Wanderings of the lost boy -2

My name is De-Graft. You can choose to call me Digi/DeGi/De-Ge/DeG…etc, whichever works for you. I am a medical student in my 5th year of study. As part of our requirements for the medical school programme, in 5th year we are posted to various districts to experience medicine outside the boundaries of the teaching hospital. We also collect data for our final year project work and thesis. I hope to take you along with me on my exciting trip with these memoires. Enjoy!

Episode 2 – Papa Doctor

1

I squint as I take a peep at my phone with one eye partially open, the other totally closed. This should be the third snooze or so of the alarm I set to wake me up at 5am. And on this occasion too, I’ve been sure to shut it up. I’ve had barely three hours of sleep and I’m not going to be made to abandon my sleep without a fight! I stretch myself out again and almost immediately, I’m gone.
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The loud sound of my phone calling wakes me up – this time for real. I remember reading the expression “bobbed up bellywise” and maybe this is the golden opportunity I have to make use of it! I check the name, and it is Uncle Kyei (My uncle, the one I’ve come to stay with – in Abetifi). In a split, I check the time at the top of the screen and it’s 6:30am (Already!). I look out the window and there’s no longer darkness – I mean everything is almost lighted up outside. I smear my palm on my face once and I pick up the call, sure to make sure I don’t sound like I was asleep. I’m sure you can guess how that part of the story went.
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About an hour later, I am in a taxi going toward Pepease – to the District Health Directorate to present my letter to the District Health Director. I am blown away – literally by the wind blowing through the windows of the taxi on my face, with my gaze fixed outside toward the surroundings… and figuratively by the exquisite landscape with magnificent rocks and trees, valleys and plains characterizing a mountain range! This whole area is known as Kwahu – A mountain range in the Eastern Region of Ghana. There is a whole world up here on the mountains with many communities with a respectable degree of development and civilization. The towns here aren’t your typical urban cities, but are not villages either. In Abetifi, the town I now reside, there is actually a University and many Public Secondary Schools. The climate is also great, characterized by cold nights and windy days – I mean I could sleep all night without a fan (something I wouldn’t attempt in Kumasi or worse, in Accra).
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In a little less than 10 minutes, I am at Pepease. I tell the taxi driver I would get down at the district health directorate and he nods in approval, telling me I have no problem – he will drop me right there. Keeping my head out of the window proves to be blessing though, as for some very strange reason we pass by a building labelled the district health directorate and this taxi driver drives right past it! I’m quiet for a bit, then I speak up asking if that isn’t the office we just passed by. He goes like “Ahnn Yes, yes, yes,” and I am like “Really (to myself though)?” I get down, give him a 5 cedi note, and he hands me 3 cedis in return. I frown lightly and in a split, I calculate how much I am going to be spending on transportation in a week, then in five weeks (humph!). I walk towards the building, one that houses both the District Education Office and the District Health Directorate on different floors.

I meet a young lady dressed like a secretary at the gate and ask her where the district health directorate is. She points upstairs and I follow the stairs (Not the ladder!). There’s a young lady sweeping when I get there and I greet her telling her the reason for my being there. It is around 7:48 am and the office hasn’t officially opened yet. She gives me a seat and asks me to wait till the Health Director comes to work. While waiting, I give her (the Director) a call to inform her that I am at her office and she asks me to wait for her till she comes. She wouldn’t be staying in the office today though as she has to attend a meeting for health directors in Koforidua, the capital of the Eastern Region.
In my waiting period, I do some reading – a habit I am trying to ingrain in myself. About thirty minutes later, I am told she is around and I am shown to her office. She is quite busy overseeing some duties and she asks that I wait for her for a bit after which she attends to me. I hand her my letter and she goes through quickly. After some few comments and conversations, she decides to drop me off at the Pepease health centre where I will be working (at least in the meantime).

2

It is a simple building with very basic modern architecture and no fancy designs or structures. It has facilities to provide basic healthcare and quite a good staff strength made up of midwives, nurses, public health officials, reproductive health personnel, a psychiatry unit, one ward (for detaining unstable patients shortly) and a consulting room. The head of the facility is a Physician Assistant, and there is no medical doctor there. When we get there, she introduces me shortly to them and tells them to give me some work to do (which doesn’t sound like a bad idea). Little do I know what awaits me!
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The Physician Assistant in charge (the only one the facility has) will not be around today and he has informed them that a doctor is coming and will be assisting them for the next 5 weeks! So as they are there waiting for me, in their minds, “Papa doctor is coming!” Ei! It is serious oo… Papa doctor! I suppose he actually told them that a medical student will be coming to work with them but I am sure they assumed that a medical student by virtue of the fact that he will become a doctor soon is, and has as much knowledge and skill as a doctor should have! They march me straight to the consulting room, and much to my relief (only temporarily) there is a man (who I later know to be a psychiatric nurse) sitting there, seeing a patient. I don’t even have the chance to greet him when the person who showed me to the consulting room announces, “Our doctor is here oo.” To myself I am like, “whose doctor?” Immediately he gets up and says, “Oh boss since you have come, over to you.” I am quick to tell him that I am not a doctor but he pretends he didn’t hear that. In fact, he leaves me with no choice but to sit in the doctor’s seat and do the consultation. I get my white coat and stethoscope from my bag slowly and put them on.

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You know, the problem I have is not with me being capable or incapable of seeing the clients oo. In simple terms, this is not at all what I expected. And when you are coming from medical school where you are reminded and washed constantly on the things you do not know, rather than being commended for what you know, you don’t exactly feel so confident in yourself. But in facilities like these, they could really do with whatever or whoever has the looks of a medical doctor – due to a lack of personnel. In the absence of the Physician Assistant, the nurses have been trained to offer basic consultation and medication – at least for the common cases that come there. There is a book on Standard treatment and guidelines available for referencing and there also is the option of referring a complex case to the district hospital not so far from this place. These provisions made also comfort me and I am sure to make use of them during my time there. The man I met (who asked me to take his place) is also of great help, especially with the drug dosages.
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3

It is a typical Monday for seeing patients and there are so many of them – maybe too many for just one person to handle. For every folder I open, I try to make references to the style of history taking used in this health facility and I notice that it is a very simplified version of the kind of histories we have been trained to take in medical school. I ask if I should stick to what I know or use their format, and I am told to go by what I know, since they could also learn from me. After about 5 or 6 patients and with the history books piling up, I really can’t afford to be so detailed in the histories I take. Very soon, I find myself using extremely simplified versions of history taking and identifying the most pertinent questions needed to pick up the important symptoms needed to make a diagnosis. There are times when I have to perform physical examination to pick up other signs and I also make quite a number of laboratory requests to aid my diagnosis. One interesting thing about being here is that, in the teaching hospital where we receive training, health care is more specialized. Hence if you are working in internal medicine, you would only expect to see referred cases on internal medicine and it’s the same for all the other fields of specialty. As such your mind thinks in a relatively ordered direction and you do not have to think so wide. But here, there are all manner of cases! Ranging from paediatrics to gynaecology to internal medicine to psychiatry, ophthalmology, ENT, name them! And with the limited time there is for each patient, you really have to be on your toes and be sure to think fast and wide!
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Time passes so swiftly and I don’t even have the pleasure of thinking about food. At about 3:30 pm, we are finally done with all the patients and the day ends with that. I am absolutely exhausted but very much satisfied, and I should add that I’m so proud of myself (Trumpet!).
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The day that follows is quite similar to the first, only that there aren’t as many patients as there were on the first day. On the third day of work (Wednesday) the driver of taxi I take on my way to the health facility is a patient I saw on Monday in a very weak state. He’s driving his taxi now, and he looks a lot better. I assume he wouldn’t recognize me but he does, and stops at the health facility for me to get down (without me saying I would get down there).

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I smile to myself… The future is exciting! And yes, I’m ready!