These days I have been busy helping out in the clinic along with Sean, Terianne, Colin (new guy). Since Peter and Derek are fluent in Creole they work as our translators most days. During clinic hours I keep track of people we are seeing and meds we are giving out. I stick people and collect urine for test such as malaria, pregnancy, STD and HIV. I also try to keep the place in order by cleaning up messes and putting things in their designated places. After hours I reorganize, make clinic books for patients, restock meds with Terianne, make Gentian Violet and sterilize instruments and water.
Under supervision of Sean and Terianne, I bandage patients with wounds. I enjoy doing this for several reasons. First, it is giving me good experience and teaching me valuable things about wound care. I also build relationships with these people because they usually have to come every other day until they heal. It amazes me to see the healing process, to see ugly, smelly wounds become small and eventually only a scar. It can be disheartening at times when I clean and bandage wounds neatly only to have patients come back with filthy bandages, infections, and also say they haven’t been taking their antibiotics. But it is a great feeling when someone has been coming every few days for three weeks and you can them today is the last time they need to come back.
Two men with wounds started coming to the clinic a few months ago. They usually came at the same time every other day. One guy had a toe injury from cutting his big toe with a machete, through his nail. The other guy had wiped out while playing soccer. Originally he had a small patch of skin missing near his right elbow, but because he didn’t seek medical attention (rather went to a natural healer for a few weeks) the small patch became a very large 5 by4 inchpatch of missing/infected flesh. So we filled out little books and gave them to them to bring back each time they have a bandage change so we can track their progress. The first few times they came back we lectured them for not bring their books back. Finally toe guy started bringing his book and started yelling at arm guy for not bringing his. Toe guy wanted to go to the beach but we encouraged him not to since he was already having trouble with infection. About two weeks later the toe wound looked really good and we praised him for his efforts but the arm wound still had little improvement. We asked him, like usual, if he was taking his antibiotics and he said “yes”. Toe guy asked the arm guy the same question and he admitted he wasn’t, he said it didn’t taste good. Toe guy started telling him how he listened to us, took his meds, didn’t go to the beach, and his toe is doing great. Every time toe guy came he asked arm guy if he was taking his meds and listening to out other instructions. Toe guy pressured arm guy to listen to our instructions and the patch on his arm healed in a few months. Toe guy helped us by yelling at others as well when he sensed they weren’t following our advice. Terianne and I love when patients lecture other patients when they don’t listen to us because it usually works!
This week a family came to the clinic, all smiles, holding a 2 week old small but fully developed baby, plus their older child, a two year old doing acrobatics. The father asked Terrianne if she remembered them. After looking at their clinic book she did. We did a pregnancy test for them 3 weeks ago. When she had told them they were pregnant they were surprised and doubted it, but after she showed them the positive on the test they were excited. We figured she was about four months along and referred her to a baby clinic (we don’t offer prenatal care). We don’t think she carried full-term but she wasn’t too early. The father said she had the baby fast, meaning she found out she was pregnant and had it shortly afterwards. It was humorous and we are happy that it is obvious they are overjoyed with their new addition. It confirms our worries about their unhappiness as false.
Starting the clinic here came with lots of learning and will require much more as time goes on. We learned some about cultural difference in priority and respect. Originally we were horrified by the unclean clinic conditions. We would clean, only to have a film of dust covering it when we finished. After our clientele grew we worried less about looks and more about seeing dozens of patients. It got very easy to say “We’re in Africa, everything is dirty.” We were approached and told how disrespectful it is to have a dusty clinic and an unswept veranda. At first we all thought there was no way to keep it clean. After dedicating a Saturday to cleaning it, though, I was embarrassed. We would never let a doctor office in the US get so dirty. Goats are always on our porch, but how does that appear to them if we don’t take the time each morning to sweep it off? Cleaning it opened my eyes to other things we can improve on to show respect. I admit sweeping the clinic just to see another layer of dirt is frustrating, but I feel better knowing I am doing my part. Also as healthcare providers it can be frustrating when people do not follow our instructions, but as time goes on we are noticing more and more how frustrating it is for them as we explain things to them in our Creole that is less than perfect. Another way to respect them is to continue to learn the language even for those of us who leave in four weeks.
This experience in Guinea-Bissau is unforgettable, especially with things related to the clinic. It showed, and will continue showing life, be it an everyday pain, the horror of a child with burns or massive infection, anger at abuse, the mystery of an unexplained condition that we have no technology for, but also the joy of telling a woman she is pregnant and the contentment of building a relationship. I thank God for this time here and thank you for supporting us in prayer. Please continue to pray for the clinic as it continues to grow and develop, but especially pray for the people who come.