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!”

A Tale of Two Sisters (and Grief and Mental Health)

Two little sisters had an extended stay in the small rural hospital. They were the stars of the Paeds ward. The little one was absolutely shining and brightened up the whole ward. I spent ward rounds with her in my arms, on my hips, and eventually falling asleep on my back. She was loved. The older one was a regular little mother-figure. No nurse was allowed to clean or feed her sister: SHE did it.

They were no longer ill, but had lost their parents in quick succession, followed by neglect and abuse by the relatives who took over their care. So, as they lived in a region with a single over-worked social worker, they were staying at hospital until placement could be arranged.

a tale of two sisters 2 Continue reading “A Tale of Two Sisters (and Grief and Mental Health)”

For Mother’s Day: A Rural Story of a Mother’s Love

I have amazing women in my life – a wonderful mother, grandmother and aunts. I have written about them before, so this Mother’s Day I am sharing a story I have told them, and I know they won’t mind it as a tribute to all mothers.

My rural Family Medicine rotation earlier this year was not just rural – it was classified as DEEP rural. The majority of the people living in the area had no water or electricity. Many of them had pulmonary disease, despite never having smoked – the so-called hut-lung disease. The nearest referral hospital was more than two hours away and was reached by traveling roads with near-dongas as potholes.

Most of our patients were unemployed, or otherwise self-employed as subsistence farmers who struggled to subsist. Almost none of them had cars, and so when we did refer them to the “nearby” hospital they were sent with patient transport vehicles that were chronically overfilled. Patients who had to go to even larger hospitals with more specialised abilities had to find their own way – although the doctors often helped them out with bus fair using their personal income. Continue reading “For Mother’s Day: A Rural Story of a Mother’s Love”

Sometimes you need to say it

When I present patients and reach the “body habitus” part of the presentation, I always become a little awkward. I’m acutely aware of body-image issues and I never want to be the cause of a patient’s emotional distress. It has happened a few times that a registrar admonished me, “You need to say it. You need to counsel your patients that they are overweight.”

That’s hard when you believe in “being nice”.

On my rural rotation, I saw a classic example of a case where it should have been said long ago.

A grade-school girl presented to us with clear-cut Cushing’s Disease. She was a preteen of average height, weighing in at 100kg (220lb). She came to hospital not because of her weight, but because she could no longer walk due to proximal muscle weakness. Continue reading “Sometimes you need to say it”

IV Lines: You’re Doin’ It Wrong

A quick contribution to this month’s Medical Monday. I am in the last week of Family Medicine and trying to finish of the mass of projects we have to present this week. Additionally I have just realised that my first set of exams (the B.Ch-part, a.k.a. Surgery) is in two months. I am not feeling prepared for that and will definitely need to focus more intently on studying.

Anyway, here is an incident that made me laugh. The rural hospital where I am working is relatively small and sometimes, patients sleep over at Outpatients’ Department while awaiting a bed. We start their treatment in the meanwhile, run tests and set up IV-infusions. The next morning, OPD essentially as its own “ward round”.

We were scratching our heads as to why a certain patient had not received her treatment overnight. Then we saw her IV line.

IVmess

(As you can see, that IV isn’t going anywhere but down the drain.) As we are fairly certain that no nurse or doctor would have done this, the only conclusion we could reach was that the IV came out and the patient or a relative tried to “put it back.”

Regardless, we had a good laugh. This has got to be even funnier than when this happened.

Mobile Update: Weekend Trips

One of the awesome things about rural rotations is the opportunity to explore the surrounds. This weekend we went to quite a few surrounding villages (and today we hiked for the better part of the day and my muscles are cursing me).

This is a photo I took on the way. I really hope it looks half as good on your computer screen as it does on this phone!

Isn’t it wonderful? I spoke to someone who has been at the hospital here for many years about how awesome the vibe here is.

He said that it is because the place attracts “missionaries, maniacs and misfits.” Hah!

Sort-Of Hiatus

I am leaving today to a rural hospital where I will be completing five weeks of Family Medicine. I expect to learn a lot, but I also anticipate little to no internet access.

I have a some posts scheduled, so I’ll still be sort-of around. I will also be able to update the blog via my (very broken and unstable) cell phone. So, I’ll be around but also not all that around.

Please send positive thoughts. I will be going without a clinical partner, so making friends and adjusting are also active concerns. It feels kind of like I’m starting a new job.

I’ll see you guys soon!

ruralmedme
Me, at a touristy spot near the hospital where I will be.

Not in my Scope of Practice

This past week I was privileged to spend a day at an incredibly rural hospital in the Old Transkei, South Africa, where I hope to complete a rural Family Medicine rotation early next year. I have heard a lot about this groundbreaking hospital and even wanted to do an elective there, but they are so popular that I could not get a space there before.

559178_166981486760247_674081776_n Continue reading “Not in my Scope of Practice”