Lena: Dispensary

Posted 11:22 AM, June 28, 2006, by lenawine

Every morning we learn about a particular topic: the vocabulary, the grammar, and the culture surrounding it. Then in the afternoons we visit a place that exemplies that component of society.

Monday: We learned about "children from difficult backgrounds" and then we visited a home for street children.
Tuesday: We learned about weather and farming and then we visited a place for mixed farming.
Today: We learned about health and then visited a dispensary.

Just to clarify what a dispensary is: it's a clinic provided by public or charitable funds according to the Compact Oxford English Dictionary. I would say that it was sort of the equivalent of a walk-in outpatient clinic, where they also supply medications and fill prescriptions.

We were told to go into a random room to find the doctor we would be talking with. Upon knocking and entering, I was surprised to find he was with a patient and all my cultural knowledge of the importance of greetings in Swahili culture went out the window and I began apologizing and attempting to explain who we were.

The doctor would have none of this and interrupted me with the traditional greetings. As he asked to sit and we all introduced ourselves, I began to wonder if perhaps the woman in his office was not a patient at all.

Just when we all began to feel a bit more comfortable, he proceeded with his consultation, pausing occasionally to explain various aspects to us. Eventually it became clear that this women was having problems with her menses and he was going to give her some fertility drugs.

At that point, the three other students in the room became extremely uncomfortable. I felt the sames light unease that I usually feel when a large group of student is privy to the intimate details of a patient's personal life. After the patient left, he said you just observed aibu, or shame.

Afterwards, all the students could talk about was how awkward and uncomfortable they had felt and what a violation of patient privacy it had been. It seemed odd that if the doctor knew the patient was feeling embarrassed and ashamed, he should have done something to ameliorate that feeling, but proceeded with no compunction. In additon, he hadn't asked the patient if it was okay for us to observe beforehand, but then I began to think that even if he had asked her, she would have agreed despite her personal discomfort.

Unlike the rest of the students, I was struck by a number of other things. Firstly, the similarity in the way one takes a history and gathers information from the patient was remarkable. Despite all the differences in health status and disease profiles as well as all the cultural differences, this doctor was modeling the same kind of clinical thinking that I had learned in the past year. He used open-ended and close-ended questions, and things like how long as it hurt and can you point to the exact location with your finger.

He also talked a good deal to us about what the most common illnesses were and had a handwritten chart on the wall of the disease burden from 2003. Interestingly, malaria, acute respiratory infections, and minor surgeries (i.e. tonsilectomies) were the most common diseases seen in Usa River. I noticed that HIV was not on their chart, nor was tuberculosis, two diseases that I thought would be relatively prevalent.

He seemed to think nothing of it, opened a book and said that they have documented 84 cases of HIV. I asked what kinds of services they provide, he again seemed to think it was obvious that they provide treatment with ARVs (antiretrovirals) and home-based care including nutritional support as well voluntary counseling and testing (VCT).

All in all, I found it to be an enlightening experience, with several surprises.

The dispensary from the outside:
Day 11 Dispensary.jpg