Doctor. Counsellor. Freedom Fighter.

She was a healthy young woman who came to see me for a “complete check-up” before a holiday overseas. Although I tend to think “complete” check-ups are somewhat overkill, they do present a good opportunity for health promotion and disease prevention. As one does, I asked about sexual history and family planning. She hesitated just a split second before answering, “Well, my only partner is a woman, so I don’t have to worry about pregnancy scares.” And then, we moved on. 

 * * *

As much as this encounter seems every day, that was the first time that a patient volunteered their sexuality without being prompted. I marked it a Very Important Day.

 * * *

8245c2f7b79d445bad550d7a04e192b9This Freedom Day, when South Africans commemorate the birth of a new egalitarian democracy, I remember those who fought for freedom so that we may reap the benefits of their struggle.

But I also remind myself that many – in this country, and beyond – are free only on paper.

And I remind myself that healthcare workers have swaying power. We have access to podiums. We have clout in policy discussions.

And we have a horrible history of turning a blind eye.

 * * *

He fell from the ninth floor
He hanged himself
He slipped on a piece of soap while washing
He hanged himself
He slipped on a piece of soap while washing
He fell from the ninth floor
He hanged himself while washing
He slipped from the ninth floor
He hung from the ninth floor
He slipped on the ninth floor while washing
He fell from a piece of soap while slipping
He hung from the ninth floor
He washed from the ninth floor while slipping
He hung from a piece of soap while washing.

Chris van Wyk, In Detention

 * * *

So today, I think of those who live in the ravages of war. Those who live under a modern Apartheid. And those healthcare workers who toil with them, to bring relief to the oppressed, and sometimes lose their lives with them, too.

Today I think of those who are not free to express their sexuality and gender preference. Those who have been hurt for it. Those whose doctors have aided in their systematic erasure. Those who have been subjected to conversion therapies.

Today I think of those who are not free to exercise control over their bodies. Those who are pinned down. Those who are denied choice in reproduction. Those who rely on dark alleyways and metal hangers to maintain a semblance of freedom, and often pay for it with their lives.

Today I think of those who walk 5km to the nearest (hopefully clean) water. The young girls who miss school at every menses. The children who queue to use a single pit latrine during their break. Those who have been found drowned in those same pit latrines.

 * * *

Today, I consider the many freedoms that exist on paper only.

You may consider this more apt for Human Rights Day, but in my mind, freedom and human rights are two sides to the same coin.

Just as my patients are not healthy if they are depressed, just as they are not healthy if they are afraid; just so, my patients are not healthy if they are not free. Nobody is.

Today, I think about being a doctor. I think about the privileges that affords me. And I realise: doctors have a responsibility to make up for the sordid history of our profession; for the many times our community has benefited the captors instead of the captives.

I do believe that we have a responsibility to fight tirelessly for the freedom of all under our care – whatever form or shape that fight may take.

Happy Freedom Day, South Africa.

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General Practice is not exciting, but it is fulfilling

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By Lauren Squires, with permission. Click image for her Instagram.

As I enter into my third month of General Practitioner work, I find myself reflecting. I started with private GP locums to fill the gap til I got the job I wanted. But now I’m signing a contract and I’m here to stay – for at least another five months.

One evening, my housemate asked, “So, did anything interesting happen at work today?” When I responded in the negative, we laughed about how my work had become almost mundane compared to working in hospital and coming home with fascinating stories of grotesque injuries and life-saving surgeries practically every day. Continue reading “General Practice is not exciting, but it is fulfilling”

GP Work is Hard

One week of some GP locums and I am exhausted.

7b609ee5184afeee3a442d25e5549028I can spend 10 minutes per consultation if people have straight-forward tonsillitis or gastroenteritis.

But what about the parents who are hesitant about vaccinating? I need more than ten minutes to make an impact.

What about the woman whose pregnancy test was unexpectedly positive, and needs to discuss options? She might not have anyone else to discuss options with.

What about the myriad people with psychiatric illness? I need more than ten minutes to figure out if it’s depression, or if there is a history of hypomanic spells. Is it substance induced? Is there another general medical condition? Who can start someone on antidepressants after a ten minute consult? Continue reading “GP Work is Hard”

The Nicest Interns: Part 2

I just recently finished a four-month Family Medicine rotation. Our after-hours duties on Family  Medicine are as casualty officers at the Accident and Emergency Departments of two different hospitals. Because A&E has high-intensity decision making, our shifts were not allowed to be longer than twelve hours (compare: 24 hour shifts in any other department).

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Continue reading “The Nicest Interns: Part 2”

On Poverty and Health: The Obesity-Conundrum

rich man poor man slimmer man fatEver since I started running (and enjoying it), I have been intrigued by the sociology and economics of health and fitness. It coincided with my “coming of age” in medicine, so to speak, so it has been in interesting and ongoing thought-experiment.

I want to address some pertinent falsehoods about health and fitness, and why the disenfranchised have such a hard time of it. Right now I intend to write a two-part series, but who knows.

Quick disclaimer: I would never suggest that being a student-on-a-budget is comparable in hardship to living in poverty. All the same, being a student on a partial scholarship and a heavy student loan certainly did teach me a little about struggling financially and its effects on health. Continue reading “On Poverty and Health: The Obesity-Conundrum”

Something Only Family Physicians Experience

I had such a lovely experience last week. I was working Accident and Emergency overnight, as I have finally completed my surgical posting and moved on to Family Medicine.

A mother brought her nine-month old baby in with a chronic cough. Now, it was probably the happiest baby I had seen all night and probably could have just waited to go to the clinic the next day, but whatever: she was there, so I saw her.

In among the questions of TB, smoking relatives, and pets, I asked if Baby was born term, and how. Her response, “Yes, he was a big baby! You did my Caesarian Section!”

pediatrician-and-baby

Continue reading “Something Only Family Physicians Experience”

Implanon in the Bible. Apparently.

ME: I’m sorry to tell you that you’ve had a complete miscarriage.

HER: Oh. Okay.

ME: Was this a planned pregnancy?

HER: No! It was an accident.

ME: Are you planning a pregnancy in the near future?

HER: Not really. I have one already. I can’t afford another baby.

ME: Then I think we should discuss family planning.

HER: *blank*

ME: Prevention.

HER: Oh. Yes.

ME: Even though you don’t want any future children, we don’t recommend tying your tubes at such a young age. The Copper T is always a good idea, but have you heard of Implanon?

HER: I don’t know.

ME: Implanon is a little stick, like a matchstick, that we put in your arm-

HER: Oh yes. I’ve heard of that.

ME: Good. It lasts for three years. It’s not too long but it gives you enough time-

HER: No. No I don’t want that.

ME: Is there a reason? It won’t hurt you and the side-effects are a lot fewer than the injections you’ve been getting.

HER: Implanon is not for me.

ME: You’re absolutely allowed your choice but can you share why you think it’s not for you?

HER: You know.

ME: I don’t.

HER: It’s like they say in the Bible.

ME: *blank*

HER: It’s the mark. The one at the end of days.

ME: Implanon is the mark of the beast?!

HER: YES!

The worst is that after some prodding, she said that a nurse at her local clinic was telling women this. I wish I could say she was the only patient who told us that, but no… it was quite a common belief.

Medicine: Keep Up!

I love how fast this field moves, and grows. It is refreshing, and it keeps me on my toes, and it demands: if you’re not ready for change, you’re not ready for MEDICINE!

Three years ago, during a Family Medicine rotation, a young Zimbabwean girl came to us for removal of a stick-like thing in her arm. Initially I did not believe her that it was a contraceptive – I thought it was a traditional medicine! But she was so convincing that I Googled “subdermal contraceptives” and it turned out she was right.

Subdermal contraceptive devices were SO rare in South Africa that we had not even learned about them in classes. We had no idea how to remove said implant, and kind of improvised.

022715jhm71Three years later, I can put in these contraceptives with my eyes closed (but I wouldn’t, sharps are involved). Continue reading “Medicine: Keep Up!”