Sunday, September 22, 2013

July 29, A Pommern Monday. Part 2.

(As written in my journal that day; grammar and minor edits only. Italicized portions are additions written after the trip.)

After cleaning, I move into the pharmacy with Patricia. The "pharmacy" consists of a rickety, mostly-empty shelf of cough syrup, OTC pain meds and antibiotics.

After seeing Dr. Elton, patients bring a scrap of notebook paper to the dispensary window - most today were for tooth pain or an abscess (some oral, some not); 18 aspirin and 30 cipro is the common scrip.

Patricia tells me we're to make "a Chinese envelope" out of old homework paper for each pill type - because there are no envelopes, plastic or paper, in which to give you your pills. She explains, "We say things are Chinese when they are badly made," and I lean in and tell her, "We say that in America too." She laughs and laughs, and she loves that my mother's name is Patricia too - she calls me her mtoto, her child, for this week, and tells the other nurses they can call her Mamaemmy. (I've shortened my introduced name to Emmy, with an exaggerated pronunciation like Ay-Me, as Emily is just too hard to wrap around for Swahili mouths.) The other nurses laugh at her.

Finally we move into the lab, as tests have started being ordered. It seems like people are tested for one or more of: malaria, typhoid fever, HIV/AIDS, a baseline urinalysis, a stool sample. No other possible diagnoses are discussed. We don't see any malaria; we see one typhoid fever. The tests are all prepackaged single-use, but the procedure is, simply observed and without frustration or surprise to me, just totally horrifying.

Sometimes alcohol swabs are used to clean the inner elbow site where blood is drawn - sometimes not. A new prepackaged syringe and needle is used to draw blood each time but there's no hand washing in between (there's no sink with running water in the lab, only the common one just outside the door in the public waiting room), and the drawing of blood is probably done with a skill level that I'd have after a few weeks of training. 2, 3, maybe 5 stabs with the needle into each patients arm. A little digging around to find the vein. The blood comes out slowly, thickly.

A glove serves as the tourniquet first, and then as the sterile surface to place the test and blood-filled syringe on (see the background of the above photo). Sometimes multiple blood draws are taken, put on their glove, and only then is each test run. No tests got switched around - I think - but you can imagine the potential for a blood vial to get moved, and then recorded in the little blue-book-like health record of the wrong patient. Oh, those blue books. Talk about taking charge of your health care!

It's a little terrifying to be allowed to help with this, though all I'm doing is dropping blood into a small plastic hole and adding the right solution to start the test...

Meggie wears gloves. She is smarter than me. 

This is a close-up of a malaria test, sitting on top of the blue-book health record. If that was your health record, you'd keep it with you for each doctor visit. The "back up" record kept at the clinic is a giant bound book with lists of patient names, estimated ages, date of the test and results. So unless you know what day you came for a test, there's no way the clinic records are going to be helpful. Lesson? Don't lose your blue book! 

Drop-drop-drop the solution on top of the blood sample.

Multiple tests to get going; we wait two minutes by Patricia's watch for results. Who has malaria? Who has typhoid fever? I keep thinking, what if you have cancer? What if you're depressed? What if it's Chrone's Disease or fibromyalgia? What if you've developed an allergy or esophageal damaging reflux or a urinary tract infection? 

Basically if it doesn't show up on these few tests and it's not enough describable pain for a knock-ya-out course of Ciproflaxin, then it's probably not a disease recognized in Africa. Or not in Pommern, at any rate.

The four tests we take sit out, on the gloves, on a table also strewn with empty packaging, dried alcohol swabs, partial bottles of the processing solution. The disorganization, the mess - these are not too shocking. The trash can, however, is. I don't think they've heard of sharps containers.

It all goes into the same place - blood, needles, you name it.

Then a young man, who says he is 27 and has only a primary school education recorded in his blue book, has a malaria test come back negative. He's been feeling unwell for a little over a year and was referred here by another clinic in the nearby village for this set of tests. The AIDS set of tests. With fascination and horror, Meggie and I watch Patricia get a first-test positive. SOmetimes these aer wrong though, so she puts the rest of his blood in to the second one. Count down two minutes, and watch the lines appear. Positive.

Normally the doctor delivers this news but if he is really busy, Patricia does. Which, HIPAA concepts be damned, she does with Meggie and me in the room. 

I have the same reaction as when the students were being beaten - I try to become physically small, I look at the floor and refuse to make eye contact or be seen as a voyeur; I won't watch. I breathe quietly. I think, I want him to forget I'm here. Patricia speaks calmly in Swahili. She sounds straightforward and unemotional; she doesn't touch him or appear to give words of comfort. Just the facts, ma'am. She asks often, "Sawa? Sawa?" which is, "OK? OK?". He nearly whispers in response. Sawa." She gives him a CTC information notice; that's the once-a-week AIDS clinic on Thursdays here. I think, there's no way this guy is showing up again later in the week. 

Blood draws. Single use test kits. Recording the results in patient blue books, and again in the clinic ledger. Using our own pens - no one at the clinic can ever seem to find one. Rinse and repeat. How long would this relatively simple work take Patricia if we weren't here helping? At her pace, it seems like we're cutting the time by half, helping the patients move twice as fast through the line. And it finally feels like I am being useful. I'm supporting existing work and not supplanting existing knowledge. Just a pair o' hands here. And this is exactly what I wanted to do in Africa: pitch in, not harm, experience life as it is before I was here and will be after I go, among the poorest on the planet, as one of the richest.

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