Photo Montage #2

Some of my co-workers Alamean, Musa, and Joseph. 

You say "Po-ta-to", I say "Pa-tah-to"

One of the biggest challenges I have encountered working at the hospital is deciphering the patient's medical complaints. Let's just say that obtaining an accurate history is next to impossible because the people here have a totally different concept of disease. For example, I would say that 95% of the people I see state that they have "burning in the urine." At first I thought it was a glitch in communication with my translator, but after hearing the complaint on average 50 times a day, I started to get suspicious. In addition, when I have had patients that speak English they say distinctively in English "I have burning in my urine."  Even the mothers of 9-month old children look me straight in the eye and state that their babies have "burning in his/her urine." This lead me to have two large concerns: is there a urinary tract infection epidemic here and why hasn't my nephew of the same age gained as vast of a vocabulary yet? Dr. Tom has assured me that UTIs are not running rampant in the Nuba Mountains and confessed that even he is unsure what to make of the compliant. I will have to discuss the latter concern with my brother and sister-in-law via skype or perhaps directly call child services because they clearly are not taking this parenting role very seriously. It doesn't help that the follow-up complaint is usually "I have hotness in my body." One might conclude that all the patients have hemorrhoids, ulcers, and horrible sunburns, but being the astute clinician that I am, I have discovered that they are not all suffering from such inflictions simultaneously.

Another barrier to getting to the bottom of a patient's problem is their warped sense of time and convoluted  stories.  I have learned that one can not trust a patient's concept of time when they honestly have no idea how old they are. This is probably every American women's dream, to just pick a ball park age, but it makes getting a history that much more difficult  Allow me to reenact:

Patient (who appears to be in her late forties but claims to be 31 years old): "I have burning in my urine, headache, joint pain, and back pain"

Me: "Okay. For how long?" (in perfect Arabic)

Patient: "I have hotness in my stomach, hotness on the bottom of my feet, and my left eye waters during the night when the hotness reaches my head."

Me: "For how long?" (again, using impeccable Arabic)

Patient: "A long time."

Me: "How many weeks, months, years?"

Patient: "15 years."

In my training as a PA I have yet to come across a disease entity that fits that description and has no findings on physical exam.  

Another problem is that the patients tend to be rather tricky and slip in the legitimate compliant at the end of all the temperature sensitive ailments. A patient whose hotness throughout the body is "so strong" will casually reply that they have had vaginal bleeding for 2 months or say they have some swelling on their thigh which turns out to be an abscess with over a liter of pus inside.  I guess all that heat fully encompasses the patient's body and consequently consumes all of their other physical problems. 

Having been here now for 3 months, I have gotten a better handle on interpreting their medical complaints and making a proper diagnosis, but it has not been an easy path.  I must say that it is quite fitting that here in Gidel the sun is amazingly strong, beating down on your entire body, and that the "roads" around here are twisting paths of rocky dirt.