Day 281, It’s like being slapped in the face with a wet fish. Medicine here really isn’t about half measures. Whether its clinical signs or attitudes to treatment, it never cease to amaze. I’d like to be able to say that it was just the odd case but looking back through my time here I have been gobsmacked on so many occasions that my face is in a permanent state of stupor.
Quantity, that’s a big thing. This is perhaps particularly applicable to the sheer volume of pus and extraneous fluid that can be collecting inside a person’s body. There was a patient who presented with mild chest pain, from the x-ray we realised that there was a collection of fluid around his heart. When we eventually relieved him of it we had taken out 3 litres of fluid. That’s 3 coke bottles of fluid in a sack that’s not meant to expand significantly, against which his heart had to pump. In terms of quantity that was only outdone by the man with a bulge over his liver who drained five litres of pus. Presuming that it has the equal density of water (in actual fact it is probably much denser) that is a minimum of 5kg of infected material dwelling inside the man’s liver.
Extent, never ceases to amaze me. I have literally had patients waiting at home until there foot falls off before coming into hospital. The usual culprit is the HIV related Kaposi’s Sarcoma but we have ischaemic legs, much the same as would be seen in any hospital in the UK, with gangrenous feet requiring amputation. I have asked about why they will wait until the extent of the disease is so advanced, and the answers have been varied. Some say it is because it is hard to get to the hospital if you have painful legs and for others it is because they will try traditional medications first. My favourite is that they are afraid if they go to hospital they will have their leg cut off, of course waiting so long turns this into a self fulfilling prophecy.
Stoicism, by and large the people in rural areas are very stoical when it comes to health. From not flinching during lumbar punctures without anaesthetic, as is the practice is here to walking around doubled over with two sticks as support from their crippling arthritis, it is hard not find the locals very stoical. Sure, we get our share of screamers and shouters, usually younger individuals, but it is both admirable and frustrating to see people just put up with poor health because in the past there was no other choice.
Scepticism, there is definitely more than a healthy share of scepticism towards conventional medicine. I have had asthmatics who I can hear wheezing across the consultation room just because they are scared of inhaled medication. Even more frustrating can be the ease with which many believe that antiretrovirals make you sicker whilst they are quick to believe when the Minister of Health states that beetroots will cure HIV.
It is the wonderful quirk of working in an environment such as ours that every time I make the mistake of thinking I’ve seen it all, a patient pitches up to say or show me something that is completely unbelievable. That is the reality of medicine here.
Every day is a School Day.
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