Mary Buckler’s Blog

August 16

August 29th, 2008 Posted in Uncategorized

16 August 2008

“Country med-cine”

Two weeks ago marked the end of the hardest week so far. I was in charge of running the 28 bed female-ward by myself, and there were some very sick patients, six of whom died over the course of the week. Nicknamed the “HIV/AIDS” and “meningitis” ward, female-ward has recently received an influx of meningitis cases. I maintained a relative amount of composure all week until Saturday morning. I had left the ward finally at 10:30pm the night before after checking on a few patients in particularly critical condition.

One of them, Stella, was a 25 year old HIV+ woman who had been advised to start antiretroviral treatment three months ago and instead had consulted one of the traditional doctors (a common course of action here). When she was admitted for acute abdominal pain earlier in the week, her caregiver-brother handed me two big sacks. The first one contained an assortment of medicines I was familiar with (two different antacids, various antibiotics with a few pills missing from each packet, some bisacodyl for constipation, and paracetamol (the Cameroonian version of Tylenol)). The other sac contained five unlabeled bags of various sizes that contained a mixture of things that looked like dirt, herbs, tea, and who-knows-what else. These were the “country med-cin” she had been taking. The nurses took one look at it, advised me not to touch it, and proceeded to scold the patient and caregivers about using “country med-cine.” The style of conversation here is generally more harsh-sounding then in the U.S., and I am still learning how to tell the difference between bluntness and actual anger/frustration. However, the family did not look particularly appreciative of the scolding, and I made sure to come back a bit later to explain to them why we really recommend she stop taking these medicines, especially while in the hospital. Stella and her brothers agreed to stop taking them and seemed to be appreciative of the conversation.

Over the next few days, her abdominal pain resolved but her mental status gradually deteriorated for no apparent reason. All of our tests came back negative, and despite all of our efforts, she became unresponsive and comatose. Her CD4 count came back showing advanced AIDS. By Friday evening, she had improved a bit and was actually taking food by mouth and murmured a few words – a huge improvement! The family seemed very happy. Imagine my surprise, then, when I walked into the ward the next morning to find am empty bed and sobbing family. An empty bed means two things – discharge home, or death. I went straight to the nurses to ask what happened. Evidently she had developed respiratory distress at 5:30AM that morning and quickly ceased breathing. The nurse then informed me that the previous afternoon a traditional-medicine-man had been observed by two-staff members in the ward administering various “traditional” treatments. We still don’t know the direct cause of Stella’s death. Certainly advanced AIDS itself can predispose to OIs (opportunistic infections) that could be deadly. Very high on our list, however, is intoxication from some unknown drug.

In the six weeks I have been here, I have learned a bit about what is referred to as “country” or “traditional medicine.” From my very-outsider’s perspective, these terms may refer to anonymously marked bags full of what looks like dirt, powder, tea, or other unknown substances that patients bring with them to the hospital. It may refer to small collections of needle marks on a patient’s skin – I have seen these clusters of black-marks on foreheads, backs, abdomens, feet, and even genitalia. These are the manifestations of “country medicine” I can see directly on physical exam.

Other manifestations are less obvious. One elderly woman in a coma for nine days, now presents to the hospital only after trying traditional methods first. What might have been a treatable illness at its start – meningitis – now presents in its last stages and is deadly. Another young woman presents complaining of dizziness. She has epilepsy and has been on treatment (Phenytoin and Carbemazepine) for four years. Because she recently began having one seizure a month (in my estimation, due to too low dosages of her seizure prophylaxis medications), she sought help from traditional doctors three days ago and now presents with dizziness, requesting to stop her seizure meds as she thinks they are the cause. I try to explain to her that her meds are unlikely to be the culprits as she has been taking the same meds for four years with no dizziness symptoms – the likely culprit is the country-medicine. She left looking less than convinced.

I have never spoken with one of these traditional practitioners, and do not have enough experience in the culture to necessarily make a judgment on my own. Good excuse, I decided, to ask questions of those who have!

Dr. Sob, a native Cameroonian doctor, explained to me that, in her estimation, the main issue is their lack of documentation. “These country doctors, the thing is that they don’t write anything down. If something works, or doesn’t work, you have to write it down so that the next person will know and can use that knowledge. Even Chinese medicine at least has been written down and documented for thousands of years. That is the problem with these African traditional healers – they don’t write anything down. That and that oftentimes they are just someone trying to make some money. The problem then is that patient’s spend all their money on these healers, and then don’t have any money left for when they come here to the hospital.”

Dr. Palmer’s wife, Nancy, has a PhD in cultural anthropology and spent many years talking with many of these traditional healers. “My main issue with it,” Dr. Palmer explained to me this morning, “is the animistic/spiritist philosophies that underlie most of what they do. It isn’t just trying a medicine that you don’t know. It’s buying into a whole philosophical and spiritual worldview. For your knee pain, they will tell you who you have offended that is now making your knees hurt. For your headache, they will tell you who you should apologize to and pay money to so that the curse will be removed from your head. For your HIV, they will tell you who you have to take revenge against for doing voodoo against you…”

Dr.Nkwenti is a pharmacist Ph.D. that trained at Oregon State University (the arch-rival of my undergrad-alma-mater) and then returned to his home in Cameroon to teach and work on diabetes education, prevention, and treatment. As a pharmacist trained in the U.S. but with in many ways a Cameroonian worldview, I asked his opinion. “You see, this is the thing,” he said over his lunch of fu-fu- and n’jama-jama. “I have some “traditional medicines” that I take everyday. And I’ve known people who were unhelped by the hospitals that then were helped immensely by these things. They just go out in the jungle and find some herbs, that’s all it is.” “Do they know what the different herbs are, then?” I asked. “Of course.They know. Most of them do, anyway. Thing thing is, there’s a different between “country/traditional medicine” and the animistic rites or ceremonies…”

Later this morning, we were interviewing a new patient who had been having total body pains on-and-off for 27 years. She told us that she had gone to “many hospitals,” but they could not help her and so she then went to traditional healers. After some time the pains left for a few years at a time, but they have always returned. Dr.Nkesha (another native Cameroonian doctor) asked her, “so did they tell you who did it? The country doctors, did they tell you who you must make amends with?” “Yes,” she said, “But I did not agree that I had done anything to that person and so I left.” She is, evidently, the minority.

Certainly I hope no one will blame her for seeking help for her chronic pain. When the “medical” and “scientific” hospitals fail, where are people to go? In the U.S. I am not opposed to all of the eastern or even homeopathic remedies – as long as it works, it deserves at least a second look by. Certainly I want to be respectful of other people’s cultures and worldviews. I appreciate Dr.Nkwenti’s distinction between “country medicine” as opposed to “animistic rites.” At the same time, I am not sure I can rule out entirely the many Cameroonians (at least in the hospital culture I am working in) who themselves refer to such country doctors as “charlatans” and crooks. Different cultures have much beauty. But not all in a culture is necessarily good or just or even healthy. Tolerance is good much of the time but it is not a universal virtue. Surely we ought not to “tolerate” thievery, abuse, and injustice?

In sum: I will wear my Cameroonian wrappa (wrap skirt), I will tie fabric around my head, I will learn as much of the language as I can, eat fu-fu- and n’jama-jama with my fingers, and do my best not to offend people in matters of manner and gesture; I will do all these things, but I will not, for the sake of being culturally-sensitive, tell people it is okay to go to a “country doctor” if I know he is taking their money, blaming their illness on another person, and giving them, at worst poison and at best, dirt.

 

As he went along, he saw a man blind from birth. His disciples asked him, “Rabbi,
who sinned, this man or his parents, that he was born blind?”
“Neither this man nor his parents sinned,” said Jesus, “but this happened
so that the work of God might be displayed in his life…” John 9

Posted by Mary at 1:47 PM 0 comments

more Yancey

What helps most (Philip Yancey, “Where is God When It Hurts,” fromChapter 13):

“…What can we do to help those who hurt? And who can help us when we suffer?

I begin with some discouraging news. The discouraging aspect is that I cannot give you a magic formula. There is nothing much you can say to help suffering people. Some of the brightest minds in history have explored every angle of the problem of pain, asking why people hurt, yet we still find ourselves stammering out the same questions, unanswered.

As I’ve mentioned, not even God attempted an explanation of cause or a rationale for suffering in his reply to Job. The great king David, the righteous man Job, and finally even the Son of God reacted to pain much the same way we do. They recoiled from it, thought it horrible, did their best to alleviate it, and finally cried out to God in despair because of it. Personally, I find it discouraging that we can come up with no final, satisfying answer for people in pain.

And yet viewed in another way that nonanswer is surprisingly good news. When I have asked suffering people, “Who helped you?” not one person has mentioned a Ph.D. from Yale Divinity School or a famous philosopher. The kingdom of suffering is a democracy, and we all stand in it or alongside with nothing but our naked humanity. All of us have the same capacity to help, and that is good news.

No one can package or bottle “the appropriate response to suffering.” And words intended for everyone will almost always prove worthless for one individual person. If you go to the sufferers themselves and ask for helpful words, you may find discord. Some recall a friend who cheerily helped distract them from the illness, while others think such an approach insulting. Some want honest, straightforward confrontation; others find such discussion unbearably depressing.

In short, there is no magic cure for a person in pain. Mainly, such a person needs love, for love instinctively detects what is needed. Jean Vaier, founder of l’Arche movement, says it well: “Wounded people who have been broken by suffering and sickness ask only for one thing: a heart that loves and commits itself to them, a heart full of hope for them.”

In fact, the answer to the question, “How do I help those who hurt?” is exactly the same as the answer to the question, “How do I love?” If you asked me for a Bible passage to teach you how to help suffering people, I would point to 1 Corinthians 13 and its eloquent depiction of love. That is what a suffering person needs: love, and not knowledge and wisdom. As is so often his pattern, God uses very ordinary people to bring about healing…”

Posted by Mary at 1:44 PM 0 comments

“…deafened by the clanking chains of mortality.” (Augustine)

I am up late in the hospital library, reading up on congestive heart failure. This common disease takes on a new “mysterious” flavor here, where EKGs are few and far between and cardiac echoes are untrustworthy at best. We have three patients with CHF currently diuresing on the ward, each with distinctly different body habitus and each with different responses to the diuretics. How does one tell the different causes apart? Can my stethoscope be somehow transformed into an echo-machine, and myself into a highly trained cardiologist?

A few of the residents and doctors have passed in and out before retiring. My friend Dr. Anna is on call, and stops by to see what I am reading and tell me about the latest admission she has just tucked into bed before heading there herself. How very familiar and even comfortable this all is. Surely not so different from back home?

Trying to focus back on my cardiology textbook, my right hand lies unthinkingly over my left radial artery and I notice my own pulse. Regular rate and rhythm. Just a few hours earlier, that same hand rested on a different wrist, one whose pulse was irregular, thready…skipping beats…pulse…pulse…pulse…and finally…still. Twenty-two years old. HIV-positive. Unknown cause of death. What diagnosis do I write on the chart? “40% of the stage-four AIDS cases that present to the hospital will never be discharged.” A statistic that Dr. Palmer quotes almost daily. Oft-quoted, one might say, because there is some measure of comfort provided by realizing the larger-perspective within which we work. Oft-quoted, I suspect, because he is frequently reminded.

In medical school, one of my supervising-interns taught me the criteria for declaring a patient dead: fixed dilated pupils, no respirations on chest auscultation, and no palpable pulse for longer than one minute. Here there is no such official criteria to speak of. If I do not document these exact physical findings, no one will question my “diagnosis.” No one will review the chart. No one will bring a malpractice case against me. If I do not write a cause of death, no one will call me on it. And yet I still write it.

“Time of death: 5:20P.M., 13 August 2008. Called to bedside by nursing staff for blood pressure of 60/40, five minutes prior the patient was sitting up asking for food, oxygen-sats = 50%. Nasal canula switched to face-mask for oxygen delivery and sats increased to 70%. Nursing unable to obtain IV line since pt pulled it out this morning, cut-down not done due to inability to reach surgeon-on-call, attempted to place line myself but unable to visualize any vessels, while attempting a blind-placement, pt ceased breathing. Pupils fixed and dilated. No respirations present on anterior auscultation. Pulse absent for > 1 minute. Pt was a known case of HIV, likely HIV encephalopathy, acute cause of death unknown.”

And then the wailing begins. What orginates as a body-wracking sob accelerates into a wail and then a piercing shriek that alerts the entire hospital-compound of the recent death. Some bodies convulse and shake so much that they fall to the ground and are escorted outside by other caregivers. Others cry out accusations to God, and questions (”Jesus, where are you? Where are you Jesus!?!”) over-and-over. Once a newly bereaved mother began the grieving process by singing a fifteen-minute heartrending lament, a song so-beautiful in its poignancy and tender in its agony that even the nursing staff, so practiced at continuing on with their other duties come-what-may, paused for a few moments to listen with downcast eyes.

When it happens that a patient dies – as it so happens almost everyday on my ward – then I say “Ashiah” (a term expressing empathy and, sadly, not present in the English language) to the grieving family and go to the chart to record what happened. No one will read it, I am almost certain. But with no cardiac monitor, no defribrillator, no intensive-care-unit, and in the young girl above, not even an intravenous line through which to push fluids in a desparate attempt to raise her blood pressure— with none of these things and therefore none of the usual illusion of control I am trained to have, all I can do is tell what happened. These “discharge summaries (reason for discharge: death)” are the part of my personal journal that will forever be included in the medical records of Mbingo Hospital in Cameroon.

In the states, documentation is a burden and annoyance, slowing down patient care and requiring physicians to stay late into the night finishing dictations from the week before’s patient-load. Not so here. Documentation is so scanty, medical-histories so scarce, that oftentimes I find myself digging through the too-thin-charts looking for something – anything – that can give a clue to why a patient is sick, why a certain thing happens, why a person dies.

Except – I am then reminded that no physiologic mechanism or diagnosis will tell me “why.” My cardiology textbook may tell me “how” it is that CHF develops. A book on HIV/AIDS may explain to me the “how” of my patients’ deaths, the physical mechanisms by which the various fragile organs stopped working, or even the historical events that lead up to my patient’s eventual state of “asystole.” Science can explain the “hows”; but one has to look elsewhere to explain the “whys.” I am certainly not the first person to have seen death up-close; many have seen it closer than I. Neither am I the first person to speculate and contemplate the meaning behind it. “It is hard to have patience,” C.S.Lewis said upon the death of his wife, “with people who say, “There is no death,” or “Death doesn’t matter.” There is death. And whatever is matters. And whatever happens has consequences, and they are irrevocable and irreversible. You might as well say that birth doesn’t matter. I look up at the night sky. Is anything more certain than that in all those vast times and spaces, if were allowed to search them, I should nowhere find her face, her voice, her touch? She died. She is dead. Is the word so difficult to learn?”

I like quotes; I read them, write them on flashcards, take them on runs with me, and memorize them, whether I agree with them or not. One of the biggest things I’ve missed here in Africa is ready access to quotations. I do have a few books with me, including Philip Yancey’s “Where is God Where it Hurts” which in one section uses quotes to introduce different people’s reaction to death, pain, and suffering.

“I have seen the moment of my greatness flicker,
And I have seen the eternal Footman hold my coat,
And snicker,
And in short, I was afraid.”
T.S. Eliot, The Love Song of J.Alfred Prufrock
(Fear.)

“The doctor said: this-and-that indicated that this-and-that is wrong with you, but if
an analysis of this-and-that does not confirm our diagnosis, we must suspect you of having
this-and-that, then…and so on. There was only question Ivan Ilyich wanted answered: was
his condition dangerous or not? But the doctor ignored that question as irrelevant.
Leo Tolstoy, The Death of Ivan Ilyich
(Helplessness.)

“It is not so much the suffering as the senselessness of it that is unendurable.”
Friedrich Nietzschie
(Search for Meaning.)

“All that the downtrodden can do is go on hoping. After every disappointment they must find fresh reason for hope.”
Alexander Solzhenitsyn
(Looking for Hope.)

Even C.S.Lewis questioned, like my patient’s grieving family, the role of God in death and suffering after the death of his wife:
“Not that I am (I think) in much danger of ceasing to believe in God. The real danger is of coming
to believe such dreadful things about Him. The conclusion I dread is not “So there’s no God afterall,”
but “So this is what God’s really like. Deceive yourself no longer.”

Death and suffering are two of the most-discussed philosophical and theological topics. And yet, even here where daily I am at the bedside of people who are suffering and dying for reasons sometimes known and frequently not known –even here, I am at risk of uttering opinions and “true-isms” about something I have not experienced directly. “Those who have known pain profoundly are the ones most wary of uttering clichés about suffering…” (John Howard Griffen). Instead of attempting to condense some hundred-thousands of philosophical/theogical theses into a few paragraphs in a too-long-already-email, instead I’m going to end with a page out of Yancey’s book that has recently taken on new depth of meaning.

From Philip Yancey’s “Where is God When it Hurts”:

…The fact that Jesus came to earth where he suffered and died does not remove pain from our lives. But it does show that God does not sit idly by and watch us suffer in isolation. He became one of us…Not once did he say “Endure your hunger! Swallow your grief!” When Jesus’ friend Lazarus died, he wept. Very often, every time he was directly asked, he healed the pain. Sometimes he broke deep-rooted customs to do so, as when he touched a woman with a hemorrhage of blood, or when he touched outcasts, ignoring their cried of “Unclean!”

The pattern of Jesus response should convince us that God is not a God who enjoys seeing us suffer. I doubt that Jesus’ disciples tormented themselves with questions like “Does God care?” They had visible evidence of his concern every day: they simply looked at Jesus’ face.

And when Jesus himself faced suffering, he reacted much like any of us would. He recoiled from it, asking three times if there was any other way. There was no other way, and then Jesus experienced, perhaps for the first time, that most human sense of abandonment: “My God, my God, why have you forsaken me?”…The record of Jesus’ life on earth should forever answer the question, “How does God feel about our pain?” In reply, God did not give words for theories on the problem of pain. He gave us himself. A philosophy may explain difficult things, but has no power to change them. The gospel, the story of Jesus’ life, promises change.

Love’s as hard as nails
Love is nails:
Blunt, thick, hammered through
the medial nerves of One
Who, having made us, knew
The thing He had done,
Seeing (with all that is)
Our cross and his.
(C.S.Lewis, “Love’s as Warm as Tears”)

There is one central symbol by which we remember Jesus. Today that image is coated in gold and worn around the necks of athletes and beautiful woman, an example of how we can gloss over the crude reality of history. The cross was, of course, a mode of execution. It would be no more bizarre if we made jewelry in the shape of tiny electric chairs, gas chambers, and hypodermic needles, the preferred modern modes of execution.

The cross, the most universal image in the Christian religion, offers proof that God cares about our suffering and pain. He died of it. That symbol stands unique among all the religions of the world. Many of them have gods, but only one has a God who cared enough to become a man and to die…
“If God is for us, who can be against us? He who did not spare his own Son,
but gave him up for us all—how will he not also, along with him,
graciously give us all things?” (Romans 8:31-32)

 

 

 

 

 

In some incomprehensible way, because of Jesus, God hears our cries differently. The author of Hebrews marvels that whatever we are going through, God has himself gone through. “For we do not have a high priest who is unable to sympathize with our weaknesses, but we have one who has been tempted in every way, just as we are—yet was without sin” (4:15)….T.S.Eliot wrote in one of his Four Quartets:
The wounded surgeon plies the steel
That questions the distempered part;
Beneath the bleeding hands we feel
The sharp compassion of the healer’s art
Resolving the enigma of the fever chart.
The surgery of life hurts. It helps me, though, to know that the surgeon himself, the Wounded Surgeon, has felt every stab of pain and every sorrow…

Posted by Mary at 1:41 PM 0 comments

08 August 2008

Meningitis…STAT!

Fever and stiff neck means meningitis until proven otherwise. There are many flavors of meningitis, and so far I have seen a wide selection here (my apologies to non-medical folks for the medical-eese-lingo):
-run-of-the-mill-bacterial-meningitis
-an elderly woman who didn’t improve until we added antibiotic coverage for Lysteria
-an HIV+ woman with left hemiparesis and a fixed pupil who turned out to have toxoplasmosis
-a young HIV+ woman with Cryptococcus in her CSF
-a woman with mental status changes and a positive malaria smear

One of the only ways to distinguish between these various mengitis “flavors” is to perform a lumbar puncture. This procedure consists of inserting a long needle into a patient’s lower back, penetrating the space where the CSF (cerebrospinal-fluid, the fluid that nourishes the brain) flows and withdraw a few mLs for laboratory analysis.

Although I have never seen a case of meningitis in the U.S., I do remember learning that anyone with fever and a stiff neck needs an LP immediately. The first few times I wrote “stat LP” on a chart here, the nurses laughed at me. I soon realized that, short of doing it myself, “stat” means it will be done within the next 24-48 hours and not a minute sooner. Although in the U.S. most doctors will do their own LPs, here they usually refer them to the nurse anesthetists who are less than excited to leave their busy OR obligations during the day. With the start of the new residency program, Dr. Palmer wants the residents to start doing all of their own LPs, and so last week I went on a mission to find someone to give me a refresher lesson. That’s how I met David.

David is one of the three nurse anesthetists working in the hospital. There are no anesthesiologists here, so David and his three colleagues are what makes it possible for the three operating rooms to be running most days of the week. They are very overworked, and often-times are up for more than 30 hours after being called in overnight for an emergent c-section or other procedure. David is the most senior nurse anesthetist, has been here for 17 years, and is as it turns out a very excellent and patient teacher. After watching him do one LP, I performed the next one and left feeling optimistically elated. A few days after the lesson, however, I attempted another LP by myself and failed dismally. Later that day, I passed David in the corridor and he said “they called me to redo a failed LP, what happened?” Before I knew it, we had set up another “lesson” for later that afternoon. I brought one of the new residents, Dr. Anna, along, and soon we had both successfully filled a syringe with the precious-spinal-fluid. While walking the sample over to the lab, he said “So what did you learn this time that you will do better for next time?” People here like awards and certificates, so I joked a few days later I was going to make him a certificate as the “official LP-instructor of the internal medicine residency program.” He laughed but looked pleased.

Posted by Mary at 1:07 PM 0 comments

Billy Bank’s Bootcamp – sustainability model?

Nine months ago one of the missionary wives began inviting women in the community to do “aerobics” home-videos with her. After two months, she went home to the states on furlough. The women still meet three times weekly for an hour, one of them in charge of bringing the video, and visitors (such as myself) are enthusiastically invited and made to feel welcome. Beautiful example of a “Felt Need” being met in a sustainable way! (Not to mention how my abs still feel a bit sore…)

Posted by Mary at 1:03 PM 0 comments

“Doctor Mary”

In addition to the ulcer and surgical wards, there are four medical wards at Mbingo Hospital - mens, womens, childrens, and maternity. During my first few weeks at Mbingo, I mostly followed the ward doctor (Dr.Sob) around female-ward on rounds and in OPD (outpatient department). Before the start of the new Internal Medicine Residency on August 1^st, however, there was a one-week period where the old doctors were gone and the new residents were yet to arrive. Even though I officially graduated medical school in May, I didn’t bother to buy the longer-white coat that doctors are allowed to wear and have instead been wearing my shorter-medical-student-version. All of the patients and nurses have called me “Dr. Mary” from the first day, however. What used to be a foreign-sounding title is now familiar and even fun, and I enjoy the challenge of increased responsibilty. “Dr. Mary, Dr. Mary!” is a sound that I frequently hear across the ward or from down a walkway from a patient with some question or complaint, and warrants a response of “I am coming” or “Ashiah.”

“You’re running female ward for the week” Dr. Palmer said, a few days before Dr. Sob and the others were to leave for their new postings. “I’ll be around if you have any questions.” As much as I’ve been wanting more of an active role, the thought of being soley in charge of the care and treatment for the 27-bed-ward was rather daunting. The first day took me six hours to round on all 20 patients. The nurses, used to rounding in one-two hours at the most, were growing rather impatient by the end. By the second and third days, however, I knew all of the patients, was finished in only a few hours, and had the ward down to 12 patients. (Many patients needed to be either sent home with palliative care or more proactively managed.)

One of the most difficult things about patient care here is obtaining a complete history. Often the doctor’s admission note is skimpy, and the daily follow-up notes two lines or less and illegible. Some patients are very good at explaining. Others, however, have a very tangential way of answering questions even to the nurses who can speak pidgin fluently. Here is an example of a typical dialogue:

Me or Nurse: “When did it start?”
Patient: “It di hurt PLENTY plenty!”
Me/Nurse: “How long it di hurt for?”
Patient: “Doctor, it di hurt SO much, for many days.”
Nurse (getting frustrated): “The doctor di ask for HOW LONG it di hurt. You need for answer the question, for how long it di hurt? One week? One month?”
Patient: “One week my belly di hurt, then it di stop, then I di cough and have fever, oh I di have plenty PLENTY fever.”

Eventually we’re usually able to get a rough estimate of the chronicity of their illness. From my time shadowing Dr Sob I picked up some useful pidgin phrases. Although the nurses chuckle sometimes when my pronunciation is off, they have cut down my history-taking time by quite a bit. For example:

“You di shit fine?” = Are you stooling normally?
“You di piss fine?” = Are you urinating normally?
“You di breath fine?” = Are you breathing normally?
“You di choppa fine?” = Are you eating normally?
“You di walka fine?” = Are you walking normally?

If any of the above questions get a “no, doctor, I NO di shit/piss/choppa fine” then I would follow up with a “How you no di shit/piss/choppa fine?” The first few days of saying “shit” and “piss” to all my patients I felt a bit uncomfortable, but after seeing how they didn’t batt-an-eyelash and even understood me better than if I were to say “stool” or “urinate,” I stopped worrying about it. The nurses laughed when I told them how, in the U.S., the big debate was whether to ask “did you stool” or “did you poop,” and how “shit” would be considered rather vulgar coming from a doctor in a hospital-setting.

Overall I am enjoying being directly responsible for patient care and am learning more than I could ever have imagined. I also wish could be hear longer to learn the language more fully.

Posted by Mary at 12:48 PM 0 comments

The Albino

I got auburn corn-row braids done a few weeks ago in the market. From a distance, Dr. Palmer confused me for an albino. Next time I’ll ask for a darker color.

(footnote: some people might suppose that sitting in one place for the three-hours it took to braid my hair was a waste of time. In my opinion, however, it was a great excuse to have a three-hour conversation with the two women involved in the “procedure.” At one point the braider (“Beck-ee”) said (in Pidgin English) “You di very strong, very strong! The other white woman, she di cry the whole time.” The other woman helping laughed and said “it’s because she di sociable.” Turns out she’s Catholic, and we ended up exchanging our favorite verses (mine Ps139, hers Ps24). Should I ever live in Africa long-term, I think I would strongely consider finding a hair-braider that I would go back to every few months – in addition to getting a better bartering-price, it seems like a great way to make a friend. There’s nothing that builds relationships and allows for conversations like having someone stuck to your head for three-plus hours!)