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The Challenges of a Rural Outpatient Clinic

Although I am supposed to be here as a "Medical Expert" I often feel like I am the one being taught. As to be expected, I have been seeing lots and lots of children in the outpatient clinic. Not only do I work with adults back home but as a nurse I am not the one diagnosing and prescribing treatment regimens. Thus, anytime I do this type of work abroad it is incredibly challenging. In addition, each country has its own system for data recording and management. During my first day of seeing patients I completely failed at the paperwork portion of my task. Again, some "Medical Expert". It all came down to basic communication, which is actually quite challenging. While English is spoken amongst the health care workers and staff, the accent is so thick and the words used to describe things is quite different from what I am used to. Then you have the added challenge of working with an interpreter; which comically comes with the same set of challenges regardless of which country you are working in. How I wish that I could speak all languages! For whatever reason, the interpreters always seem to get more distracted, overwhelmed and exhausted and thus feel the need to take more breaks than the clinicians prescribing the care and seeing the patients. Translators also take it upon themselves to assume that they know what it is you want to ask the patient before the words have left your mouth, and I often doubt whether they are actually translating my instructions and questions versus communicating what they feel is best. Local translators get so used to working in their given context that they become the β€˜doctors’, thus bringing the added stress of having to argue with and explain the bases for your medical decisions to those whose job is to interpret.

I also find that it is common across different cultures for mothers to bring their kids to the clinic for a wide variety of ailments that can readily be treated at home; such as the common cold/flu. Almost every child came in with complaints of fever and cough, however very few were actually running high temps and the majority of those kiddos tested positive for Malaria. The other kids had nothing more than a common cold, however the caregivers always insist that you prescribe antibiotics. There are many generalized, non-descript complaints for which there is little that I can do.  Many kids are in need of parasite treatment and meds for fungal and bacterial skin infections. Other kiddos come to the clinic with chronic and acute ear and eye infections and one kid today came in reporting tooth pain. When I looked into his mouth I saw that his two back molars were completely rotted out! Apart from the visiting ministry of health dentist who comes once a month, here is another example of a situation where I can do very little. 

My first paracentesis, for starters....

My first paracentesis, for starters....

Fetoscopes, Matoke and African Snow