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.
Wednesday, June 11, 2008
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.
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.
Saturday, June 7, 2008
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.
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
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.
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.
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