patient encounter 5:" God bless you"

I pulled a chair close to his bed and just sat there. Both of us, engulfed in silence. He was the first to speak," What can I do for you?" He asked. I was wondering about the same question. I was passing by this patient's room in the ICU, when one of the Nurses called me to tell me that, Mr. K as I will call him, was being rude to the Nurses and very abuse. Showing signs of combativeness and clearly, just trouble making. He was a 29 year old man who had been rescued from Suicide by Overdose on some prescription medications and He was annoyed and angry at everyone who participated in the decision to revive him because he believed that he should have been left to die as he had earlier planned. I listened to him. He vented his problems, anger and frustrations. He asked me If I was going to say anything or I was just going to keep quiet. That's when I seized the opprotunity and I told him that I thought he was a good man making very wrong choices. I asked him about his children, if he had any.( I did not know this patient before). He had Two. 4 year old and a 6 year old. " You do not want your children to go through life thinking that they are the ones that drove you to commit suicide. They will definately miss you and You may not realise but you are the only hero they may know in their young lives.You are selfish for not wanting to share the love of a father with your lovely children. Life throws at each one of us some challanges but running away from them is escapism and you drag your loved ones with you. Your life may be more valuable than you actually think it is." He started crying. He said NO ONE in his entire life had ever told him things from the perspective that I was informing him. He said he would behave himself and will not try to Kill himself again.That remains to be seen but what was immediately evident is that he stopped harrassment of the Nurses on the floor and threatening that he was going to commit suicide. We still involved the Psychiatrists who came and cleared him to go home as they did not find him at risk for suicide. I stood up to leave the room and he called me by name and said," God Bless you".

Patient encounter 4: "Grandfather"

She was a shy little girl. Standing at the door way to the Clinic, she had to be encouraged to get in. Eyes fixed on the ground, she only spoke when spoken to. Even then, just a whisper.
Twas my last day of gynecology clinic and I was very excited to finish my Internship rotation in Gyn. I liked my interactions with the patients, its the speculum exams that I was not so fond of. I would pray silently that the next patient on the list did not have any complaint that warranted a Speculum exam. I was often unfortunate in that regard. Most women presenting to this clinic, just like in most poor rural clinics i had been to, were solely here because they had been witnessing something "weird" from their "private parts". Preventative care is still not a norm around here rather an exception.
She said she was 13. She had been in eighth grade when she was hurriedly married off to offset her father's dowry debt accrued when her older brother married two years earlier.
She had been having abdominal pains for 3 days. She had gained weight . Hours earlier she had seen some watery discharge from her "private parts."
One look at her and it was Obvious, she was in Labor!
I quickly took her to the Labor room and she was 8cm dilated on VE. She was now very exhausted. She had labored for 3 days. On intrapartum monitor, The fetus was in distress in addition to being a transverse lie! In 5 minutes I was doing the C-section and a beautiful 3 pounds 6 ounce baby boy was delivered. Had some meconium staining at first and on a few suctions later,He delivered the best sound in the OR. Cry.Cry.Cry.His mother was excited and for the first time I saw her smile. Since she was under epidural anesthesia and I handed her her baby, before we rushed him to the Nursery, as I finished closing her skin with sub cuticle sutures.
She was wheeled to the Post-delivery Unit and she made a quick recovery. The baby did well too. It was One week later that I met some of her relatives.
I was rounding on other patients in the Obstetric ward when I was called by the Nursing staff and asked if it was ok for the baby's grandfather to see him. I went out to meet him.
He was an old 6'3'' tall man, with golden hair and a stooped gait, a cane in hand for support, wearing a Maasai garb with a younger ochre-covered warrior in tow.
I quickly assumed that the younger man who may have been in his early 20's was the father to the baby and I ushered him in the nursery and took him to his baby's cot. He was satisfied with the care and I assured him that we may discharge his son in a day or two. That's when he turned and told me that the old 70-something year-old man at the waiting bay was the baby's father and not him. I was speechless! The 13 year old girl was the old man's 7th wife!
I went and met him again. Now recognizing that he was the proud father of a the 37th addition to his nuclear family. He was as proud as a first-time dad! The age gap notwithstanding!

Patient encounter 3: I want to be a patient!

I was working at one of the HIV/AIDS clinics that Indiana University has helped establish in Kenya and there was one patient left, before we closed the clinic.

The day had been long and we had seen close to 100 patients in this 2-roomed clinic.

The last patient came into the room. I will call him: J.

J. was 28 years old, 5' 10'' tall, slender and had completed 12 years of schooling. He quickly sat down and as usual i offered a handshake. J had a good grip, notably shaky and with sweaty palms.

I started my usual questions. I asked him to give me a piece of paper that showed his HIV status.

He had none.

He had an explanation.

" I know am HIV positive but I have tested three times now and my results are always negative. I have travelled for 2 days to get to this clinic and there is no way that you are going to turn me away now. I want to be part of this program-AMPATH (Academic Model for the Prevention and Treatment of HIV/AIDS)."

I quickly went and got the rapid HIV kit. I told him that I was going to test him for HIV again and explained the whole concept to him. I also informed him that if negative he would have to come back in three months for a re-test. He agreed albeit grudgingly.

My pre-test probability was very low. He denied any high risk sexual encounters. He had not been sick before. No recent weight loss. No history of alchohol use or illicit drugs use. Monogamous.Had 3 children.

The test result was Negative. Again. I was happy for him.

He went ballistic! He could not believe it!

This was an unusual reaction. I had never encountered anyone who would be livid on discovering that they were HIV negative.

J. tried to "sweet-talk" me into enrolling him in the program but I informed him that we only enrolled HIV positive patients. Unfortunately, he promised me that he would be back!

I later found out that he wanted to be part of a family that cares. He had heard a lot of positive things about AMPATH and wanted to be a member. Part of it was because of poverty. He wanted to get the services provided by AMPATH.

With this organisation; Patients are seen by doctors, are cared for and seen in reasonable time, are given free HIV treatment and treatment of opportunistic infections. Patients are taught survival skills, are supplied with food the first few months after diagnosis and offered training on business and farming initiatives etc. He wanted to be part of all these...

On the other hand... If HIV neg. There is nothing for free and one pays for what one gets. With most of the population below the poverty line, Its no wonder someone would rather be HIV positive.

This experience was an eye opener for me.

I want to dedicate my life to the care of these poor people and work with them in establishing systems that can absorb the non-HIV positive poor patients.

It is my hope and prayer that J. does not show up to the AMPATH clinic at all, because am very sure he will be positive this time round!

Chite.

Patient encounter 2: Lets Pray.

I was on call and cross-covering a patient on another team. I had received a change over that the patient was likely to die that night. I will call him Mr. X

Mr. X had been diagnosed 5 years earlier, with Idiopathic Pulmonary Fibrosis. He had been given less than 2 years to live as his disease was so extensive.

His family had all along known what was coming and It was no wonder that he was a DNR.

I was called to his bedside by the Nurse as Mr. X had gotten more short of breath and was now on supplimental oxygen by face mask. I briefly introduced myself and talked to him. I do not think he understood. I knew he was about to die. I then called his wife and informed her to come to her husband's bedside as this was it.

20minutes later she was there with her daughter. The time was 01.00am. He finally breathed his last at 05.12am.

His wife was devastated. His daughter uncontrollable emotionally.

I led them to a conference room nearby.

I was overwhelmed with their emotions. I had thought that it was going to be relatively easy to talk to them because they had spent quite sometime with him from the time of diagnosis and they knew what would happen.

Its never easy even when death is expected.

I asked them if they were believers.

Yes they were.

I asked for permission to pray with them.

Gladly they accepted.

We held hands and I offered a short prayer. It may have been just a minute or two but it was effective.

They quickly calmed down and started reliving some wonderful moments they had with him. They even talked about some of his favourite jokes. He was truly a great man as gathered from their recollection. He was a war veteran too!

I listened. Sometimes added a comment. I did not know the man before this night. I was simply caring for him as one of my colleague's patient but I was left richer by my interraction with this family.

I excused myself to attend to other patient duties.

It was not until 2 months later that I received a card in the mail from the two women: mother and daughter. They hed appreciated all the efforts we had done in taking care of their loved one. The phrase that touched me immensely is when they said:

"He (their loved one), could not have died at a better time and under your care (me). You eased the transition for us and we will be forever grateful, for it is doctors like you that make us have immense confidence in the health care system.You care. God bless you"

There were tears welling in my eyes and I relived the whole experience again.

There is never a good time to die but when you do, the little things that us health care professionals do become memorable by the deceased relatives' years to come and may impact them forever.

Chite.

Patient encounter 1: The Mirror Image

I was on call and had just admitted an unfortunate young man:

30 years old with Chronic kidney failure, Hypertension, Diabetes Mellitus type 1, h/o Stroke with neurological deficits and left eye blindness. He also gave a history of having a "small" heart attack in the past. Had been admitted countless number of times for diabetes. He had been diagnosed being diabetic at the age of 7 and been on isulin since then but had been very non-compliant to meds and follow-up appointments. His primary care had been Emergency rooms and he spent more time in the hospitals than he was in school, hence did not graduate from high school.

2hrs later, I admitted a 17 year old boy in a diabetic crisis (DKA), he also had issues of non-compliance and had not been taking his medication. He did not even want to have a primary care doctor to follow him up. He thought since he was young, he could get by most days without his insulin. It did not help matters that he was already emancipated.

The following morning I was struck by an idea that I discussed with the Medical social worker on my service. After confirming that I was in the clear I went for it.

I went to the 17 y/o whom I will call Eric. I did the usual counselling about complaince to medication and bla bla bla... about complications of Uncontrolled diabetes. One could tell that he had heard this several times over and over and he was not paying much attention anymore.
I still went on and on.

Then I went to the 30 y/o whom I will call James. He had learnt his lessons by now and was very compliant to meds and all. He was admitted this time around for Hemodialysis. I asked him If he could be willing to tell his story to someone who unfortunately was already going his path but luckily was still intact-organ systems-wise. I did not have to ask twice or even convince him
at all. He was more than willing to talk to anybody that was willing to listen and who would hopefully be changed by his experiences.

I now had to convince Eric to listen to One last person before he was discharged. I found his father in his ward room and It helped. Once I explained to them what I wanted to happen, He agreed. We organised for the two to meet. It also helped that they had similar backgrounds.

I did not have to wait for long.

His father came and told me that Eric wanted to speak to me.

Eric wanted me to arrange his folow-up care. Get him an outpatient doctor close to his home. He would have wished to come to my clinic but its downtown and he could not keep appointments.
He wanted to take control of his life now. He wanted to know all the resources at his disposal.
He sounded more like a man that had been newly diagnosed!

I was ecstatic!

It worked.

I checked the records one month later and he had been to his doctor. That was a good start. I can only hope that he is doing well.

My mum always sys "seeing is believing"

Chite.

culture shock 3: Fat is not good?

I had a reality check when i started working at one of the hospitals here in US and I met my first obese patient. He was 465 pounds. I had never seen anyone like that except in the movies.

In Africa, Obese people are most likely rich and therefore are on a " rich-man diet" of beers and roast meat (goat). I, being 165 pounds, was already considered " kinda fat." I quickly learnt that the tables are reverved over here with the junk food being cheaper than healthy food therefore a disproportionate number of obese people not being necessarily rich. This guy for instance was not rich and survived on cheap food.

My mom has always told me that if i took home a girl that was dieting or as thin as a broom stick, she would get me a wife from the village who has some "meat-on-the-bones" We prefer bigger, full figured women than thin women. Besides, with HIV all around us, some people equate thin women to Infected people( which is NOT true!)

On the other hand, here in the US, there is glorification of paper-thin women as Hollywood dictates.

Obviously one has to be healthy-low cholesterol, LDL etc but I think with our low life expectancies in Africa, the effects of cardiovascular events from poor lifestyles may not be fully grasped like it is in the US. Some countries have as low life expectancies as in 40's.

Since then, I have seen so many morbidly obese people that when I went back to my home country recently, it seemed like everyone I met was undernourished!

Most of my friends felt that I was now " more than kinda fat".

I have learnt to be conscoius about my weight now and I even have a weighing machine in my washroom! How American!

Is Fat good or bad?

Make an informed decision...


Chite.

culture shock 2: riding the bus?

I always love public means of transport for several reasons:

1. Growing up, that was the only choice my family had

2. One can strike conversations easily on your way to work or wherever, and you get to socialise

3.Anything shared is less painful

4.Its cheap

5.....and on and on..

So It was surprising to me when I boarded a bus here in Indy and when the driver knew what I do for a living she asked me why I was using public means instead of having my own car?

The people in the bus, I quickly made a mental note, were mostly indegents with less options of transportation means besides walking.

I tried conversing with an older lady sitted next to me but it did not go so well. She responded in monologues and monotone and when I asked her where the bus stop was on the street we were on she simply said, "I don't come from here!"

My appetite for morning commute by bus were obviously dampened, My extrovert spirit bruised and my memories etched forever.

Do I still love public means of transport? Make a guess...

Chite.

Culture shock 1

I had just arrived in US from Africa and went with my white host to do some shopping at a local chain store.
People were standing a long queues to pay the cashiers jsut like in Africa but what was surpring was the distance/ space left between any two people in a queue.
I came to learn that that was "personal space."
Where I came from, we pretty much breathed onto each others necks in shopping malls.
I came across some interesting definitions of personal space from Webster's:


Main Entry:
personal space2
Part of Speech:
n
Definition:
the space reached by the human body's extremities while stationary, also called kinesphere


Main Entry:
personal space1
Part of Speech:
n
Definition:
the sense of invisible boundaries around an individual body and separating one from others, the encroachment of which may cause anxiety, cf. intimate space

I am now very aware of peronal spaces to the extent that when I visited my country recently a lot of my friends thought am a little bit "stand-offish"

Lesson 1.

Chite

Africa needs honesty

I do not think that a lot of us have been honest enough with the problems bedevilling Africa.
My mother continent has not only been ignored but at times I find that some "experts" seem to prescribe one thing in the news or public fora and do something else in private.

There has been a lot of buzz lately about Africa, be it if adopting Malawian kids or simply visiting HIV orphanages.Its all good but sometimes unfortunately it leaves me with a bitter taste in my mouth because some of these "shows" are for self aggrindisement.

Highlighting the plight of Africans has been well documented the question now is what do we do about it?
Celebrity visits to spas in some metropolitan city in Africa does not in any way equal bonding with the community.
What do we do about poverty eradication/minimisation? How do we close the gap between the rich and the poor?Not by myriad conferences...that I know, not by doubletalk and endless campaingns...that has not worked and will not work.
Lats go to the basics...What is the problem?
Poverty.
Why? Lack of resources...
Wrong.
Try again...
Poor management of the available resources.
Maybe. Whose fault?
The countries' politicians.
Wrong again.
The countries' politicians fuelled, oiled and services by the international community.
Yes. Very quick learner there!

These so called economic advisers are interested in protecting their interests aka keeping their jobs therfore the more they come up with long winded reports that have little to do with the suffering poor, the more they need more conferences to unravel the mystery and the more unlikely that they are about to retire any time soon.

Is HIV/AIDS a problem?
certainly. When the world's 75% of HIV population are in part of a continent then thats a problem. Right!

What have we doen about it?
Talk.
Talk.
More talk.

We have attended "fruitful conferences", workshops, seminars, focus groups, leadership drives, rallies, events, fund-raisers, concerts etc...
Results... less than 15% with acess to the much needed HAART.
Results...High death rates and under five deaths...
Results... we are still compiling the reports.

I do not in any way blame the International communities alone.

How many rich people in Africa with billions of dollars overseas?
Many.
How many contributing to worthy causes?
er..ehrr.. do not know.
Precisely the point.. may be none.
private-public partnerships with our very own institutions of higher learning by the locals almost non-existent.

Gentlemen and women, we need honesty. Please stop lying to yourselves here. We may be poor in finances but not in our brains. We see right through pretence, unfortunately we are on the receiving end from you, our politicians, experts, celebrities and ...what's your name and title
again?

Be serious.

Chite.