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.
