22 March 2014

The Cost of a Check Up

Lately my mind has been occupied by the reality of the great cost of seemingly small decisions pertaining to life in these parts.  A patient who runs into a burning house in order to salvage her life savings.  Or the son who decided to hold his father upright while walking because he can't spare the extra money on a walker.  Or the grandmother who hasn't eaten for two days because her kiddo has a therapy appointment.

My Favorite F. came to see me on Wednesday.  She was supposed to come last week, but they didn't have enough money for the bushtaxi fare to get to the NGO clinic that would drive them the rest of the way to the hospital. 

When they arrived, Granny greeted me and immediately helped herself to a floor mat that was rolled up in the corner.  She spread the mat in the middle of the gym, laid down and fell asleep.  When she awoke about half an hour later, I asked if she was unwell and needed to see the doctor.

'I'm fine,' she said.  'Just hungry.'

19 March 2014

Desperate Measures

Over the weekend, another of my long-stay burn patients died.  When she was admitted six weeks ago, her sister informed me that she was 130 years old. 

I double checked a few times to makes sure this wasn't just another language error on my part.  Nope!  I had heard correctly, 130!  

I used my mad-skills in the art of chiniki (bartering for the best price possible with a vendor at the market) and eventually I got her down to 80.

The right side of her face was badly burned, but from the unaffected side, 80 was an estimate I could work with.

As I continued through the WHO international burn registry data form that we are piloting, I began to ask very specific questions about the cause of her burns . . . she had been burned in a house fire, but her story was incredibly unique.

11 March 2014

The Ears of Your Skin

Proprioception.

That's what we in the biz say when we're talking about your body's ability to know precisely where it is in space.  It's what allows you to close your eyes and touch your finger to your nose . . . or to clasp a necklace behind your head . . . and to walk on sand without spraining every joint in your body.

You see, throughout the human body, there are these little receptors . . . they gage pressure and position and then send nano fast messages to the necessary muscles which will manipulate the involved joints in order for the body to respond appropriately.

Yesterday, we had one of our frequent flyers come back to see us because he's got secondary issues as a result of an old heel fracture and bad ankle sprain.  Apart from some stiffness and weakness, his main problem was that he still hasn't regained his proprioceptive sense . . . but in order for him to buy into the exercises, he'd have to first understand why they were necessary . . . which meant I'd have to explain it to him . . . in . . . Hausa.

04 March 2014

With Grief and Trembling

Yesterday morning, just before lunch, a patient was sent to see me.  Under the 'diagnosis' section of my referral form the doctor had written 'intention tremors significantly impairing function, cause unknown.'

Immediately my thoughts went to the overhaul of tests and months of treatment this gentleman would have received if we lived anywhere other than here . . . even after three years of this, I had to take a minute a grieve the imbalance between what could be and what is.  


This man came to me as a last hope, it helps no one if I say 'Well, since you can't spend weeks in a highly specialized neuro unit of a rehab hospital, I can do nothing for you.  Sorry.'  No . . . I was going to have to do something.