Note: At the time you’re reading this, I am most likely out in the village again. That would be why I may not respond quickly to any questions or comments you have.
I’m not a doctor (as I regularly tell the people), but a little bit of training, a doctor on call, and a stockpile of medicines does provide an opportunity to show Christ’s love and to more naturally enter into people’s homes and lives and get to know them as I help treat illnesses and injuries to the best of my ability and pray that God will work through my efforts to heal.
Dispensing medicines in a semi-nomadic, traditionally animistic people group in the jungle has it’s unique challenges. People seem to believe medicine will bring them (magical?) benefits and so they seek it even when they are not sick, and tend to answer questions in ways that they think will influence me to give them medicine. Because the lifestyle demands flexibility and reacting to conditions rather than regular, disciplined, daily activity, people have an extremely hard time coming back every day for medicines and finishing the course they start, especially if they have already begun to feel better. Additionally people tend to see spiritual, rather than natural causes for illnesses, and so when you ask “how did this sickness start”, the answer will be a spiritual one (hearing a noise or a voice, seeing a certain kind of animal, etc), rather than a step by step history of the signs and symptoms. This, combined with the language barrier (I don’t speak *Muniyo, yet), makes obtaining a helpful patient history nearly impossible.
Fortunately, I am able to learn from colleagues who have had years dealing with these issues.
One of them, a Dutch missionary working on the south side of the island, developed a village health-care system that is simple to use, easy to teach, and generally takes care of the most common illnesses found in the village. Before going out to the village this time, I was able to take her course and make my own “pill-box” chart, a canvas hanging-chart with rows of booklets.
Each booklet represents a particular set of symptoms commonly seen (the cover has a picture representing the symptoms). The inside pages show pictures of an adult, an older child, a young child, a baby, and a newborn, and across from the picture is a color-coded chart showing which medicine to use (the medicines have color-labels so that being able to read is not necessary) and how much to use for each dose. Above this are rows of circles representing doses of the medication each day. When I want to treat a patient, I select the right booklet and page, and then I copy the rows of hollow (check-box) circles, the color for the medication, and the drawing of the dosage onto a piece of cardboard, which I send home with the patient with her medication. Each day I give the medications for that day and check off what I gave her on her card.
My colleague also taught us ways she’s learned from her experience to make sure that people return for their medications and ways to weed out people who are just trying to get medicine for its power. I’ve been able to begin using the system in the village. For now, I’m just going to use it myself while people watch. But the evangelist says “This is really clear and easy to understand”, so I have high hopes that after I’ve got enough experience using the system myself, I’ll be able to train others to do the same.
Heartbreak and Rejoicing During Medicine Hour
One of the crucially important things to learn in order to be able to last out in the village is to be able to limit one’s own emotional involvement, and especially sense of responsibility for his patients. Last time I was out there, with the girl with the machete wound on her wrist, I was losing lots of sleep and peace over her injury in particular, as well as over several others who were sick and not consistently coming to me for medicines. I spent lots of time chasing patients down to give them their medications. This is not a practice I can continue and maintain my mental and physical health.
Nonetheless, as a believer, I do want to get emotionally involved, I do want to care, to have compassion, in short, to love my patients, and I do. And this, coupled with the challenges mentioned above, means there will be many heartbreaks in the course of trying to help people get well and live healthier lives.
As far as I’ve seen up to this point, parents generally do not force their kids to do anything they don’t want to do. That means a lot of kids who only get one dose of chloroquine (anti-malaria medication that still works in some places in the interior), because it is extremely bitter to the taste. I’m grateful that so far no child has died because of this, but I expect that will happen. Lots of kids are walking around covered with open sores, mainly due to poor hygiene (which, to be fair, is tough to maintain in a tropical environment with no soap and a semi-nomadic lifestyle). Yaws (a disease related to syphilis) is incredibly common. Skin conditions like yaws-sores and scabies and fungal infections lead to scratching, which leads to wound infections and often tropical ulcers, big gaping sores that just keep growing and never healing. I can usually treat those successfully if a patient will come back every day for ten days to take medicine and have a salve applied to the wound. But this is too much to ask. I chided a man (one of my “fathers” in the village) because his daughter’s tropical ulcer got worse (fungus, flies, bigger wound) after she took about five days of antibiotic and failed to come back (because he failed to bring her).
Also difficult to deal with are the cases that I can do nothing about with my training and resources. One woman in the village has some kind of bone or nerve infection (I suspect leprosy is possible) that is slowly eating away one of her fingers. One day, when I was just about to board the plane to fly back to town, she brought me a bloody bone-fragment that had just fallen out of her finger.
In spite of challenges, frustrations, and heart-breaks of village healthcare, I’ve also had much to be thankful and rejoice over. The young girl whose had was nearly chopped of by a machete has healed. The use of her index finger in that hand has decreased some, but otherwise she has fully recovered!
A man with a lung infection (which I think might be due to chronic heart failure) looked really bad, like he might die, for about a week, and then recovered fully as he took a course of antibiotics. Even though his recovery meant less peace and quiet at night (because he could now stand guard over his unmarried daughters again and would regularly holler at young men who tried to visit them), I was glad to hear this and also to see that he was able to go to the jungle looking for food again, because I knew he had recovered.
A close friend suffered a head injury and then came down with a scary-looking case of malaria, to the point that he couldn’t eat or drink much, couldn’t swallow medicines, and had a distended abdomen (probably liver and spleen swollen). He looked so bad to me that I advised him to fly out and eventually reached the point to where there was nothing else I could do for him except pray. And then he got better!!!