…some more. met an interesting person yesterday in casualties, a doc I haven’t seen before. for some reason he quickly took a liking to me, I wasn’t thrilled, I prefer to fly more under the radar here. from the moment he met us the lecturing began:
…this country’s anthem is ‘we are poor, we are poor’ but it is not true. there are naturally resources and we get aid, it is just what we do with the aid, there is corruption high up in the government, the majority of the people suffer as a result…
he was fairly articulate and I understood most of what he said, losing only a few words to his thick african accent. I know what he speaks of, but what can I say? I listen intently and nod sympathetically. i reinforce that we are aware of these problems and we went to help. but we’re only first year... well, going on second year, medical students. how much can we do? we’ve repeated over and over how helpless we feel here. but he was relentless in his preaching and he went on:
…you see these beds, they have blood stains on them. you see the sinks, they don’t work. you see me, I have no place to sit, no table to write on. this patient, he must stand because there is no room or bed to put him in. these curtains, they have never been washed, they are used as hand towels and tissues and they are never cleaned…
before I know it he has swept me away into an exam room. I glance back with a final, pleading look toward amy and thu. they are standing there and shrug as if to say ‘good luck sucka!’ as I turn and follow him obediently. our first patient is an old woman, we take her bp. he instructs me all wrong but I can’t correct him, im a woman, and more than ten years his junior. I bite my tongue and report her bp to be 128 over 68. it was easy to hear and I was sure of my precision. he writes 120/60. we round, he tells me… ?! your rounded skills need to brushed up on! I think, frustrated, and bite my tongue again. next thing I know the bebe is out of the room, some arbitrary prescription in her hand, and he is asking me to close the door and sit. what is your cell phone number, he wants to know. I retrieve my local cell and he takes it from my hand. dang it! I thought I put it on silent earlier but a text came in and there was a quiet ring, no hiding the fact that I have a cell on me… he exchanges the numbers, then satisfied, the lecture begins anew:
… the reason here we are allowed cell phones in the work place is because we must take care of ourselves. no one will call our work if something bad happens at home. in the US you think it is rude, unprofessional, here it is the way it must be. if something goes wrong, I need people to be able to get a hold of me…
this makes sense I suppose. I’ve discussed the lack of cell phone etiquette here and several times during our conversation his phone would ring and he would answer it. usually I think he would say he’s busy and ask them to call back later, a short conversation, then hang up, but often it would ring again almost immediately, and even mid-sentence, he would answer it without an apology to me for the interruption.
a new patient enters. a woman 25 years old. she complains of left sided abdominal tenderness. we lay her on the dirty, rusted, sheetless exam table. he palpates abdomen then invites me to do the same. I rub my hands together attempting to warm my icy fingers before I place them on her stomach. he looks at me appalled. she is not a baby, he says. I laugh because to me, it doesn’t matter weather she cares or not if my hands are cold, the polite thing to do is to try to warm them; it is the same courtesy I’d want paid to me were I in her situation. we emphasize bedside manner so much in the states, it is a huge part of medicine and I really value that. he scoffed at me for even this tiniest effort to make the patient more comfortable. there’s something wrong with that. such differences in what is valued when it comes to healthcare. Sure enough her spleen was very enlarged. unfortunately, he prefers to preach on the adversities in tanzania and not explain so much about the medicine, so she was sent away without me getting to ask questions about her condition. nonetheless, it was cool to feel a spleen, usually you cannot palpate it. pt is out of the room and again I find myself closing the door and finding a seat. I’m starting to get exasperated. this time he wants to tell me a story:
…when I first started working here seven years ago I was approached by a woman from the UK. she wanted to offer me a 13 week course in a medical school in her home city, she said she would pay half the price. she emailed me again and again with the offer, she wanted to help me. when I asked the administration at this hospital they said no. you have only been working for a few months, they said, and already you want to take leave for more school, we cannot allow it…
I started to get an idea of where this story was going. he sees me, a mzungu, and all he sees is dollar bills and a ticket to the U.S.
…I know you are only a medical student, and you do not have money, but you know people, you can ask at your school, I am only asking for three months, please, lindsay, you are different, I can tell, I am begging you, please, can you help me?…
it went from a simple story I was having to focus very hard to understand, piecing together what words were unclear or improperly used. it turned suddenly to a plea for help, a demand for me to make a promise I cannot possibly keep. who am I going to talk to at OHSU? do we even have exchange programs for physicians like this? I don’t think so… grants for these people? doubtful, my school’s in the gutter! I tried to explain to this doctor, all I can do once im back is ask, but I cannot make him any promises. I’m not even sure my school offers what he is looking for, it is very small and… he says again:
…please, lindsay (he kept using my name and it was starting to annoy me), you can help me. I am asking for this small favor, please tell me you can talk to someone…
again I tried to explain. I’m not sure he was getting what I was saying… ugh, language barrier. I was also getting a little fed up and tired of being so polite. this was obviously his prerogative from the beginning. why’d he have to pick me? um, can I please switch places with one of the work the world brits? they’d give him a piece of their mind. instead I sat quietly and listened as the preaching continued, it was an annoyance, but a unique experience as well… he must’ve finally been satisfied with my response because he moved on:
…your teeth are very white (uh oh, here we go! weren’t thu and I just having a convo this morning about all of the tea here turning our teeth yellow?!)… the people here, their teeth are stained, it is from the fluoride in the water. because the water comes from mt. meru, from killimanjaro, both dormant volcanoes, the fluoride content is so high. it makes it difficult for the body to use calcium properly, there are problems with bones, joint pain, muscle pain, the teeth develop problems. the people do not realize it is all from the water they are boiling to drink (in my head im thinking, wait a second, I’ve been drinking boiled water this whole trip! and my tongue instinctively rubs against the front of my teeth, searching for decay), I tried to collect information on the fluoride content of the water and the water people would not tell me, the people have a right to know!…
at this point it had been almost three hours of preaching and I was starting to wonder what he should be doing, since obviously the hospital does not pay him to lecture me. also I was itching to see the cool cases outside I kept glimpsing when nurses would come in and out of the room. finally a patient entered, rescuing me! the smell was familiar before I saw the young maasai woman walk into the room. she carried a tiny bundle of dirty blankets, I didn’t think twice about it and started to leave the room, make my get away when… ‘lindsay!’ crap, not fast enough, I turned defeated and stepped back into the room. that’s when I saw it, a very tiny baby on the young woman’s lap. ‘uh, thu, amy!’ I heard my voice quiver, they came quickly. we all stared. the baby would have easily fit into the palm of my hand, (and for those of you who know me, I have very small hands, so that’s saying something). it was so tiny and frail, it looked like a shrived little old man. and to add to the shock of it all, apparently this baby was six days old! knowing what we do of the maasai, it could have taken them that long to get to a hospital. he admitted the baby and asked us to take the family to the preme ward. no problem, get me outta here!
I had enough for one day. now im torn between wanting to observe and help more in casualties, and wishing to avoid that doc and his long-winded sermons on everything that is wrong with the healthcare system and tanzania as a whole. as I told amy and thu about all of the things he had said to me, they both couldn’t believe I had tolerated it for so long. it’s funny because I was very fed up with his preaching, but as soon as they started to bad mouth him I felt suddenly defensive. take our frustrations, as visitors, with the hospital and then imagine if you were an employee and you had been dealing with these problems every day for the past seven years. I cannot even fathom the aggravation he must feel working within a system where he doesn’t have professional support, the correct supplies, adequate facilities, and so on. you would want to voice your irritations to anyone who will listen as well, particularly well-to-do mzungus who find themselves in your department with judgmental looks on their faces they aren’t good at hiding. when he would speak to me today I would try to push away my irritation and instead acknowledge it as an interesting experience, to hear how this local doctor really feels about the situation. I respect the fact that he needed to vent. more importantly, I truly admire him for what he does, despite not approving of everything. you can only do so much when you have so little. the fact that he still comes to work under such conditions is commendable in and of itself and I don’t think it is my place to judge him for needing to preach to an open ear.
did get to see a few other cool cases. a guy with many deep head wounds, he said he had been attacked by a thief, and they did they same thing, removed the thick sutures though the wounds were still open and bleeding. there was a young girl so frightened she wet herself while sitting on her father’s lap – lucky him. they pretty much just spread the urine around on the floor to make it dry faster – so cleanly :) a young woman came in unresponsive and foaming at the mouth. that was interesting. two older women brought her in and neither of them could explain what had happened. it was almost as if she were seizing – drug overdose? she had huge sweat marks on her shirt, which was on inside out and backwards. they did the sternal rub and got nothing. her eyes were closed but you could see them flittering beneath her lids. then, like the snap of fingers, she came to, and was fairly oriented, though she also could not explain what had happened. a few minutes later they were asking her to stand and walk out of the room, they needed the bed for a guy who we think just had his appendix burst. when we left to take the baby to the preme unit, the girl was nowhere to be seen, the guy was being wheeled to surgery (we hope) and two other men covered in leaves were laying unconscious, one on a bed, one in a wheel chair, and no one really knew what had happened to them either, the docs didn’t seem too concerned… is this place for real?!
on a happy note it is a gorgeous saturday and we’re enjoying a restful day of doing pretty much nothing. finished two loads of hand-washed laundry yesterday, so im feeling good (and smelling much better ;) when I went running yesterday a random local guy joined me and proved to be great company with a stride to match mine. tried saffron ice cream today and I’m hooked. went to our favorite fruit and veggie lady (we go to the same woman every week and she loves us!!) and she picked us out the best pineapple I have ever tasted. last night was live music and the blue heron and it was a great band, a beautiful starry night, and all of our friends were there. the hospital can be frustrating for sure but it’s memories like these that remind me of how much im going to miss this place.
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