I wish you could have been there.
The clinic looked more like an abandoned house. Cement floors, no electricity, no running water. Nothing in the windows. The waiting area had a bench on one end where few people could sit down, and at the other end was the pharmacy which was basically a table with a scattered array of boxes, and tubes, and jugs of all kinds of different medicines.
I was nervous. I hadn’t been in a primary care setting, taking care of regular medical problems, in a really long time. What if I missed something important? There were other people as part of Safari Doctors. There were three other women doctors from other parts of Kenya, one male nurse, and their support staff of volunteers. I just felt self-conscious. I was basically this new person that they had just met the day before. This white girl in this clinic, extremely far from home, hoping to help people.
Each person as they arrived to be seen as part of this mobile clinic was given a little prescription, then went over to the nurse for their vital signs. They then came to see the doctor. My first patient was brought into me with this little piece of paper with her name, her vital signs, and her main complaint. Her name was Rakia.
I was sitting at this little table – my chair and a chair for Rakia. No exam tables. Rakia was an older lady from the village. Her complaint? Dizziness.
I’m thinking, “I went into OBGYN because most people do fine most of the time.” I had to contain my nervousness. I couldn’t do any blood testing. I couldn’t do any urine testing, but I did have a stethoscope, and I did have my hands. I was able to do a brief physical exam on her, listening to her heart and lungs, and try to come up with an idea of what could be causing her dizziness.
It reminded me of when I was in medical school. Back then, I was also in a circumstance with a language barrier where I was working in a clinic in Southern California, where most people didn’t speak English. Huge difference: they spoke Spanish, which I speak. So in that setting, I was actually able to speak with the parent (it was a pediatrics clinic), find out what was the matter with the child, and take care of it pretty quickly. In my evaluation, I actually got dinged and told that I wasn’t spending enough time with the patients. In any case, there I was in Kenya having flashbacks to medical school, and I had someone waiting for my help.
This time an older, more mature version of Doctor Liz knew what to do. I asked the interpreter to ask Rakia to hold on a moment. I went to the next room and did a consult with one of the other doctors. She looked at the vital signs with me and said, “You know, her blood pressure is a little on the low side. Maybe she’s on a medication that’s lowering her blood pressure. So, you should ask her about that.” I said, “Yes, excellent.” This doctor also informed me that a lot of times in the village, they take each others’ medication. Their access to meds is usually once a month, only when this traveling clinic comes to see them.
I went back in and I asked Rakia, and the answer was no, she wasn’t taking any medications. However, I repeated her blood pressure and it was even lower. I had the diagnosis.
I then went into a charades kind of discussion with my English speaking interpreter to ask her, because what I wanted to give her was a kind of rehydrating salts. (What I really wanted to give her was a Gatorade, but I didn’t see one of those the entire time I was in Africa.) I managed to explain to my interpreter what I wanted. She said, “Wait. We have something,” and she went outside. She rummaged in their pharmacy, and she came back with these little packets of oral rehydrating salts.
I said, “Yes!” That’s what I want her to have. So I explained to Rakia and said, “Even though these don’t taste good, I want you to have one every day for the next four days, and I want you to do what you can in terms of staying hydrated,” which is difficult for them. I also said to her that if she started to feel better, that that was an indication that this was the issue.
We were on this entire trip in Kenya to help people in remote areas have better access to safe drinking water, so I knew I was up against a challenge just giving her this instruction.
She understood what I meant, and I felt a little sense of hope and a little sense of accomplishment helping her. I learned a lot on this trip. I learned how much we can do with very little. I also learned from the patients that I saw in the clinic that around the world, no matter who you are or where you’re from, everybody likes to leave the doctor with a little something 🙂