My journal expresses a good deal of frustration over not being able to really "do" much of anything in the dispensary. Part of that was the language deficit, part of it was the fact that there was indeed not much for more than three people to do (I made a fourth person). My productivity increased over time, however, and the experience was invaluable.
There were four chairs in the waiting area where some of patients would sit. The rest would sit outside on benches against the wall. There were no appointments; each patient carried a notebook of some sort, which was his medical record. Every time a patient went to the hospital or a clinic, the doctor he saw would write the diagnosis and whatever treatment was prescribed. The patient kept the book, making it easy for every subsequent doctor to see what had been done (the American medical system could really learn something from this).
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| The door on the left is the pharmacy. |
First, our patients would receive a paper from the pharmacy, which would be marked based on what they were coming for (general consultation, gynecologic consultation, ultrasound... each one had a different cost). Then they would see the nurse, Camellia, who would take down their general symptoms, maybe some vital signs.
Then they would see the doctor, Michele (he's not an MD, more like a nurse practicioner), who would talk to them, maybe do a brief exam related to the complaint or take their blood pressure, and write a prescription in the notebook. The patient would then go to the pharmacy to pick up the prescription.
As a side note, the reputation of the hospital in Mouila is, "You go there to die". More on that in another post, but it may be partly why we had so many patients. One man came on Easter Monday, when the dispensary was closed, saying his wife urgently needed an ultrasound. I explained that the dispensary was closed and suggested that they go to the hospital. He said the hospital didn't do ultrasounds. Case in point.
When I first started working in the dispensary, the "doctor" had me take one of the chairs from the waiting room and sit with him in his office while he did consultations. Pretty soon, that became the routine: I would finish French class, get my sethoscope case from my room, and go sit in the office until all the patients were gone or 12:45-ish (lunch was at 1:00 and I didn't want to be late).
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Dr. Michele's air conditioned office. We were spoiled, unless the power went out, in which case it was insufferably stuffy, not to mention dark. |
Another thing we quickly established was how I could help with the ultrasounds. Some days, nearly all our patients were there for OB/GYN visits. I believe I assisted with upwards of 200 ultrasounds in my time there. Anyway, there were several numbers (nothing I ever learned when studying OB, but then, plenty of stuff went on there that I had either never learned or learned differently) that had to be written down, femur length and head circumfrance and fetal weight and whatnot. The doctor would do the ultrasound and I would write down the numbers.
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| Our exam table. The ultrasound machine is on the left. |
The due dates the mothers were given were based on what the machine said (which I think based it on head circufrnace) which was absoluetly ridiculous. It is very easy to acurately estimate a due date using something called Naegel's Rule; I can only imagine how pathetically inaccurate the dates we gave those women were.
We also had an unbelievable number of twins show up on those ultrasounds, at least 12 times. The first time I saw it, I thought I had seen the monitor wrong. I thought I more or less knew what was what in the picture, but when I thought I saw the head twice, in two different places: "Well, I guess I don't know how this works." Then I heard the doctor say "jeumeux"-- twins!
While most visits were gynecologic, there were also a number of people who came in with malaria (I had never heard of the oft-prescribed Artefan before, and it was months before I learned it was an anti-malarial) which the Gabonese call parlui, something I only found out later. I tried looking it up in my dictionary, but that was a French dictionary, not a Gabonese dictionary!
One day, for whatever reason, I was asked to take a blood pressure. It was something very odd, but I got the same reading two or three times, so that was what I told the doctor. He didn't believe me, so he went to check it himself. I remembering thinking, "I'm doomed; he'll never trust me with anything again." He came back and gave me a thumbs-up-- he had gotten the same reading! My capabilites were somewhat raised in his eyes after that.
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| "Les Buissonnets" was the name of the home where St. Thérèse grew up in Lisieux. |
The thing with the blood pressures, though, was that I would say the numbers like I would have in the U.S., but in French. He didn't seem to understand me, so he had me write it down. I quickly found that he only told the patient the first two numbers of the systolic: 120/80 was "douze", twelve, which is insane, becuase "douze" could mean anything from 120 to 129, over anything! I thought perhaps it was a French thing, so I asked Canon Sigros. He explained how the French say the blood pressure, which is different from English, but also said that you say both numbers, "They're both important." So I guess it (like many other things) is a Gabonese thing.
There were some more serious-looking cases, such as the man whom I diagnosed (in my head) with larangeyal cancer, after observising his extremely thin frame, hoarse voice and hearing that he had had multiple tests with no diagnosis. There was also a woman I am convinced, to this day, had leprosy. She had a sort of ulceration on her thigh, and apparently had had one before that had gone away, a classic symptom of leprosy. Thinking back on it, I would have liked to be able to do more for them, and wonder what has happened.
There are more stories I could tell, but this post is already long enough. There will be more stories from the dispensary along the way before we're out of Gabon!
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