this was my second week of clinic at Reach Out. i love it. it's hard to explain, but this is why i became a doctor. this is why i spent all those hours in labs and libraries and lecture halls. it's why i stayed up night after night on call, drinking old coffee and eating vending machine snacks in florescent lit rooms, trying my best to put people back together again and not unravel myself, while my little blond zoe slept at home with her dad. not for the title. not for the white coat. for the opportunity to take it and bring it here.
and here i begin again. to re-think how to diagnose and manage illness with severely limited individual and system resources. here i begin to trust myself again. i need to rely on my hands and my eyes and my brain more than ever, because there isn't always a test to do, or a scan to fall back on. here i begin to know a new community of people- people who are poor poor. people who i always felt i was meant to serve.
this week i was asked to be the doctor at another site about 5 minutes from the main Reach Out campus. the neighborhood is kinawataka. there are more patients, they are poorer and speak less english. some of the doctors are away on leave, this was a need that i could meet.
my luganda is not very good even though my class is finished. i can say greetings and count and know some verbs and nouns- mostly vegetables, or educational or religious words- like chalk and cross- not too handy in clinic. so at this point i need either a translator or english speakers. on monday i was given the chart of a lady who i supposedly could communicate with. after introducing myself i asked if she spoke english to confirm.
"yes i speak english, but not muzungu." great.
this sort of thing happened a few times. i could over hear the triage person speaking rapidly in luganda to the waiting patient. "blah blah blah blah muzungu blah blah blah" was all i understood, followed by a glance in my direction, and a long size up from the patient. most of the time they agreed to be seen by the white lady.
today i saw a woman who was enrolled in the program in 2003- one of the first 25 patients. i looked through her chart like a history lesson, archeology. past the recent occasional computer note that might be entered and printed if the power is on, past the different evolution of forms recording her ARV (anti-retroviral) dose and history, her CD4 counts, her weights, and into the old pages of plain white paper SOAP notes. pages before there were ARVs available. and there, buried in the inch of her chart was a note from me in 2004. i went to 'pick' her from the line of waiting clients. i was so excited. i told her- i met you seven years ago- i saw you before you began your medicines- and here you are- you are working- you lost your husband- but you have 5 children who are HIV negative. you are living- you are well. it works! Katonda bulungi! God is good!
then i 'picked' a boy who spoke english. his name was pius. he had come early- his appointment wasn't until next week. i asked him if he was sick (he looked sick- but chronically). no, he has exams next week. he is in vocational school. he's studying to be an electrician. i began to go through my interview- the review of systems. + cough for more than 3 weeks, non productive, no night sweats, but TB is so prevalent here that we check for it in any HIV+ person who has been coughing for more than 2 weeks. skin rash for a year- not itchy, not painful, doesn't go away. i look through his chart for his CD4 count- it's 19. he is 17 years old. he's been on ARVs for 2 years. something is broken. very broken.
his mother died of AIDS, his father died of AIDS. his grandparents are dead. he has not aunties, no uncles. he is an AIDS orphan. the clinic pays his school fees. he lives at school- he gets two meals a day. no one has his back. no one checks if he's taken his meds. no one cares if he's been coughing for three weeks. i asked him who at school knows he has HIV. nobody. nobody? nobody.
you have no one to talk to about your life? about your dead parents? about your living with life threatening illness? about the stigma of the disease you were born with- the disease gifted to you by parents who didn't even know they were sick? about the fact that you don't know what healthy feels like? that you've had more loss than most people i know? that you are terrified? that you have no hope because you've only know this disease to steal from you- stole your mother, father, and is slowly stealing your life?
it broke my heart.
'yet this i call to mind and therefore i have hope- because of the Lord's unfailing love we are not consumed'
i spent an hour with him. my hand held his while we talked like i would my child, tears rolled down his rashed face. i acknowledged his suffering. i spoke of hope. i told him of my patient who i met 7 years ago- with a CD4 count so low then- is alive and healthy. i told him he was loved by God and his life was valuable. then we spoke of partnership and honesty and the desperate importance of taking his medicines and how in his school day he could find alone time to take them with out feeling the eyes of his classmates. he went to the lab, i promised him a 'days of the week pillbox' to try to help with adherence, and we agreed he'd return in one month. i have his cell number. i told him i'd be praying for him.
this is what speaks to me. this is what even now, gets me out of bed at 5:40 in the morning. to go to this church building turned clinic and find both the stories of redemption and healing and those in such need of restoration, those whose broken is badly broken.
this week i didn't cry and hide behind my hair. this week i began to own my ability to do something about it. this week i feel a deep thanks for being able to give and to help. this week i feel such gratitude for my own healing, for the ongoing mending of my brokenness. out of this comes the hope that is contagious.
tonight i tucked my three children in their beds. thankful. tonight we prayed for pius, and we prayed for our friends who are sick, and we prayed that we'd be mindful of the needs of others.
may we always be mindful, and hopeful. may we live into what we can do for each other today, or tomorrow. good night.
and here i begin again. to re-think how to diagnose and manage illness with severely limited individual and system resources. here i begin to trust myself again. i need to rely on my hands and my eyes and my brain more than ever, because there isn't always a test to do, or a scan to fall back on. here i begin to know a new community of people- people who are poor poor. people who i always felt i was meant to serve.
this week i was asked to be the doctor at another site about 5 minutes from the main Reach Out campus. the neighborhood is kinawataka. there are more patients, they are poorer and speak less english. some of the doctors are away on leave, this was a need that i could meet.
my luganda is not very good even though my class is finished. i can say greetings and count and know some verbs and nouns- mostly vegetables, or educational or religious words- like chalk and cross- not too handy in clinic. so at this point i need either a translator or english speakers. on monday i was given the chart of a lady who i supposedly could communicate with. after introducing myself i asked if she spoke english to confirm.
"yes i speak english, but not muzungu." great.
this sort of thing happened a few times. i could over hear the triage person speaking rapidly in luganda to the waiting patient. "blah blah blah blah muzungu blah blah blah" was all i understood, followed by a glance in my direction, and a long size up from the patient. most of the time they agreed to be seen by the white lady.
today i saw a woman who was enrolled in the program in 2003- one of the first 25 patients. i looked through her chart like a history lesson, archeology. past the recent occasional computer note that might be entered and printed if the power is on, past the different evolution of forms recording her ARV (anti-retroviral) dose and history, her CD4 counts, her weights, and into the old pages of plain white paper SOAP notes. pages before there were ARVs available. and there, buried in the inch of her chart was a note from me in 2004. i went to 'pick' her from the line of waiting clients. i was so excited. i told her- i met you seven years ago- i saw you before you began your medicines- and here you are- you are working- you lost your husband- but you have 5 children who are HIV negative. you are living- you are well. it works! Katonda bulungi! God is good!
then i 'picked' a boy who spoke english. his name was pius. he had come early- his appointment wasn't until next week. i asked him if he was sick (he looked sick- but chronically). no, he has exams next week. he is in vocational school. he's studying to be an electrician. i began to go through my interview- the review of systems. + cough for more than 3 weeks, non productive, no night sweats, but TB is so prevalent here that we check for it in any HIV+ person who has been coughing for more than 2 weeks. skin rash for a year- not itchy, not painful, doesn't go away. i look through his chart for his CD4 count- it's 19. he is 17 years old. he's been on ARVs for 2 years. something is broken. very broken.
his mother died of AIDS, his father died of AIDS. his grandparents are dead. he has not aunties, no uncles. he is an AIDS orphan. the clinic pays his school fees. he lives at school- he gets two meals a day. no one has his back. no one checks if he's taken his meds. no one cares if he's been coughing for three weeks. i asked him who at school knows he has HIV. nobody. nobody? nobody.
you have no one to talk to about your life? about your dead parents? about your living with life threatening illness? about the stigma of the disease you were born with- the disease gifted to you by parents who didn't even know they were sick? about the fact that you don't know what healthy feels like? that you've had more loss than most people i know? that you are terrified? that you have no hope because you've only know this disease to steal from you- stole your mother, father, and is slowly stealing your life?
it broke my heart.
'yet this i call to mind and therefore i have hope- because of the Lord's unfailing love we are not consumed'
i spent an hour with him. my hand held his while we talked like i would my child, tears rolled down his rashed face. i acknowledged his suffering. i spoke of hope. i told him of my patient who i met 7 years ago- with a CD4 count so low then- is alive and healthy. i told him he was loved by God and his life was valuable. then we spoke of partnership and honesty and the desperate importance of taking his medicines and how in his school day he could find alone time to take them with out feeling the eyes of his classmates. he went to the lab, i promised him a 'days of the week pillbox' to try to help with adherence, and we agreed he'd return in one month. i have his cell number. i told him i'd be praying for him.
this is what speaks to me. this is what even now, gets me out of bed at 5:40 in the morning. to go to this church building turned clinic and find both the stories of redemption and healing and those in such need of restoration, those whose broken is badly broken.
this week i didn't cry and hide behind my hair. this week i began to own my ability to do something about it. this week i feel a deep thanks for being able to give and to help. this week i feel such gratitude for my own healing, for the ongoing mending of my brokenness. out of this comes the hope that is contagious.
tonight i tucked my three children in their beds. thankful. tonight we prayed for pius, and we prayed for our friends who are sick, and we prayed that we'd be mindful of the needs of others.
may we always be mindful, and hopeful. may we live into what we can do for each other today, or tomorrow. good night.
3 comments:
your beauty is staggering.
the clearness of Him in you.
that's all.
Yes, this is beautiful doctor-being and human-being.
Beautiful. Simply beautiful.
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