Tuesday, March 03, 2015

"Casualty"

Since PDM, life in the village has been busy! I have been everywhere from school visits to clinic day. Last week, as I was walking home from a school, I caught my foot on a tree root.

The root snuck between my Chaco and foot, attacking the soft space where toes meet foot. It smarted a lot, but I disengaged and kept walking; laughing at my klutziness and ability to stub my foot instead of my toe.

As I walked, I could feel it bleeding. My WFR [Wilderness First Responder]/Ship's Medical Officer habits kicked in and I developed a plan to prevent infection. I got home and immediately filled a basin with boiled and filtered water to soak my foot. It still hurt more than I thought it ought to.

Finally, it was time to survey the damage. With my headlight (my hut is dark in the afternoon), I found a nice cut...and a few chunks of wood and bark in it. I used tweezers to remove most of them, but the largest one would not move. It was set a few millimeters from the cut and was pointing straight in (or out, depending on your perspective). No matter what I did, it would not move.

It was time to call PCMO [Peace Corps Medical Officer]. After sending some photos and two phone calls, PCMO decided I should go to the local emergency room as a trip to see her in the capital was too far.

I bandaged myself and tried to put on sneakers for the dusty 2 km walk to catch a taxi. That was not an option, increasing the pain too much, so I chose to be highly fashionable in socks and sandals. I realized as I left my house that I had only 90 minutes to get to the hospital before they closed for the day. The trip usually takes over an hour.

Thus, I found myself trying to ignore the pain while speed walking through the donga. Thankfully, I got to town in under an hour. A friend was in town and met me at the hospital.

Despite being there monthly for a teen HIV+ support group, I had not idea where to go as a patient. The Butha Buthe hospital is government run. It is comprised of nearly a dozen one-story buildings, most of which are labeled. I asked the security guard where to go and she walked us to the nearly empty outpatient building.

The only person we saw as we entered was a woman mopping the hallway. The security guard has us sit on a bench in the hall. A few minutes later, the woman mopping has us move to a bench further down the hall before she disappeared. We spent a few minutes alone in the empty hallway chatting as I tried to ignore my anxiety about it being near closing time and empty.

A door labeled Meno (teeth) opened and a friendly man greeted us, making sure we were not waiting for dental care. Then, the door next to us opened and an nkhono (grandmother) shuffled out. The man we had been talking to smiled and told us to go in the room she had just left. It is a good thing he was there to instruct us after decades of American medicine have taught us to wait until we are called.

We entered, going through the proper greetings before I explained my problem to the woman at the desk. She immediately told me we were in the wrong place and needed to go to “Casualty.” She pointed in the direction of most of the hospital and told me it was there.

Following her directions, we found the Adolescent Corner (a building I know well from work related visits), Administration, and X-ray but no emergency or casualty. We stopped at X-ray and asked for directions to the unmarked emergency department.

Once there, we had to wait a few minutes as the two staff-members present finished discharging a boy with a broken arm. The, we were the only ones there. We entered the office, greeted appropriately, and I explained the problem again. PCMO had been explicit as to what to say to ensure only sterile equipment was used without being offensive.

One of the two staff then took us into a treatment room. My friend, who used to work in a hospital, later compared it to something out of The Saw. It had two patient tables as well as a table with a pile of loose gauze and forceps, and another with various medical supplies. I took off my bandage and tossed it into the open, nearly full 20L bucket marked Bio-hazard.

The man, who I later decided was a health worker as he was not in a nurse's uniform, looked at the foot and grabbed a pair of forceps. Without preamble or touching my skin, he latched the forceps onto the wood and pulled. The forceps slipped off a time or two, but he successfully removed the wood as the doctor walked in. The doctor looked at the wood and my foot, saying, “good,” before turning around and walking out.

My foot was then dressed with what looked like an iodine ointment and burned like putting Ben-gay in someone's eyes, gauze, and athletic tape. We returned to the office to speak with both men about billing and further care. This, it turned out, took more than twice as long as the actual medical care.

In Lesotho, patients keep their own medical records in green or yellow books, called bukana ea bophelo or book of life. Yellow books are for children and green for teens and adults. I am familiar with these books as I record infant and toddle weights in yellow books each month at our village clinic day. Having never received medical care in Lesotho, however, I did not have a green book.

First, we went back and forth about how they could prescribe antibiotics without writing the prescription in my green book. The doctor ultimately wrote the two prescriptions on another piece of paper. Then, I asked how to pay for my medical care and we went back and forth again. It sounded like the doctor thought that without a green book, it would be best if I simply did not pay because the administrative staff only know how to bill with a book and I thought I could probably get the medications from Peace Corps instead of the hospital pharmacy. The health worker simplified things by asking if I had 15 rand. I did, so I bought a bukana ea bophelo.

The doctor wrote out the  shockingly brief record of my visit:
“Foreign body in the foot
Extracted and dressing applied.”

The health worker than walked as to a partially open window outside the Administration Building. Before stepping up to the counter, I called PCMO and confirmed she wanted me to take both antibiotics. She insisted upon them and gave me additional care instructions in far more depth than the hospital doctor had.

I stepped up to the payment winder and paid 30 rand (less than $3 US) for the medical care and two prescriptions. I was given a receipt and we headed to the outpatient building where I thought I had seen a window labeled pharmacy. I was thankfully correct.

At the pharmacy window, the receipt and two prescriptions in my green book were checked off. I was given two bags of pills with instructions about when to take each. These medications in these dosages must be prescribed often as there was no wait. The pills were pre-packaged in the correct quantity to fill my prescription immediately.

As my friend and I walked past the hospital gate, I thanked the security guard for her earlier help. I glanced at my walk and realized the whole experience had taken only 35 minutes and we were leaving ten minutes before the hospital was to close.

Since it was now four and neither of us had eaten lunch, we went to our favorite local food location in Butha Buthe. My friend then bought me ice cream—everyone deserves a treat after visiting the hospital, right? I joined him for the food shopping he had put off to participate in my medical adventure. Then, we headed to our respective taxis, villages, and homes.

While in town for those two hours or so, I had bumped into seven different people I knew and even managed to schedule some future work with one of them. My taxi, as is often the case on the last run of the day, was heavily overloaded. Squished in between three men, a mirror, and a few 80kg bags of maizemeal, I reflected on my “casualty” and consequent adventure.

Although walking out of the village with a chunk of wood in my foot was pretty uncomfortable, I am grateful I had enough time to get it taken care of and get home before dark. (Peace Corps asks us not to travel after dark and my walk home from the taxi stop is pretty treacherous in darkness.) I am glad I could take care of this silly problem locally instead of traveling 4+ hours to Maseru and having to spend the night. I feel incredible blessed to have the kind of friends who will give up valuable town and internet time to join me at the hospital. And, to be completely honest, I am really grateful my injury was not something more serious being treated in the local hospital.

Once home, I shared the story with my brothers before we sat down to finish watching How to Train Your Dragon on my tablet.


If you're squeamish about blood and cuts, do not scroll down! But, if you are one of my many friends who loves medical stuff, here's my little injury after I had cleaned it up. The lighter colored thing is the piece of wood that would not budge. 





1 comment:

Jen Webber said...

"how to ask that only sterile equipment be used without being offensive." yeek. Is there a special award for stubbing your foot? Glad to see your sense of humor still shining through!
hugs

You should choose as your life's work whatever feels the most like play.
-Harvey Oxenhorn