Random Thoughts From the Clinic

1. For some reason, getting a full medical history on people is very difficult.  It was brought to light this week with a very sick woman that I saw.  I repeated asked if she had been seen somewhere else - and she repeatedly said NO.  The second time that I saw her, she was continuing to have intense stomach pain and constipation and wanted something for the constipation.  I told her that I couldn't give it to her and wanted her to go to the regional hospital - because I was worried that she had typhoid and might have a perforation in her bowels.  yes, she said, that is what the other 2 hospitals said that I had.  REALLY??? 

2. I also learned this week that if I tell someone that they need to go to the regional hospital, it strikes fear in their hearts for 2 reasons….. one, they are just afraid of the hospital which is known for giving bad care and taking all of your money, and two, it means that I think there is something REALLY wrong with you.  I am also not a big fan of the hospital and will do whatever I can to treat people here in the village - people know that - so if I say go, they know it is not good.  I found that out because of a conversation that ensued after I told the aforementioned woman to go to the hospital and she started crying saying, I am going to die! 

3. If you show up in my clinic wearing a heavy jacket, or sweatshirt or snow pants, and it is around a million degrees and I am sweating profusely, I KNOW am going to test you for malaria - even before you open your mouth to tell me your symptoms. 

4. Polygamy and STDs are a VERY bad (and very expensive and  very frustrating) combination. 

5. I am finally getting better at NOT taking money with my left hand.  Here, it is SUPER rude to take or give anything with your left hand, as it is used for toiling purposes.  Unfortunately, the way the clinic is arranged, we sit with our left side to the patient, so when they hand me money, it is instinctive to grab it with my left hand, even when I am very conscious to not do that in a normal situation.  But I have been watching Dr. Sana reach across his body with his right hand to grab the money, and now, after a few days practice, I am getting better at it! 

6. I had the sweetest patient come this week - a lady with a baby.  Her baby was ill - she explained that her husband had died recently but that she wanted to come right away for medicine so her baby didn't get sicker.  I chose the most inexpensive meds I could and she was so grateful.  She asked about my kids (not unusual) but then asked if I had eaten, because it was late in the day and she was worried about me (VERY unusual).  Then she told me of some native medicine that she had given her baby, and wanted to make sure that it was ok to add what i was giving on top of that (also very unusual).  I just wanted to squish her. 

7.  I am EXTREMELY bad about waiting for cultural customs to take their course!  After we see the patient, and write the order for meds, and get them all packaged, and add up the cost, we tell the family - it will cost this much.  And then we all look at each other.  And we wait.  And we wait.  And we look at each other.  All the while, there are either lots of people in the waiting room or I am ready to go home.  And the waiting makes me CRAZY!!!!!  Finally, after saying it again, people will either pull the money out - or go out in the waiting room to get it from a stash they have with a waiting relative.  About 95 % of the people try to bargain down the price of the meds  - that doesn’t make me nearly as crazy as it used to……  When I am alone in the clinic, I try to wait a little bit and then I say - Did you bring the money with you or do you need to go and get it?  Probably not entirely culturally appropriate - but it keeps my sanity mostly intact. 

8. We use a common drinking bucket and cup - that makes me crazy as well - I guess it is job security?  I have talked with the health care worker about it - some customs are hard to change. 

9. Consent is a tricky thing.  In the US, everyone has to sign a ton of paperwork that serves as consent for a procedure.  In our clinic, basically, if you show up, we take that as consent to treat - and follow through accordingly.  I saw a woman yesterday with an abcess on her eyelid.  I had started treating her a few days before - when she showed up yesterday, she didn't want me to lance it.  But it was SOOOO ready to be opened and I knew that she would feel So much better.  So I washed it and was going to bandage it but couldn't walk away.  The midwife was with me and we talked the patient into letting me open it (we didn’t give her a lot of choice but she sat and let us do it).  I was very worried about it affecting her sight or having the infection  go into her brain.  The pus that came out of that eyelid was incredible - and the smell was overwhelming.  The midwife even commented on the smell - which is unusual for her. 

10. Starting my day off by sweeping up the mouse, lizard, and bat poop that is on the floor makes me feel icky.