More clinic frustrations (2)...

Although I love my work here, it can be frustrating as well! I blogged about this in a previous post, which I ended with “to be continued…” See: http://sandralako.blogspot.com/2007/11/frustrations-in-outpatient-clinic.html. One thing I mentioned is that parents “load their kids up on meds”. This is no joke. I’ll give you an example:

On Monday I saw an 8 month old with a 2-day history of diarrhea and vomiting (D+V); she had been worse the previous day. Because the mom said the child had a slight fever I sent her to the lab; her blood showed NO malaria. To be honest, when I examined the child she was chubby, happy, well hydrated, and other than an eye infection looked healthy. So I put it down to an eye infection + viral gastroenteritis (stomach bug) and prescribed eye ointment, some packets of ORS (oral rehydration solution) and paracetamol. So she left the clinic with 3 medications and health education. Case closed, so I thought.

Well, of course, the story continues. On Friday I went to Emergency (referral center) to join the doctor for ward round. One of the patients was an 8 month old, admitted for dehydration on Thursday. I didn’t recognize her (we had seen 70 patients on Monday). As the doctor was talking, the mom pulled out a bag of medications: malaria medication, 3 antibiotics, vitamin syrup, paracetamol, eye ointment, iron tablets and some other colored tablets. She said she got them from Mercy Ships- not knowing I was from Mercy Ships! The doctor was annoyed that she had a bag full of drugs. I was annoyed that she said she got them from Mercy Ships. (gives impression that all we do is hand out bags of drugs!) I still didn’t remember the child, but could see by the packaging that out of all the meds she had, the only thing that looked like the packaging we have was the eye ointment, paracetamol and iron tablets. Anyway, the mother was obviously lying. I’ll leave out some details. I’m still not sure exactly why the child ended up being admitted, she looked well on her hospital bed. I guess probably the D+V continued and the mother wasn’t giving ORS. Instead she ‘loaded up her child on meds’ while her child became more and more dehydrated to the point of needing iv fluids. And people wonder why so many children die of diarrhea!!!

Still annoyed that this lady would say she got meds from Mercy Ships, I decided to check our database for the child’s name. As I read her file I saw that the mom was right, I had seen the child, but wrong in saying we gave her all those meds! The history is just as I stated above. A simple case. Nothing special. Typical outpatient case. So, why the frustration?

This is another classic example of an ignorant mother, the influences of culture (the more meds the better), incompetent healthcare staff (you can buy ANYTHING in the pharmacies here!), lack of [health] education etc. This patient would have done well at home if the mother had given her the ORS as told. But she didn't. Instead she went to the pharmacy. If there’s no instant recovery they believe they need more medication; usually tablets and syrups, often injections, sometimes iv’s. Sometimes patients will actually do all of this BEFORE seeing a doctor. Two weeks ago one of my patients had spent Le 60,000 (US$20) before coming to see me! A daily wage here is Le 15,000. But most of these mom’s are unemployed! What a waste of money. Unfortunately many people don’t understand that every medicine works for a specific disease. They don’t realize medication can be dangerous. The scary thing is that many children (and adults) are treated in their homes, by trained nurses. Why??? And why do pharmacies sell so many drugs to one patient. Is it to make money? Rather than to make people better? I think this is something I will never understand. And I am afraid this is not something that will change overnight.

I can only hope that somehow, sometime, people will start to understand some of these concepts!