I have to say that the past 3 days have been some of the roughest days since I got here, and also the first days that have really made me realize that I am NOT in America or just 'playing doctor', I am in rural Africa surrounded by some of the toughest situations I have ever seen. I'll explain. . .
I've been spending most of my time in the clinic with the physician, George. We have a pretty good system going, because I do all of the recording and charting while he translates, and he does a lot of explaining and teaching along the way. Monday afternoon, after finishing the child immunization clinic, I went in for one final consultation in his office. We ended the day doing HIV testing for a married couple and their 7 year old daughter. Actually it was the father's child from a previous marriage, and the child's birth mother had died. We received the results, and both parents were negative, but the child was positive. This isn't the first time we've had positive HIV tests, but often patients are already aware of their diagnosis (and just suffering from denial), and this is the first time I've ever had to witness such a young child being diagnosed. I thought this was pretty emotionally tasking, and then Tuesday came. . .
Tuesday morning we got into a long discussion with George about our clinic and the provision of condoms as a measure of HIV prevention. Turns out, because the clinic is a catholic institution, they do not give out condoms to anyone. So, even if we test someone and find out they are positive, we can't give them the one measure to prevent the spread of the virus. We are going to try and do some research over other Catholic instituions in Africa and if they provide condoms, and see if we can make any steps in changing this policy. So, if anyone has any information (since internet here is so slow. . .) Feel free to email it to me. Right after lunch we had another married couple come in with their infant son, because the father was complaining that he'd been having numerous fainting spells/fits over the past 24 hours. Because we have no way to take a CT scan at our clinic, we gave him a referral to go to a hospital, and went to get him some drugs to temporarily control seizures, as we assumed it was epilepsy. While He was sitting outside our office waiting for the medications, he had another seizure, fell on the floor and hit his head which began bleeding pretty profusely. He was unconscious for about 10 minutes before we took him into our other 'room' so that we could suture his head and arrange transportation for him to get to a hospital immediately. After his head was stitched, he immediately went into another seizure. All the while his wife and infant son were standing by, worried sick and his son was crying hysterically. I have never been in such a situation and had no idea how to handle it, and to add fuel to the fire there were still dozens of patients to be seen.
After he finally got off to the hospital, we began seeing other patients. Our last patient of the day was a woman who was about 34 weeks pregnant who arrived with her 15 month old son. She let us know that she has five kids and the one on the way is number 6. I went to examine her son only to find the most malnourished child I have ever seen in my life. It was one of those experiences that I may have previously seen on TV or in photos, but seeing it in real life was gut wrenching. She had no money, no job, and no way to feed her kids. George wanted to refer to her to therapeutic feeding program, but then we found out that there IS no feeding program ANYWHERE in our area (which is just awful in and of itself), and she would have no way to get to another location. The food that is used for malnourishment is this protein rich porridge that is very very cheap. They had some at the clinic previously, but it was all gone, so we essentially had nothing to offer this woman or her child. At this point, I simply couldn't bear what I was seeing, so we offered to help. George took Lisa and I after work and we bought 6 months worth the food (although the feeding regimen only takes about 2 weeks, so this should go to use for other kids as well), for a total of 5 US Dollars. Really. That's what it costs. And they truly can't afford it. I also gathered information from someone who had run a feeding program previously, and to begin an ENTIRE feeding program and run it for a whole year would cost under $3000 US. Yet they do not have one anywhere in our area. I still can't believe it. So anyways, we have the food at the clinic and are having the woman come in every day with the child so that we can feed him (because if we just give them the food, it will get split and then the malnourished child won't get what they need.) This way we can monitor the child every day to see how he is improving. I know it's only a drop in the bucket, but I am desperately hoping that we can save this child, at least for now. I still dread to think of what the future holds for the mother and the whole family. Anyways, I apologize for the morose post today. I feel like I myself needed a bit of a reality jolt, and I wanted to share the reality of some of our surroundings here with everyone else. Hope it's not a total downer, and I hope to update everyone with positive news very soon.
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