To be a good GP you have to be curious and interested in people. You have to like them, whatever their foibles and failings. And you have to be able to laugh with them.
An old grandma came for her blood pressure and diabetic review. After sorting this out, I asked her, “Is there something else I can help you with?”
“Yes,” she said, “I want some help with my bowels.”
I should have known. Like older people in UK, gogos are obsessed with their bowels. If constipation persists for more than a couple of days, out comes the home enema kit. I thought she was aiming for “inner cleanliness”, like the Andrews Liversalts advertisement. But I was wrong.
“Whenever I eat beetroot, my stomach growls,” she said. “It’s been happening since I was a girl.”
“Does it happen every time you eat beetroot?” I asked. “Does it matter how much you eat?”
“Not every time I eat it, but if I eat a lot, my stomach growls louder,” she replied.
“What about beetroot prepared in different ways?” I asked. “Boiled and eaten hot, made into a salad, pickled?”
“No difference, my stomach growls however I take beetroot.”
“Has any treatment helped?”
See what happens when you ask direct questions? All you get back is answers. But whenever I employ open questions, my patients either look blankly at me or change the subject.
“OK, madam, you want me to fix a problem that you’ve had for sixty years. I might be a good dokotela, but I am not that good.”
“How do you know I have had it for sixty years?” she asked me.
“Because you said it started when you were a girl and now you are over 70.”
“Oooohooooh” – this is meant to convey a rising tone in the middle of the expression, conveying the meaning, “now I understand.”
“Right, I think you should consider giving up eating beetroot, even if it is just for a week or two,” I suggested.
“Nev-vah, doctor! I love it too much.”
A sixty-three year old gentleman came to the clinic and complained to me that he felt tired all the time. After a few questions fishing for physical illnesses, such as TB and HIV, I told him that he looked tired and sad. Sometimes this remark provokes tears in Swazis who are generally adept at concealing emotions behind a poker face. But this man just replied that it was true.
“Is there something that is bothering you, something making you unhappy?” I asked.
“Yes, my wife died three years ago,” he said.
“Snap,” I thought, but I didn’t share this information with him. “Do you think about her a lot?” I asked.
“Yes, I do, especially when I am in bed. Really I need a young wife to keep me warm and cosy under the bedclothes. That would solve my problems. But I don’t have enough cows for the bride price.”
As my sympathy drained away, I said that we can’t help you with the dowry and asked him to come back if the tiredness persisted.
A man in his late forties sat in the patient’s chair, dressed in ragged clothes, smelling of stale alcohol, in need of a bath and a dentist. “Belly ache,” he said.
“Tell me more,” I replied.
“What is there to say? It’s belly ache,” he said.
“What kind of pain is it, where is it, does anything make it worse or better, does the pain move anywhere, what is the effect of food, how long have you had it?”
“Oh, I don’t know. I am lacking power,” he replied.
This is a code for erectile dysfunction. I asked him to climb up on the couch and examined his abdomen. He had a soft, enlarged liver but no other stigmata of hepatic disease. The fluorescent light in my consulting room is so dim that sometimes it seems the room is darker with the light switched on. I looked at his rheumy eyes but there was no jaundice. I took him over to the window and looked again. Perhaps there was a tinge of yellow in his sclera.
I ordered some blood tests and this confirmed mildly raised liver enzyme levels, but no hepatitis markers. “How much alcohol do you drink?” I asked him.
“Enough,” he replied.
“What do you drink? Bugano season is over now.”
There was a long discussion with my translator who eventually said that he drank locally produced liquor. He could not afford any of the decent stuff, apparently.
“OK, you have to stop drinking alcohol. It is damaging your liver and preventing you from having sex with your wife, or is it your girlfriend?” I said.
“I have a wife and two secret lovers,” he said. “If I stop drinking alcohol, will I get my power back?”
Cheekily, I told him that if he quit drinking hooch for a month, he would be fit enough to take on a third secret lover. That brought a smile to his face, revealing a wide gap where his upper front teeth should have been. Perhaps that was a tad unprofessional, but the health education message certainly seemed to hit home.