Clinic stuff

On my walks with other expats in the research/healthcare field, or volunteering at Magu District Hospital, Kanyama Village Dispensary and Baylor Children’s Hospital, I have heard some stories and made some observations more relating to my clinical life. In no particular order:

Vaccination sites. Vaccination against HPV didn’t catch on at first with the teenage boys. It’s a virus transferred through intercourse, and the young boys didn’t show up because they’d heard it would given directly into the penis. No wonder they didn’t show. File this under: “Things I never thought needed further explaining”.

Research budgets. A research project had randomized villages to participate in a given survey. The researchers found that very few of the selected villages sent in data. Turns out, a ‘VIP’ from a non-chosen village had been calling everybody not to do it because his village wasn’t included and he was upset that he was bypassed; he wanted money to stop telling people not to participate and through that payment he still felt included and part of the project. The concept of randomization was lost on him. I now wonder how research budgets are proposed with that expense in mind? “Miscellaneous”?

Patient. Baby at 1,5 years old. So skinny I can see his veins, I can feel the different parts of his quadriceps and he has a sixpack – that’s how little body fat he has. He’s born with HIV – which happens less and less due to an excellent program of anti-HIV medication to prevent transfer in utero – but that wasn’t initiated here. Baby has HIV because mom has HIV. Mom got HIV from her ‘adventurous’ husband. Husband left her because it was her fault getting HIV. Husband quickly married somebody else, but then died in an accident – all of this happened during her pregnancy. Her baby is born not just with HIV but also with cerebral palsy. Because of the cerebral palsy, she is now cursed and an outcast and has no support from her family. She’s a widow at 24. Now that’s a tough ticket. I’m just going to check my privilige in a corner over here…
I’ve worked on the baby a few times now, and he’s sleeping much better, he’s able to extend his hips and his eye movements are much more accurate. His arms are less spastic, has no more convulsions (reportedly he’s less scary to the kids in the neighbourhood) and he is starting to grasp at objects with greater accuracy. The attending MD now wants to become a chiropractor and the kiddo might have a chance at maybe walking with crutches when he’s older?

Patient. 14 year old girl, HIV positive, pregnant. Expecting grandmother is furious as she has now wasted money on school and to what end? The only mitigating factor is that the previous president had banned girls from re-entering school if they got pregnant and the current (female) president reversed that decision. So this girl can now drop out of school, have her baby, and at least now she’s not prevented by law from going back to school. About 1 in 4 teenage girls in Tanzania is faced with an early pregnancy, and many will give up their education to care for a baby they might not be ready for, just because they lacked information and support.

Patient. 40 year old woman. She’d been in an pikipiki accident a month earlier; x-rays of the spine had been taken. The conclusion was that there was “Something wrong with the spinal cord” but she was sent home to do ‘exercises’, whatever that might entail. As one typically doesn’t observe soft tissue on x-ray to any great accuracy, I asked her to bring the photos next time and proceeded with care during the first session. Upon reviewing the x-ray, a classic compression fracture of the first lumbar vertebra was clearly visible. I’m pleased to report that miraculously, no fragments have moved around so far, so she’s still able to walk…

How my daily clinical life differs…
I ask patients if they have any questions from last time? Blank stares. I take that to mean that folks don’t generally participate in discussing their health care with the docs here. As my Kiswahili is not yet superb, I ask my colleague to ask “una endelea” – how are you doing? You would think that because I rely more on observing nonverbal cues, I’d be able to grasp some of the good news. However, I’m still in the dark, when they report that have much improvement and again can perform a variety of activities pain-free as their faces and bodies remain completely without sentiment, seemingly detached from their words. That goes for history taking and physical exam too – this is where I can appreciate my training in Odense and my 19 years of clinical experience…

Contrary to some of the patients in Amsterdam, they are all crazy for home exercises and do them with religious fervour, and then ask for more! Speaking of exercise: For the patients I attend to, there is no gym, no yoga, no swimming, no badminton, tennis, squash, no kayaking, rowing, stand-up paddling, no cycling, no running – just walking and whatever body weight exercises I can think of that are easy to do but still make a difference long term. We become imaginative!

In Amsterdam, I’d often get patients to get some blood work done, assess the status of various vitamins and things like cholesterol and triglyceride levels etc. Possibly diagnose some Hashimotos here and there, and through targeted supplementation and dietary advice get them back on track. That’s not going to happen here, no access and no money for that. Despite such a rich local production of all kinds of fruit and vegetables, my patients eat the same 3 different things day in, day out; I reckon a lot of the weird tingly sensations they come in with are long-standing vitamin deficiencies. I have never seen so many cases of peptic ulcers from late teenage years onwards, I’ve never seen so much gout and so many urinary tract infections!

But: Their hips are all amazing!! Even in men, even in very old people: They have sublime hip range of motion – likely because not much sitting at a desk goes on here, but it’s all ‘Bum in the air’- work in the fields and ‘wash your clothes by hand’-type of activities with lots of squatting. And apart from the Muslim ladies, they all get enough of the sunshine vitamin!

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