From the exam-room door, I looked past the waiting room, across a dirt road toward shacks baking in the desert heat. It was noon in Baja, Mexico, and we needed to finish up soon to get back to California before sundown.
Our small group of doctors, nurses, translators, and pilots had flown to this little fishing village the day before to run our monthly two-day clinic. Some of the folks we treated had struggled over dusty roads for four hours to get to us.
We had one last patient. A volunteer brought in a woman who, I was told, was in her early thirties. She looked much older. In this part of the world, that is not uncommon. Conservatively dressed, she seemed unfamiliar with the clinic, a bit shy, unsure whether she should sit or stand, not knowing which of us to look at, my translator or me.
Through the translator I learned that my patient, Maria, felt very tired. She had been feeling that way for a long time. She had seen a local practitioner about it once before, about a month earlier.
“He told me I had anemia,” Maria offered. Looking at her, I had my doubts.
“How did he determine this? Did he do a blood test?” I asked.
“No,” Maria replied, shaking her head. “He looked at my eyes.”
Sometimes an astute clinician can pick up on anemia by noting pale coloration on the inner surfaces of the eyelids. But you’ve got to be pretty low in hemoglobin for this effect to be noticeable. Frankly, Maria did not look anemic to me.