My last blog was about a day in my life as a doctor in the Congo. And don’t get me wrong, it is a pretty complicated job. Yet, it is nothing compared to the life of an average Congolese patient! I have talked with many patients and nurses, and collected some stories. Some are bizarre, some are funny, and some are extremely sad. So here we go…
Where to even begin?! Probably the hardest thing I see coming from a country with universal health care coverage is when patients struggle with payment for our services. The first one that comes to mind is a 9 month old was sitting in triage with his mother. He had fevers, diarrhea, and was severely malnourished. For context, the normal weight for a 9 month old is 9kg and the lowest percentile for weight is 7kg. This child was literally off the charts at only 4.5kg! In addition to being severely underweight, he probably had malaria and needed some lab tests and treatment. We explained to the mom that at this hospital we treat malnutrition for free, they just have to pay a basic admission fee (something like 10000cfa, or $18). Unfortunately, the mom was unable to pay for anything and requested that we just give her the medicine so she can leave! It was heartbreaking!
If you decide to get a full admission to hospital, the next step is paying for everything ahead of time. You buy your medicines from the pharmacy, and bring them to the nurse. What if our pharmacy doesn’t happen to have it? Well, you go walking in to town to find it at another local pharmacy. These are often tiny and very untrustworthy.
So you’ve got your medicines, now you have to supply a “guarde de malade”, which roughly translates to the guardian of the sick. A family member must accompany any person who is in hospital to make them meals, change their sheets, buy their medicines, give them baths, pay for their medicines etc. I can only imagine how ecstatic nurses back home would be if they found out that the patient’s family would be the ones dis-impacting the bowel, or ushering them to the commode!
If you are really sick you will be spending a night or two in the salle d’urgence (emergency room) or the sale d’observation (observation room; this is the closest we get to an ICU, but make no mistake, we have nothing special except for an oxygen concentrator). Typically, to make it here you will have malaria that has gone to your brain or malaria that has made you ridiculously anemic. If you are anemic and need a transfusion, we can do those here (unlike the other hospital in town). The catch is that you have to get 2 of your family members to donate blood to replenish our little blood bank!
Also, just about every patient that walks through the doors will be dehydrated by a liter or two, constipated, and if you are a kid you will have worms. Literally almost every patient has these, and it really complicates the medical treatment! I had a little 4 year old girl come in who had been poisoned by a neighbour, and had a kidney injury as result! We were trying to collect her urine but each day we came she only had a small cup half full to show us. So we finally asked how much she was drinking, and it had to have been less than 300 ml per day! We gave her the task of drinking 1-1.5 liters, and she couldn’t believe we wanted her to drink that much. The main problem is that there is no running water for the city or power most of the time, so almost every has to haul water from a cistern!
Maternity cases are their own special thing. Women here generally freak out if it is their first child and we often hear them yelling in the suite d’accouchement, the maternity building. I know this is coming from a male and I will never know what they are truly going through, but women go crazy here compared to Canada. I had a patient literally roll out of bed and start writhing on the floor with her IV arm dangling above her in the middle of labour, and those floors are not clean! The nurses here have seen so many dramatic labouring patients that they have a hard time telling if there is actually something wrong!
Another fun thing is the buildings here all have these shutter type windows that never fully close. The family’s of the ladies in labour find this out quickly. So imagine you’re in the middle of labour and having a confidential conversation with your doctor when your mother-in-law starts chiming in through the window! Next, if you are an Aka pygmy or just anxious to have your baby, you may just decide to take a traditional medicine to help kick in labour or make it faster. In Canada someone would usually take something like cod liver oil that works worse than it tastes. But in the middle of a rain forest in the Congo, people have found some absurdly potent medicinal plants that act way too well! I frequently have someone in labour who shouldn’t be but is having huge and painful contractions because they have taken some of these plants! It sounds funny at first but is actually quite dangerous and often end in C-sections.
A usual patient in the medical ward has no choice but to be quite social because it consists of 5 stretchers (iron bed frames) laid out with old mosquito nets dangling over head. No walls. No privacy. Your business is everyone’s business. This is so typical for the Congo that people are completely unfazed. I mean, the usual home has around 10 people living in about 300-500 square feet of space! So when I am explaining a diagnosis to someone during rounds, I often see many more attentive faces hanging on each word. They also aren’t afraid at all to chime in with their thoughts for other patients as well. More than once a spirited debate has broken out during rounds with all the members of the ward!
The main drawback of this set up is with sensitive diagnoses, particularly HIV/AIDS. This is a diagnosis you will never here anyone say out loud in the hospital. Instead we use code word because there is a huge stigma surrounding HIV here. It is so bad that I have literally heard these words from a 24-year-old woman refusing an HIV test, “if I was HIV positive I would hang myself.” A 30-year-old woman I treated faced the same decision. Her husband was abusive and she had just had a miscarriage and was quite sick. She was losing consciousness so was transferred from the other hospital to ours for treatment (this happens not infrequently). She had a bad cough, was thin, and looking so ill we decided to order an HIV test. For 3 days in a row she agreed to the test during rounds but would later back out. Finally, we walked her to the test with her approval. It came back positive. Her husband promptly left and her father in law was one of the only one’s who stuck around to be here guarde de malade and to pay her bills! She came extremely close to dying, and I don’t think she could have waited another day to start the anti-HIV treatment.
One of my favourite patients I have is a 75 year old man who greets me emphatically every morning with a hoarse “Mbote Docteur!” and both hands waving! This acts to somewhat counteract the smell of incontinence emanating from his hospital bed, a hospital bed that has no shiny layer of vinyl but some sort of porous canvas to protect it from the ‘rains’. He has a chronic ulcer on his leg and has been in hospital for months, but you wouldn’t know it. His attitude in spite of all this is remarkable! He always has a smile on his face.
Some patients travel from a long distance to stay here. We were driving with a local missionary about 8km out of town and an Aka pygmy family flagged us down. Their daughter had just had a seizure from malaria!
There are many more stories to tell like these so stay tuned! Let me know what you think in the comments, and I hope you enjoyed the read.