Liberia #12
“I wa ultrasnd!” But you don’t need an ultrasound. She looks around at her two fiends, “ba I wa ultrasnd” I finally give up discussing why I think it isn’t needed and tell her to go pay, and I will do it. This 25 year old says she had a miscarriage 3 months ago. “Den dae klin me aut” I think this meant that she had a curettage to remove anything that remained and stop bleeding. Den dae … injection da last 3 momph. I assume Depoprovera, but she cannot confirm the medication. It was done somewhere else so I cannot look it up. She goes inside to pay for the ultrasound.
The physicians assistant, who decided to work today, but won’t be here the rest of the week, asked me to see another guy. He said the man had an infection starting with a sore on the top of the foot, then the foot fall off. I was skeptical, as you are right now. He heard from a neighbor that sorcery was the cause, so he came to me for confirmation, whether a medical issue caused it or a spiritual issue. The man walked in with crutches. He sat down and I asked him to take the sock off the stump so I could see his leg. There was a healed stump over what appeared to be the upper portion of the ankle joint. A small sinus below, appeared to be draining fluid. He said he had no drainage. He didn’t ask me the same question that the PA had. We discussed what happened and he confirmed the same story of his foot falling off. We discussed that if someone could make a prosthesis, that a below knee amputation would usually fit a prosthesis better than what he had, it also supports the weight differently so it would not have the same pressure points that his current condition would develop if he tried to put something to walk on down there. He decided to try the JFK hospital for a prosthesis possibility.
The previous patient was waiting outside the tent, when I came out, to go inside the hospital again. “No money da ultrasnd! Injection!” You want an injection? She nods her head. They say we have Vit K and ergometrine. Neither of which I will expect to help in this situation. I tell her that, and she goes off to get them anyway, with my order.
I go home to eat lunch at 2PM. Just as I finish a liter of water, the nurse is there, she wants and ultrasound and now has paid the money. How frustrating people can be! I figure if adults want to pay for a useless test, after Ive explained it’s futility, I will do it, unless it will harm them. An ultrasound wont harm her, it just is now annoying me. It shows blood in the uterus as expected. So I still prescribe her meds, including contraceptives in high doses, that actually may help her, and tell her to come back in a day or two if it doesn’t stop, and I would “kleen her aut!”
Another old woman complains of generalized weakness. She had been seen here 4 days ago, and the labs we have were negative. I recommend drinking a lot of water- thinking of dehydration, and eating food- nutrients and vitamins. The son asks for something to help her eat. I give her a multivitamin, which everyone here believes will help your appetite (it doesn’t medically, but might psychologically when then think it will). After a bit more discussion they are content and leave.
I’m done with rounds and one of the burn patients dressings, and now done with the above two patients, so am eating lentils and typing. The more medical issues I see, the more grateful I am not to be an internist / family practitioner / pediatrician… you all are amazing to deal with this stuff every day! But I do think that the generalized weakness and numbness that so many describe annoys me the most. I still haven’t figured out yet whether they mean the same to the patient as those words do to me. (When we were in Cameroon, Nigerians would talk about fever- and to them that was the word for pain. Fever in head, fever in abdomen…) So some of it may be word choice, another is I can do nothing about it- neither diagnosing nor treating. I need patience.