Last week I started seeing patients at the Hepatitis C clinic. Before that I spent some time shadowing the other doctors, to see how they managed the flow in and out of their exam rooms and the considerable paperwork required to get all the patients the labs, medicines, counseling, and follow-up appointments they need during the 12-week treatment. You can’t get away from paperwork, no matter where you work!
Lab requisitions in Khmer and French--the bane of this English-speaker's existence. Photo: Theresa Chan / MSF
Before MSF introduced free direct-acting anti-viral (DAA) medicines to Hepatitis C patients in Phnom Penh, there wasn’t a lot of information about the demographics of Hepatitis C in Cambodia. The staff were expecting to treat a large number of younger patients co-infected with HIV, but what they have found is that most of the patients who have been diagnosed with chronic Hepatitis C through our program are in their 40s and 50s. In fact, we are seeing a fair number of much older people in their 70s.
The older demographic of our patients brings a familiar, primary-care quality to our visits. They bring their home medicines with them so I can see what they are taking for other chronic diseases, such as hypertension or diabetes. I look for medicines which may interact with DAAs, or medicines which may harm the liver.
Me (looking at a blister pack of anti-hypertensives): “How often do you take this medicine?”
Me: “How often is sometimes?”
Patient: “If my ankles hurt in the morning when I wake up, I take the medicine. If they don’t, then I wait.”
Me: “I don’t think think that will help your high blood pressure.”
Patient: “Does my high blood pressure make my ankles hurt?”
Seeing patients in this way is both familiar and new to me. Familiar because the exploration into the understandings and misunderstandings people hold about their health appears to be universal. New because those understandings and misunderstandings are heavily filtered through the specifics of Cambodian culture. Familiar because Cambodian patients, like their American counterparts, so often save their comments for the moment they are about to leave the exam room. New because, so often, their comment is a heartfelt thank you: “Without MSF, I would never be able to afford to be treated for Hepatitis C... I never thought you would offer treatment to someone like me... Thanks to you, I’ll live a healthy life again.”
New because, so often, I get to say something like this: “It makes me so happy that we are able to treat your Hepatitis C. It is a great honor to be one of the doctors working here.” Which usually leaves me smiling, even though I’ve still got paperwork to fill out.