I have taken over from two young female doctors, who were very popular and had a great time here.
The first consultation I had on my return to the Valley was for a “man’s problem”. It occurred on the night I arrived in the village when I was approached by a man on my way to dinner. His wife had been complaining for months that he wasn’t doing his duty. “Why didn’t you go to the clinic and see the doctor?” I asked. “I couldn’t go to a young girl about this! It’s good to have a man-doctor who knows what it is like and really understands my problem.” Hmm, I am not sure I liked the implication of this statement.
My handover was very brief, along the lines: “You’ve done this before, so I can’t tell you anything new.” I transferred the drug database onto my laptop and thawed out the drug fridge. I learned how to operate the security device and the locked differential on the doctor’s car. The differential was not the only thing I needed to lock. “Keep everything of value in a secure place as there has been a spate of burglaries recently.” Two of the neighbours have been burgled; one had his phone stolen from beside his bed.
There is a safe, about the size of a shoebox, and not much heavier. It could be easily carried away by a thief, as it is not bolted down or built into the fabric of my house. Six months ago, the doctor working in the valley had a phone and a laptop stolen one week, then another laptop soon afterwards. My laptop won’t fit into the safe. I’m not revealing where I am hiding it.
My home is in an internet black spot. We are trying to run cables from an area where the reception is stronger, but surprisingly, I feel I can manage without it. I have a dongle which I plug into the USB port on my laptop and I can access the internet – £10 for 2GB – but only where there is a good signal, such as at the clinic during lunchtime. I can’t use my iPad or smart phone without Wi-Fi.
Unlike fine wine, the clinic has not improved over time. The waiting area is packed with building material for the planned “mothers’ centre”, which will allow pregnant women to lodge close to the new maternity wing. The delivery suite was built with financial help from a Swedish aid organisation, but it is so small you could not swing a cat in there. There is another fancy microscope in the lab, but without the necessary reagents for it to work. The PIMA machine is breaking down repeatedly, and the haematocrit centrifuge is “buggered”. We are still washing out and re-using sputum and urine pots. There are no lancets, so we are having to use hypodermic needles to get blood from fingertips.
There are fewer drugs in the pharmacy. We have no painkillers stronger than paracetamol, only one drug for hypertension (nifedipine) and one for diabetes (glibenclamide) both of which have been exhausted. We ran out of dressings today. The only intravenous fluid we have left is 5% dextrose. I can prescribe medication privately of course, but there is no guarantee that the pharmacies in the nearest big town two hours away will have it.
I was pleased to see the towel that I donated to the clinic two years ago remains on a shelf in the consultation room. But there was no soap or alcohol gel until I replenished the stock. There were no gloves available last week, so I had to bring my own. Apparently the Ministry of Health is having an “efficiency drive” to cut down unnecessary use of gloves.
The consultation desks are piled with old versions of the British National Formulary, donated by previous doctors, but too valued to throw out when newer editions arrive. Beside them are training manuals and textbooks, and an old diagnostic set containing broken instruments. There is hardly enough room for the medical student’s laptop computer which is playing popular gospel music constantly in the background. Perhaps it relieves the boredom of consultations consisting of headache, cough, chest pain, back pain, total body pain and fever. Maybe it gives him divine diagnostic inspiration.
This isn’t really a shock to me. You may say that it is senseless to have a doctor working in a health centre without the tools/drugs necessary to utilise his/her skills. I try to be inventive with the few treatments we have. (Nothing for genital warts? How about trying a brief application of phenol from the lab?) I just get on and do the best I can. Occasionally, I might try to oil the wheels and get someone the treatment they really need, but which isn’t in stock. The lodges are often happy to get their workers fit and healthy even if it means shelling out a few dollars on an asthma inhaler or diabetic medication which we do not have in stock.
Skin problems – HIV related, burns/scalds and ulcers – all very common.