Being the patient, what to do...

Even though I don't feel sick, I do have a medical problem which I have to see a GP & specialist for, so I guess in theory that makes me a patient. Thankfully, I am rarely 'the patient'. I have been very blessed to stay healthy over the past 7 years in Sierra Leone, with only 3 sick days in that entire period and a few minor illnesses here and there.

So, I guess the question is, as a doctor what do I do when I become the patient? Do I:

a) self diagnose and treat

b) ask a colleague friend for advice

c) ask your sister (a GP) for advice

d) go and see your GP

e) leave it and risk waiting too long?

I suppose for me it depends on what's wrong and where I am at the time. If in Holland, I think I would go to my GP fairly quickly. In Sierra Leone, I'm more inclined to sort it out myself. Especially if it's something minor, like a skin infection or eye infection: I self diagnose and treat. Pharmacies are scattered throughout Freetown and medication is easy to come by, which is convenient but not always so reliable. I generally stick to the one pharmacy that I believe has good quality drugs. Having said this, when I had an abscess just above my knee I self-treated and even ended up doing some very minor 'surgery' on my leg. At that point I got a bit worried, wondering if my leg would be okay. I had reached the point of considering checking with a colleague but fortunately after 48 hours of antibiotics (doubling the dose to the maximum!), my leg looked better and I could walk normally again and there was no need for a consultation.

Likewise, if I had a fever I would probably head down to one of the few laboratories I trust (because I know the technician) and get tested for malaria. If positive, I would self-treat with the same thing I prescribe for my patients, if negative I'd wait it out. And, after two days, if I was not better (or if I got worse in the meantime) I would go and see a GP in town, possibly after checking with my colleagues or sister.

I think asking for advice from colleagues or family can be quite helpful. However, I also realize it puts them in a difficult situation. I know this because I have been in that situation a number of times. It's hard to be objective when you're treating/advising someone you know well. So, for the most part, I would ask for their opinion but generally not have them treat me.

So, how do I decide what to do? I guess part of the decision making has to do with my own experience in treating patients - if it's a condition I'm familiar with, I would self-treat. However, if it's something bizarre, I'd be more inclined to get it checked out. The same goes for treating colleagues, friends, expat children - I am happy to help/advise, but if it's more complicated and they need to be seen properly, i.e. more tests, full physical, etc, then I would refer them to a GP in town. (Remember: I don't have a clinic of my own and am not doing full-time clinical work.)

Part of the decision-making also has to do with the quality of care available in Freetown, or lack thereof. Sometimes it might be better to try to sort it out yourself or go to a colleague you trust, rather than some random clinic. There are a lot of random clinics in Freetown! You need to know where to go. With my anemia for example, I was happy to check my Hemoglobin myself. I wasn't as convinced to go to local labs, because I wasn't sure if I would even trust the results. Plus, knowing I was going to Holland, I decided to wait and get it done properly. So, on arrival here (after consulting my GP sister, I have to admit), I went to my GP and he got the ball rolling. It did come to the point where I could choose to go back to Freetown and go to a local lab/GP once a month or stay here and get things sorted out first. For reasons mentioned above, it seemed wise to sort things out in Holland. So here I am, 3 1/2 weeks later...

Second blood donation...

After a four-month wait, I was finally allowed to donate blood again at the Children's Hospital. I still think it's crazy that women have to wait 4 months, while men can donate after 3 months but rules are rules. Anyway, after lunch on Good Friday (great day to donate and reflect on the blood Jesus shed for us!), Shona and I headed to the blood bank to donate. Last time we enjoyed Christmas music, this time we enjoyed an Independence song serenade by yours truly: Omar.

I have to say, the whole process is quite amusing every time we donate. My Hb was 12.3 g/dl this time I believe, which is not bad considering I hardly eat meat these days. And I lost 3 kilograms since the last time I donated. I won’t complain about that either. So, Hemoglobin fine, weight fine, ready to donate. And that’s when my least favorite part comes in- the big big needle needs to be inserted into my arm. Ouch. And unfortunately this time, shortly after the needle was in place, the blood stopped flowing. After some slightly painful maneuvering, the blood still didn’t want to come out and so we decided to give it another go. This meant a second needle stick. Fortunately this time, the blood flowed quickly into the collection bag. And there was a fresh bag of blood, waiting to help one or more women or children.

I love the thought of helping others in such a tangible way. And what does it cost me? A little time and a little blood. Oh, and two needle sticks this time. I would again encourage everyone in Freetown to come and donate blood at the Children’s Hospital; every 3-4 months please. And really, if you come, I’ll buy you a coke!

Life-saving blood...

While driving past an NGO hospital last week a friend read out a sign painted on the hospital wall stating that patients need to come with their own blood donors. He thought that was very odd but having been here for years it didn’t seem strange to me. I suppose in the developed world, one would not see such a sign.

Every day children come to the hospital with severe anemia, mostly due to malaria. So, not only do they need to receive anti-malarial medication, they often need blood transfusions as well. Unfortunately it can take up to hours if not days for some of the children to receive blood.
The reason for this is that the blood bank runs on a donor replacement system.

Basically, a family member needs to donate a unit of blood to the blood bank in exchange for a unit of screened blood that is stored in the fridge, which will go directly to the patient. Meanwhile the blood donated by the family member will be screened and if uninfected, it is stored in the fridge and used for a patient needing blood at a later time. It sounds simple but unfortunately in practice, the system does not always work. The main problem is that there is often no family member willing to donate; either no one but the mother is around or relatives do not want to donate. And for some reason the blood bank often refuses to take blood from the mothers.

I do not know why, but in general Sierra Leoneans do not like to donate blood. They either assume that by donating they will get infected with something, or are worried about the HIV screen or various other things. This is a problem because it means a child will not receive blood from the bank because the unit taken out is not going to be replaced. And, in all fairness to the blood bank, if this happens too often the blood bank will be depleted.

I have seen in the Emergency Room and ICU countless children in urgent need of blood. Children literally come in with a hemoglobin as low as 1 or 2 g/dL. Some of these children will die if they don’t receive blood within the first hour. It is for these cases that I will take the child’s blood sample and blood request form to the blood bank and ask for a unit from the screened stock, explaining how critically ill the child is. I do end up getting the blood but not without hesitation. And in all fairness, I totally understand the concern because the more we make exceptions, the more relatives will refrain from donating, assuming we will arrange for them to get blood without having to replace it. This is obviously not sustainable.

In December I was asking for blood so often that I decided it was time to replace some of the blood myself. It was time to donate. So, together with Shona (VSO doctor) we headed to the blood bank on a Friday afternoon after lunch thinking we would be in and out in no time. I should have known better. Although it took a while, I have to say we had an interesting experience.

We wanted the technician to go through the usual procedure to make sure we were fit to donate so he proceeded to check our hemoglobin with the Hemocue. Unfortunately it was not working. He pulled out a color card, which literally was a piece of paper with various shades of red painted on it. I questioned this method and suggested he use the centrifuge for a spun hematocrit. We were rather unfortunate once again as the blood spilled out of the capillary tubes while spinning in the centrifuge. What are the odds? Since I had recently had my blood checked at home, I knew my hemoglobin was okay and we decided to go ahead with the donation.

After the blood grouping, we reclined on the two makeshift beds and got as comfortable as we could knowing a large bore needle was about to be put into our veins. We were more at ease when the technician started playing Christmas tunes from his cell phone. He inserted the needle with ease and it was amazing to see my blood flowing into a blood bag, knowing that it could potentially save a child’s life. It felt incredible to be able to help in such a tangible way and be a part of a child’s healing process. It also made me feel good to know I was giving a unit to the blood bank rather than just taking.

I later learned that my blood had been given to two different children and although I don’t know who they are or what the outcomes were, I know that I helped those children. I will definitely donate as often as I can at Children’s and I definitely recommend that people come to the hospital to donate blood. It is a very worthy cause. Seriously, if you come and donate let me know and I’ll buy you a coke while you recover. And, if you’re not in Sierra Leone, donate at your local blood bank. A unit of blood can impact someone’s life. It can mean the difference between life and death.

First posted @ http://blogs.bmj.com/bmj/2011/02/11/sandra-lako-life-saving-blood/