Ethical Dilemmas Continue....

I'm exhausted. I slept about 2 or 3 hours total today. I couldn't sleep with the heat and noise of rebuilding outside my window so I ended up going and working in the clinic for awhile. But I'm so glad I did because we had a very sick girl come in with major wounds. She was malnurished, hair falling out, pain everywhere and spots in her mouth. The 3 large open bed sores on her bottom and leg looked horrible. I could fit almost my entire fist in one of them. Dr. Call saw her and then I was given the task (which I seriously love) to clean and dress her wounds. Kirsti helped me clean up her body and then clean out and dress her wounds. Her brother and boyfriend were with her so I taught them how to care for the wounds at home. I felt so bad for her but hopefully they took her to the hospital where she could get the comfort care and testing she needed to make sure it wasn't something else. I'm pretty positive she is at least HIV+ if not full blown AIDS. I guess it all started 6 months ago and she had tests done but unfortunately it isn't uncommon for doctors here to not tell patients what is wrong if it is bad news. I think it must be a cultural thing but it is VERY frustrating for us and the patients.It is just another ethical dilemma we face every day in a third world country. Can you blame physicians for not telling people they are dying and sending them home with no treatment or medication? It's hard enough to do that in the US when you have hundreds of tests and treatments you can try. Yet is it right for them not to so they keep going from clinic to clinic trying to figure out what's wrong? Another factor is they may know but won't tell you for fear you won't treat them. Last night one of my patients was an AIDS and possible TB patient and of course we didn't have true isolation precautions. And it freaked out the families of my other patients when they saw us wearing masks and gloves all the time. These people are even less educated on medical and disease processes so you can imagine the fear they all have. Bringing a loved one to the hospital isn't like America - most realize it's a death sentence here. Anyone have any thoughts? Well I'm off for some very needed sleep!