We’d followed this guy like ducklings.

But he didn’t harm us. All the man wanted was to know if his wife would be OK, and if it might be possible to get her on her feet by that evening, in hiking condition. He intended to continue his journey into Europe as soon as he could.

I diagnosed viral gastroenteritis and told him she may be ready to roll by that evening, but giving it another day or two would be better. He clearly intended to leave that night, despite what I’d said.

Later, of course, we laughed about this. Our team leader, Sahar, laughed at me for being so worried.

But the truth is that there is no way to do this work without incurring some amount of risk. Usually the risk is small, thanks largely to the fact that although there is terror and violence in the world, most humans on this planet are good, fairly honest people. Most are just trying to make a better life for themselves and their children.

As are we all.

Medical Case

image

A 44 year old man came to our clinic today with a description of chest pain, mostly on the left side. He says it’s been ongoing for about 4 months.

He arrived in Athens about two weeks ago, with plans to head to Germany in another week. He was seen last week at a Doctors of the World clinic in town for the same problem.

He says they gave him the above EKG, told him he was having a heart attack, and sent him out the door with 10 pills of Prilosec and instructions to go to “the hospital.”

Due to money restrictions, lack of transportation, minimal confidence in, and maximal confusion from, his interaction with his Greek-speaking doctor, he did not go to the hospital. He instead came to our clinic 4 days later, worried he was dying from a heart attack.

How would you handle this?

Lentils or Needles, Your Choice

church
The Church (not abandoned, as I first thought) were our clinic is located.

We saw around 15 patients on our first day. If I this was a video game (maybe all of life is?), by the end of the day my strength bars would have been around 2/5.

Today we have nearly 30 people on the schedule, plus a smattering of missionaries who seem to filter in with loooong lists of medical questions.

The missionaries are amazing. Most consider themselves to be “married” to the mission field, and are here by themselves, living on donations. And not just for a week. For years.

If you’re looking for “underserved” medical communities, no matter your own personal faith persuasion, here’s one. Most Christian missionaries donated their health and bodies to their work long ago. They see a doctor when they can (read: every 5 years on average), but it’s never a regular thing for them.

One question from a missionary yesterday, “We’re so excited. We’ve been given permission to use an old elementary school from the Greek government. People have been defecating and doing drugs in there for the past 5 years. All we have to do is clean it out, and it’s ours! Do I need Hep B vaccination? I think I had one of those shots. What about that HiB thing? Oh, and what about tetanus. Can’t remember when I last did one of those. And should I wear gloves? Maybe a face mask?”

Afghan migrants arrives on the shores of the Greek island of Lesbos after crossing the Aegean sea from Turkey on a inflatable dinghy, Thursday, Sept. 24, 2015. More than 260,000 asylum-seekers have arrived in Greece so far this year, most reaching the country's eastern islands on flimsy rafts or boats from the nearby Turkish coast.(AP Photo/Petros Giannakouris)
Afghan migrants arrives on the shores of the Greek island of Lesbos after crossing the Aegean sea from Turkey on a inflatable dinghy, Thursday, Sept. 24, 2015. More than 260,000 asylum-seekers have arrived in Greece so far this year, most reaching the country’s eastern islands on flimsy rafts or boats from the nearby Turkish coast.(AP Photo/Petros Giannakouris)

Another story: 12 year old girl with dizzyness. She left with her parents from Afghanastan over 6 months ago, running from the Taliban. The family took a number of cars overland from there to Tehran for around 20 hours. They then hiked from Tehran to somewhere in Turkey for days, eventually finding their way to a huge refugee camp there.

Then the family found a smuggler who, for most of their remaining money, agreed to put them in an inflatable raft for a trip to the island of Lesbos, which is officially “Greece,” and would allow them to begin the process of obtaining refugee status.

They were required to get from the refugee camp to the coast on their own. Upon finding the launch site a few days later, according to the mother, they found that the raft was about 8 feet long, and she counted nearly 30 people in it.

They were turned back by the Turkish coast guard 5 times before they succeeded. Each time they were turned away, they were “towed” back to the Turkish coast, which effectively half-sunk their raft because the front end kept getting pulled under the water. Although some had life vests, many did not, and nobody knew how to swim, so the affair was terrifying.

This young patient started her period 8 months ago. She has had to learn how to be hygenic in refugee camp conditions. She can’t understand why she feels so weak and tired all the time. I asked her how and what she eats.

“We got cookies on the road from Tehran to Turkey. They were good.”

“Do you eat the food in the camps.”

“Ew. It’s always bean soup, and they never cook the beans.”

I smile and look at the mother, she is looking at me, rolling her eyes. “Lentils, usually,” She says through my translator Sahar (and Superwoman). “But I can’t get her to eat anything. She’s my pickiest kid.”

Here I am, a billion miles from my homeland, from any Caucasian, from my life, and this mother is dealing with a UNIVERSAL problem of parenthood.

“I have the same problem in my house,” I say smiling. The mom laughs.

I then look at the daughter, “You are probably dizzy because you are losing lots of blood every month. It makes people feel weak, tired, cold and dizzy. The best way to take care of it is to eat. Cookies are not food.”

I look at the mom, smiling again, but shrewdly. “But I don’t know for sure if this is the problem. I need a,” (imagine the audio slowing down here for emphasis), “BLOOOOD TESST.”

The girl’s eyes widen. “Uh huh,” I confirm. “With a NEEEDLE.”

Cute, 12-year old crestfallen face. “So I’ll make you a deal,” I continue. “Lentils or needles, your choice.” Mom laughs again, getting it.

The daughter, I hope, got it too. The mother and I were able to make light of this, but it could get serious. The girl’s arms at the biceps are thinner than my wrists.

There are more stories from only this first day. To depict them is like trying to pour the entire Mediterranean Sea into a rain drop. It just can’t be done.

This world, these sorrows, these tragedies…they can only be know by walking, even for a moment, with those that are living them.

Tomorrow We Leave

We leave for the refugee clinic in Athens tomorrow.

I intended to blog the step-by-step story for how we arrived at this point. But THAT didn’t happen.

Here are some specifics:

wpid-wp-1443899443776.jpeg-We intend to see approximately 30 patients per day for a week, working half-days on Monday and Friday. I suspect we’ll end up seeing many more than this.
-We will be working in an abandoned church in downtown Athens. We’re staying in a Youth Hostel a short distance away.
-We have access to labs, Xray (maybe?) and some medications but I’m not sure which ones.
-I’ll be using an antique oto/opthalmoscope manufactured by the Riester Company, which was based in, you guessed it, Germany.
-We plan to see Afghan, Iranian, Iraqi and Syrian refugees. There could be many others.
-On the last day we will likely go into a refugee tent camp and set up our medical clinic there.
-Donations continue to roll in, to date over $6000.
-I’m not without a sense of concern. It isn’t lost on me that Americans aren’t the most popular people in the world today, especially in the lands where these people are coming from. On this, the night before our departure, I’m keenly aware of all that I leave behind, and all I hope to see again soon.

Your thoughts and prayers are most appreciated.

Donations

Sansum Medical Research Institute

I used to work at a non-profit medical research institute. There, we didn’t “earn” a single dollar. Everything was given to us through some version of a donation. So I suppose I shouldn’t be so amazed and slightly mystified to receive the thousands of dollars sent our way for the relief trip to Athens.

True, our costs are estimated to run in the $6-10,000 range, and we’re still around $3,000. So it would be nice to get closer to our goal. But even if all the money stopped tomorrow, this has been a humbling experience. Things went from what seemed like a good idea that aligned well with my interests and lifelong training, to something more important. Quickly.

I’ll explain:

I spent a loooottttaaa time in that building. Still miss those days!

The medical school I attended is located in Israel. Called the Medical School for International Health, the curriculum strongly emphasizes International and cross-cultural medicine. It’s a small school, but is comprised of people who love, love, global, cross-cultural experiences.  I’m one of them. These are “my” people. Aside from my wife and children, to this day, I love nothing more than being somewhere, far, far from my familiar world, surrounded by languages I don’t understand and histories and stories and traditions and beliefs I have yet to learn. Being at MSIH put me in the lives of people who love the same thing. I’m not sure I ever felt more at “home,” and I was approximately 6,940 miles from the suburbs of Colorado Springs, where I grew up.

A refugee relief clinic in Athens, thus, is a natural thing for me. I’m wired for this. It’s what I’d do full-time if I didn’t have obligations to children and student loans. But, as evidenced by my parents’ one single excursion out of the U.S. to visit me in all the years I’ve lived overseas, this international stuff isn’t for everyone. In fact, especially relief and refugee affairs isn’t really for most of ANYone. It’s a briar patch kind of thing: This is what I do. But I don’t expect it’s what you do.

So I am amazed to see that what started off as something I care about, has become something you care about too. To those of you who have sent money, and prayers, and follow this blog, thank you. It’s humbling, and a little disquieting, to know that the work we’re doing isn’t being met with ambivalence around the world.

Indeed, it has been quite the opposite.

Athens, October 2015

Athens has long been a crossroads for refugees trying to make their way from the Middle East into Europe. So when I traveled there with my church pastor, David, this past February to explore the possibility of starting up a medical clinic, we had no idea what kind of summer was approaching.

At the time, it was clear that activity in Syria/Iraq (ISIS territory spans both) was worsening, so we predicted an influx of migrants seeking refugee status in the EU. We knew the numbers this summer would jump. But we didn’t predict anything to the level of what we’re seeing today.

Be advised that anything you read below this blog is from the days when my blog was largely a chronicle of my time in family medicine residency in Olympia, WA. Some of the posts are fun, some whimsical, some serious, some maybe a little helpful.

After residency I moved to Germany and live here still. I’m a practicing family medicine doctor and have long planned on working in international and relief settings. This is the primary reason for moving away from friends and family, and my decision has positioned me well to help with the current crises in Europe.

Can I, and this little clinic we’re building, do much to address these massive problems? Hardly. I understand that. But if lots of people do lots of little things, it can equal one big thing over time. So I’m starting with this little thing.

As such, from this blog forward, I’ll mostly be talking about the work we’re doing in Athens and the topics that relate to that work. Namely, cross-cultural medicine and global public health. If you care about these things, you may enjoy following along as I navigate through this project.

The media element of this project is just getting started, and it’s been awhile since I flexed my creaky “blingers” (that’d be blog-fingers). So bear with me.

However, already I’ve been met with scenarios for our clinic that I hope to present to you, SW101 nation, for input and ideas. This isn’t an easy challenge, with lots of questions that have no easy answers. So approaching this as a community is, I think, a much better way forward than going it totally alone.

So, if you’re willing to jump in with me, thank you, and welcome!

Bread Between The Legs

English: Candida albicans
We call these ‘branching hyphae’

Yeast infection: Yuck-central to the average vagina owner. Discharge like milk curds, funky smell something akin to old toes floating in rotten vinegar, and an intense itch that you can’t actually itch because if you try, it hurts. Cool, huh?

When you’re talking about this fun experience, what you’re largely talking about is overgrowth of a specific type of yeast called Candida albicans, which is actually a fungus. Pretty gross.

Truth is, there’s probably a few of these little guys hanging around the average human vagina all the time and it’s no big deal, but too many of ’em and you’ve got a problem.

Candida albicans
Same as the above pic, just the DANCE version.

Of interest, Candida is kept at bay by another creature that you want hanging around in your vagina called, as a group, the lactobacilli. These guys don’t fight candida, they’re much more suave. They simply produce an acid (“lactic” acid…get it?) as part of their normal life cycle that subsequently keeps the vagina acidic. This makes things real tough for most other creatures, except for the odd Bear Grylls of the Candida world who eat acid for breakfast.

Yeast infections result when the acidity levels in the vagina drop. It’s hard to predict when and how the pH will change in that region of the world, but often it does.

Historically, yeast infections were easily treated with anti-fungal creams or a single pill of the drug fluconazole. But the “easy” part is going away. Increasingly, I’m seeing patients who have recurrent yeast infections despite the usual treatment.

Often, these patients have a history of heading to the doc for “that pill.” And often, docs (or the “provider”) just fire the pill at them and everyone calls it a visit. It’s quick for the patient, saves the doc time, everyone’s happy. Unfortunately, the happiest of all in this equation is the yeast.

Fluconazole
Fluconazole

Fluconazole works by blocking an enzyme. That enzyme facilitates reactions that create the yeast’s cell wall. With the drug around, their cell walls get floppy(er) and don’t hold together as well.

But that doesn’t mean the bug is dead. Fluconazole isn’t some flaming thunderbolt from Mt. Olympus that blasts yeasts back to the Elysian (bread) Fields. The drug is fungastatic, not fungicidal. The weakened yeast is then susceptible to other bugs our our immune systems. Like a mob boss of the pharmaceutical world. It doesn’t do the killing, it just arranges, eehh, ‘tings.

These days, fluconazole isn’t as tough as it used to be. It doesn’t work like it did, often not with the strength it had. So tossing this pill at a yeast infection is a bad idea. Real bad.

Certain types of yeasts make poofy bread and good beer and they keep Jewish people busy (some would say crazy) during Passover. So they’re not all bad. But it’s an organism that we could do without. Fungal infections, when they become systemic, have always been tough to treat; more so than bacterial. And systemic anti-fungals have always been tougher on the body than antibiotics.

Under these circumstances, the best approach to recurrent yeast infection is NEVER to just go get another pill. You should firmly request that your doctor not only get a wet prep (which is merely looking for the presence of yeasts on microscope slide), but also order a culture of the yeast should any grow on the prep. From that culture, not only can the species of yeast be determined, but it can also be tested for sensitivity to fluconazole and other anti-fungals to see if the right drug has been chosen.

Recurrent yeast infections are beatable, but not if you’re lazy about it. For reasons that most men can understand, yeasts really, really like the vagina. If you don’t like ’em there, you’ve got to put more than just a little effort into getting ’em out.