Remember your first day of school? Mine I remember with pristine clarity. Tehran. Warm, sunny day. Hair combed back in pigtails. My mom and I walk through the gates of an all-girl school into the midst of an ocean of blue-uniformed girls, running, playing tag, chatting in groups. I remember my mom letting go of my hand and how I tried so hard to hold back the tears. I did. I held them back.
Here is what I have been doing the last few days…meetings, planning, drug orders, clinical protocols, meeting the national staff, discussing legal issues, medical issues, security issues, political issues, supply issues. And more and more issues related to the set up of our clinic. But that’s not what I want to write about. Not today.
I decided that while our clinic was being set up I’d volunteer my time in the emergency department in the Angau Hospital. First things first. When I say hospital, well, if you consider buildings that are collapsing under the attack of termites, or patients lying on cardboard on the floor, or a place that does not have anesthesiologists, obstetricians, radiologists, surgeons, then you are at the right place.
I was excited about my first day. Excited about diving in, doing some clinical work, about doing what I have come here to do. Also a bit worried…what if I am double-crossed by all these cases I have never seen before…the cases that have been eradicated from our memory in the western world, so much so that after medical school we tend to forget about them. I am talking about the –asis and –osis diseases…leishmaniasis, donovanosis, shigellosis, amoebiasis, borreliosis.
I walk in through the emergency door. The first 10 minutes I see a woman stabbed in the chest by her sister causing a collapsed lung (they fought over a cell phone), a severe pre-eclamptic woman (a condition in pregnant women that, unless treated, can lead to seizures and death), and an overdose in a woman beaten by her husband. That was the first 10 minutes. For the medical people reading this…3 cases of cerebral malaria, 2 cases of meningitis, 1 Ludwigs angina, a woman in shock slouched in a chair, a status asthmaticus sitting in a chair, a severe head injury where there is no neurosurgical backup, a splenic rupture in a man beaten by the police, resistant TB, typhoid fever, a sucking chest wound in a 5 year old. All those on top of the usual gamut of broken bones, lacerations, vaginal bleeding, pneumonias etc…without the usual comforts like an ophthalmoscope, otoscope, ECG machine, blood-work, a glucometer…gauze!
Add an emergency department that I do not know, that has no formal triage system, staff that don’t know me, a hospital system that I cannot figure out, nurses that have to clone themselves to get anything done, a language that I do not speak and….oy!!!!!! The doctor I joined to work with left to his daughter’s graduation and did not return for, let’s see, 5 hours. But who was counting.
That was my first day.
At the end of the day, I am not the child who cannot keep his eyes open because he is using all his energy to breath. I am not the woman whose leg was sliced open and dislocated by her husband in February 2007, who could not get to see a health professional due to the remote area she lives in, and who will walk with crutches for the rest of her life. I am not one of the medical officers that struggle to learn medical skills while staying afloat in the tsunami of under-resourced shifts.
At the end of the day, I get to leave back home to the comfort of my life. Today could be my first day and last day…I could leave tomorrow if I wanted to.
At the end of the day, all I can do is fight back the sheer sadness and insanity of it all and ask the universe for the resolve to do what I have come here to do.
All those back in the western hemiphere, miss you. Internet and time have been a scarcity…but I do get to read your comments…they make me smile.