Suggested music: Chase and Status – No Problem
I should’ve learnt sooner.
Buthiduang is a medium-sized town south of Maungdaw. It feels incredibly remote, surrounded by mountains, dense untouched rainforests and a sleepy winding river. I like it a lot. The house for the medical field staff (me, the other doctor and two nurses) is as basic as they come. I’m still trying to work out if we have any electricity. The downstairs outdoor squat loo has me praying I don’t get diarrhoea.
The clinic is opposite, in what can be described as a reinforced bamboo house (strictly no photos allowed). When I arrive I notice immediately it was packed with patients. In the hospital I worked at in South Africa, the emergency waiting room was like a war zone, with a mixture of trauma and end stage HIV patients everywhere. This was not far off. I was beckoned by the clinic manager to the next room, where the entire clinic staff sat smiling silently.
After some time, I realised they were waiting for me to make a short speech. A wave of panic hit me. I won’t tell you what I actually said, but it was essentially a line from Michael Jackson’s Heal the World. I wish I was joking. What’s worse was that I had to hear it being translated in three different local languages. It got an applause though.
The clinic it seems was just as much PHC/Emergencies as it was HIV. I decided to sort out the emergencies, and let the other doctor see the HIV patients with appointments. My first patient of the morning was a 15 day old baby with newly acquired spasms and poor feeding. I almost missed the diagnosis of neonatal tetanus, and looking back it was fairly straight forward.
The mother had a home delivery, and had used a kitchen blade to cut the cord. Easy marks on the diploma of tropical medicine exam, but it was the first time I’d been faced with it in real life, so it took me some time. The father’s t-shirt had emblazoned across the front “You should’ve learnt sooner,” I thought that was quite apt for many reasons. The rest of the morning was spent dealing with incredibly sick patients: an obstructed labour, a severely immunocompromised pregnant lady who did not stop vomiting and had probably miscarried, dog bites, and acute watery diarrhoea galore.
It was pretty busy, especially with limited equipment and only a nurse and midwife to help. I stabilised most and referred what I could to the hospital near by. The afternoon wasn’t any easier. Its always difficult breaking bad news – in this case, explaining to a family that their father’s massive stroke has a very poor prognosis. Its even harder explaining it to a devastated family via a translator in a rat infested cave at the back of the clinic. Did I mention I f***ing hate rats?
To end an eventful first day, I was called by a nurse in a clinic an hour away requesting a doctor to assist in the transfer of a pregnant woman with severe vaginal bleeding that was on their way down – no further information. I would get a handover at the “kiss point” – the point where my 4×4 meets theirs. Armed with a basic emergency box, I got into the 4×4 and tried to remember if obstetrics experience was listed on the job description, as I have none. (It wasn’t). Anyway, this dramatic set-up was for nothing. Patient was fine. I had more vaginal bleeding than her. But I felt pretty cool.
My exhilaration was short lived however. On delivery of the patient to the hospital, I managed to see what resources were available. Suddenly it dawned on me that the whole day I’d been sending sick patients to a centre that barely had more resources than us. I don’t know what I was expecting, but I feel stupid in feeling so optimistic when making referrals. I had a look at my book just now- neonatal tetanus has an 80% mortality rate even in high care settings. Damn.