Tuesday, June 19, 2012

FIRSTS

Cherilyn Clayville, student missionary, working in the hospital

I am often asked, "So what kind of cases do you see in Cameroon?" This is a complex question. It is a question with various answers depending on the context and person asking.

From a medical perspective, I see a diverse array of diseases. I cannot describe a typical day.  I see and do many "firsts". One week I may see prenatal visits, diabetes, and typhoid along with the inevitable itchy rashes rampant in tropical climates. Another week I may see several women with irregular periods, multiple men with constipation and hemorrhoids, and a few patients with infected abscess. The specific problems that surface to my memory seem to come in no particular pattern or number.

I remember a couple weeks where I felt like a large percentage of new HIV diagnoses were being made at our one, small clinic. I hate breaking such news to people. When I have to tell someone they have an infectious, fatal disease with no cure; I feel quite useless and incapable. Some might describe it as a feeling of failure - failing to have a cure for a disease "you" diagnosed.

As I mentioned previously,  there are a lot of "firsts" for me in clinic. My first lumpectomies on a gentleman with multiple lipomas. (We sent a tissue sample off to the district hospital for analysis by a pathologist. I hope we get a reading back one day!). My first suction curettage on a young woman with persistent vaginal bleeding because of an incomplete miscarriage. My first steroid injection for carpel tunnel symptoms. My first marsupialization of a Bartholin's cyst. My first immobilization for an odd shoulder joint fracture. My first use of a French drug for smooth muscle pain which I have never tried before. My first attempt to remove a foreign object from a kid's nose with a hollow pen. The list goes on...

Most of these 'firsts' make me a bit nervous. I understand the pathology and the physiology. The book always makes things seem so simple. But 'firsts' are always unpredictable. I wish I had more reliable follow up too. I cannot tell you if everything I have done has been successful. If things work out, the patient has no incentive to come back and tell me. If things do not work, many patients move on to another doctor without coming back. Often, I am left wondering. I guess things will get better with time. Eventually, my 'firsts' will get to be seconds, thirds, and then routines. I will gain more confidence in using all the local French drugs that never crossed my prescription pad in the States. I will refine and finesse my minor surgical procedures. I will come to know where to send my pathology samples and when to expect a report back. For now though, there still are an awful lot of 'firsts'. More than I expected when I arrived at the clinic in December of 2009.