Car Park Care

My children's Amharic bible.A Tale of Three Guards
An hour’s one-on-one Amharic lesson as the first thing I do every Friday morning is enough for my already overloaded brain to cope with for practically the entire day. This week, before I attempted reading the story of Isaac and Rebekah from an Amharic children’s bible, my teacher and I spent much of the time discussing the bridge-building going on outside the Bingham wall just below our second-floor apartment. As a result, I now know the Amharic for “bridge”, but you wouldn’t believe the complex grammar needed to talk about it being built.

Bridge building in progressThe lesson takes place in Bingham Academy. I then walk across the school compound to find Haile, waiting patiently in the car park to drive me across the city to the HQ clinic. One of the problems of living and working in the same place is that I am an easy target for people needing medical advice.

This week I leave the classroom a little late, and with two bags in hand I head off to the car park. A Bingham guard who has obviously been on duty all night immediately accosts me and insists on carrying my bags for me. (Not an unusual situation – none of my clinic staff will allow me to carry anything either; nor will Haile.) However, after shouldering my bags he wants to show me his teeth. With a mix of my poor Amharic, his poor English and the way he’s dribbling I gather he has broken a tooth, has been in terrible pain all night and needs to see a dentist – a referral I have to authorise and for which he needs a letter. He pulls an unlabelled strip of pills out of his pocket that he has just bought in a pharmacy and asks me if he can take them. Guessing (by the colour) that they are ibuprofen I give a guarded recommendation about the maximum dose. I get his phone number and promise to call as soon as I get to clinic, so he can come and get a referral letter and be treated urgently that day. When he comes to HQ I will also be able to look in his mouth – something I try to avoid doing in car parks.

As we continue toward the waiting Haile, another guard trots up. I have seen him two days ago and he has a receipt for the medication I prescribed (and he still has the prescription – pharmacists often give them back to the patient). I have to endorse the receipt to authorise the reimbursement of the cost. What he either doesn’t know or isn’t bothered by is the fact that I also have to keep a record of the receipt amount so we can monitor the total each patient has spent on medical care in the course of the financial year (there’s a limit). I explain to him that I will bring the authorised receipt back in the afternoon (yes, I can say that in Amharic – the lessons work!) Looking slightly disconsolate (he wants his money) he agrees and goes back to work.

As I arrive at the taxi, so does another guard, clutching a wodge of paper. (Doctors aren’t supposed to have favourite patients, but if it was allowed, this guy would be top of my list. Every time I do something for him his gratitude is palpable, and he calls down numerous blessings from heaven onto my head.) He’s diabetic, and I have recently sent him for his annual eye check. He wants to ask me if Bingham will pay for a pair of glasses for him. He has the referral letter I wrote, an ophthalmic prescription, and a bill for the examination with a receipt for me to endorse. With Haile’s help (my Amharic has its limits) I work out that the optician said I should be monitoring his blood sugar. The optician is clearly ignorant of the fact that this guy is seen by me regularly and I am well on top of monitoring far more than just his blood sugar. I ascertain that the prescription shows he needs no corrective spectacles, just a pair of extremely expensive sunglasses that the optician would love to supply him with. Once I have explained that the organisation doesn’t fund expensive sunglasses and that I’ll bring his endorsed and authorised receipts back in the afternoon, he praises God, calls more blessings down on me and goes back to work smiling broadly.

With three consultations under my belt whilst walking across the car park, I head off to HQ with Haile, who wants to tell me about his own ongoing medical problem; something I probably shouldn’t discuss in a blog post. So that makes four…

The statue of Elijah on Mount Carmel, IsraelBible Study, Prescription Study
At our church this morning my fourth session on the life and times of the prophet Elijah draws to a close. The thirty or so people file out while I pack my laptop and projector away - the second morning service is about to begin in the main building. As I leave the room one of the attendees takes me by the arm. I’m used to being questioned after my studies, so I expect a theological question. “These eye drops aren’t available” he announces, pulling a prescription out of his inside jacket pocket. I can’t read the writing. “What’s the medicine for?” I ask, changing tack from the theology of Naboth’s vineyard to ophthalmology. “Dry eyes” he replies. Ah – ‘hypromellose’ may be one of the illegible words. “You should be able to get ‘Tears Naturale’” I enthuse, as this is something I have seen patients obtain from time to time. The bible study group leader overhears and chips in: “I need those” he inserts into the conversation, “but they’re not available either now.” I’m at a loss. The availability of medications is a constant challenge – they come and go without rhyme or reason, irrespective of the Ministry of Health’s “Essential Medications for Ethiopia” list. (A couple of years ago the entire country ran out of levothyroxine for several months – a drug for under-active thyroids needed continuously by at least 2% of the female population.) We discuss using home-made alternatives and I head off to the car park accompanied by a guy who always likes to discuss my bible studies and to correct me with his understanding of the glorious future of the nation of Israel which he feels is appropriate to pretty much every study I have ever done, whatever the subject.

We arrive at the car, and as he is telling me something about Elijah I can barely understand, I become aware another member of the group is chatting to Chris. As I finish my conversation Chris’s guy thrusts a printed list of medication into my hand. Calcium and vitamin D, glucosamine and chondroitin, and omega-3 fish oils. The list explains all the wonderful and dramatic things these chemicals will do for this guy’s terrible back problem (with which over the last few years I have become extremely familiar, despite not officially being his doctor). My explanation that if he has osteoporosis the calcium and vitamin D may help but all the rest are a placebo and a waste of money may have fallen on either deaf or misunderstanding ears. Clutching his cushion and a stick he thanks me and walks painfully towards the second service which is now in full swing. Chris and I head off to the supermarket and then the gym, and I’m secretly hoping I don’t bump into anyone I know for the rest of the day.

Tools of the trade...Too Close for Comfort
During their training all British GPs will become familiar with the work of Michael Balint and the idea of “the doctor as a drug”, with the risk the patient can become addicted to the doctor. Well, this becomes more of an issue if the doctor is extremely easily available, as I am to Bingham Ethiopian staff on Wednesday mornings. I am on the premises, and any staff member can come and sign up to see me. Over the last 10 years (five of which have been served by me) one patient has attended 114 times. During my time here, this well lady who has no long-term medical problems (I’ve made very sure of that!) has presented me with the following 61 different symptoms (the numbers in brackets are the number of times she’s presented the symptom at different consultations):

· Finger pain (3)

· Abdominal pain (18)

· Burning (3)

· Distension (7)

· Vomiting (5)

· Belching (2)

· Back pain (4)

· Headache (5)

· Double vision

· Irregular periods

· Period pain

· Eye pain (3)

· Swollen eyelids

· Eye discharge (3)

· Cough (4)

· Sweatiness (2)

· Sore throat (3)

· Shoulder pain (4)

· Stress incontinence

· Breathlessness (2)

· Tiredness (5)

· Poor appetite (4)

· Excess phlegm (2)

· Chest pain (5)

· Broken glasses

· Diarrhoea (3)

· Mucusy stools

· Bump on the head

· Dizziness (2)

· Nausea (2)

· Fever

· Toothache (2)

· Breast pain (6)

· Water going up her nose whilst drinking

· A lump on her bottom

· Pelvic pain

· Vagina discharge

· Itchiness (2)

· Gurgling in her tummy

· Flatus

· Poor vision

· Rash all over

· Itchy nipples

· Burning feet

· Swollen foot

· Weak hand

· Insomnia (2)

· Itchy ears

· Runny nose

· Itchy swollen face

· Knee pain

· Fainting

· Unsteadiness

· Joint pains (2)

· Constipation

· Peeing a lot

· Thirst

· Itchy eyes

· Rash on face

· Painful peeing

Comments

Oh my. This is an incredible example of how your clinics are not limited to the clinical setting! An impressive tally as you walk across a car park! It must be rather difficult to switch off or relax!

I am pretty sure I have had drinks stronger than water up my nose. Can you tell me Dr if I should call my GP when this happens?! Amazing how across 2 such different cultures there are similar people.xx

Oh man, shows the amazing need for medical professionals, but also the need for medical professionals to be protected.  Amazing the need that is presented around you from both cultures.  Good blog Dad, looking forward to having you guys home and resting with you.  I am planning very much on being consulted on belching (2) and peeing a lot over christmas!

I can multiply that by 100's Doc !!!!!

An enjoyable read - thank you!

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