Care in the Community

Care in the community knows no bounds as Karen (though not for a while, see later) trails off to far flung Kebelles, health posts and the like with her scanner personalised risk assessments.  She occasionally takes me too, but I have to confess to feeling rather spare as there is a queue of the pregnant who have walked miles to see her and a scan and few who would give me the time of day.  Their stories are appalling with a litany of stillbirths and near death experiences the details of which alter by the moment making it difficult to give any advice other than come to hospital and we will see what we can do.  Best avoided though are domicillaries, as organised or rather black mailed into.  Take the lady with twins of blogs passim whose husband spends his time taking up valuable clinic time telling of bleeding pain etc. post caesarean of now some weeks if not months ago and his wife’s inability to travel.  Granted she lives in a windowless hut some way up a hill and at our inaugural visit darkness and lack of facility did rather make assessment of any problem difficult but anyway there did not seem to be much of a problem however another visit was demanded and acquiesced to…..

So after an interminable clinic, a lunch of shiro and dhabo (Karen currently has shiro poisoning) we set off for a home visit, to collect the patient, take her to a health post which may or may not be open (it wasn’t) where there may or may not be an examination couch (reputably there was) putting the land cruiser (Hercule or Tintin it is after all Belgian) through all its paces we arrive, wait for her to make it down the hill with assorted relatives (making it down the hill and presumably again upwards answered the question about her general health) but then loading her, twins remarkably still alive and husband together with 2 nurses into the car we set off to the local village and a private health facility which allows us access to the examination couch.  Not much can happen at the village as we are soon surrounded by many hangers on who do not do the usual stand and stare but struggle to get a view through the window requiring much shouts of ‘Demi =go away’ to get some space.  Needless to say scar ok uterus involuted and just general fatigue so purchase some iron and diclofenic for her and wearisome journey back after some hours of wasted effort.  On the way back we acquire another passenger who having heard of the service walks to find us and get a lift back to the health centre and yes another scan.  Advice, as yet not taken was to come to hospital as she had yet to have a live baby, two previous still births one in a ‘private facility’ and one I think on the road!

Another lady then appears in an Isuzu truck, allegedly bleeding and requiring attention despite my rising irritation and desire to get home so I was I fear rather short and hurried and perhaps did not explain my vaginal examination as fully as I might, causing some familial complaint about my bedside manner, which along with my reserve of human kindness had long since gone.  The only thing I could find wrong was some haematuria and my prescription for ampicillin was rebuffed by the local pharmacist as contra indicated in pregnancy when amoxyl was not (why???) anyway by that time I was beyond caring.  Another pregnant lady, also turned up with scaly lesions all over her probably psoriasis but I tried to do some skin scapings to look for fungi but the microscope reqired sunlight and sadly (and unusually) the sun was in so all I did was draw blood and receive another dent in my reputation as the caring doctor.  I did not add that our various passengers were all vomiting copiously by now.  Finally off home with a lady leaking liquor over the seat from her fetal abnormality, firmly clutching an airline sick bag we had nicked on our travels but happily not needed and equally unhappily not returned so down to just a few bags now.  So with my fund of human kindness now at an all time low we return late to various orphan boys awaiting pizza supper and film for which we are late.  But missionary zeal being all we do our bit and give them much of the limited supply of cheese.  They then get the lion king and popcorn with American sugary butter before being escorted off the premises, leaving a sugary muddy foot imprint extravaganza behind them. I wonder if the ancient cave paintings were actually children’s parties especially when I see a perfect foot imprint on the floor.  I arrange for them to help me wash the car next day….read on and begin to think that my life as a medical missionary might be limited.  Next day I wonder if my life might be limited.