First day at the medical clinic

My first day at Khomas medi-clinic was preceded by a lively baby baboon sleep over. As a medical volunteer I’m not required to mother a baby baboon but when you share a room with two wildlife volunteers who are, then you might as well be on the schedule. We’d had Bachis and Lala and both had decided, at one point of the night or another, to practice some pretty hard core disco dancing on my head. Needless to say, waiting at 8am to be picked up to go into the clinic, I did not feel my best.

I’d attired myself in ‘appropriate clothing’ as instructed and felt a bit out of place at breakfast. Clean clothes, especially white ones kind of stand out on the farm and I only hoped I would not be set upon by turkey, big pig or one of the farm dogs in the interval between leaving my room and getting to the front of the admin building. The animals on this farm are stealthy operators and it wouldn’t have surprised me at all to get to the clinic pleased with myself for out-manoevouring them all only to find myself sporting two muddy paw prints on my bum without even realising I’d been got. As it happens, apart from taking some mild stick from the other volunteers over breakfast due to my somewhat pristine appearance and the fact I was wearing mascara (didn't want to scare the patients) I had to contend with no commando type attacks from anything furry or feathered.

The Khomas Clinic is a large private medical practice in the centre of Windhoek which means a 35 minute or so drive in from the farm every day with Dr Rudie van Vuuren who with his wife Marlice set up the Lifeline clinic for the Bushman out at Epukiro and who also own the animal sanctuary where I live during my time at the project. Having arrived on Thursday lunchtime and having spent four days in the compound, my feet were itching to see different surroundings and I was looking forward to the first part of the drive especially as there was chance we would see some game and possibly some warthogs and wild baboons (known by the locals as the 'black mafia'). 

The medical practice has eight doctors in total and also houses a pharmacy, dentist and optician and a coffee shop which is open to non patients. The practice is light and airy, well maintained and modern. On the way in I’d been given an instruction manual and was told now to read several of the early sections which related to patient clinical history taking, wound care, ultrasound and taking blood pressure. In the process of doing this, I took on a battery of new words and phrases that sounded like a foreign language - dyspnoea, claudication, vasovagal, pyloric stenosis. The trouble was I didn’t know what any of them meant. I started to feel a bit out of my depth. After all, at some point, much much later on I expected, I’d start to deal with real people. But I was sure that wasn’t anything for me to worry about just now and so in the meantime I stuck my nose back in the book - supplemented now with a med student handbook and medical dictionary - and started to feel marginally less twitchy. Rudi stuck his head around the door, ‘come with me’ he said and disappeared. I sat for a moment and then grabbing my notepad followed him down the hall. I learnt I was going to see a large absess on a patient’s face being drained. The patient was already at the nurses station on an examination couch and as Rudi pulled the curtain around he handed me some sterile gloves and told me to put them on. A second later I was staring at them as they lay on the floor. My first instruction and I had failed miserably. Rudi observed drily that they were no long very sterile. He asked me to describe what I could see while he injected local anaestetic into the swelling on the patients face and then after a few seconds used a small blade to make an incision about ¾ of an inch long. Blood oozed out, followed by thick yellow pus. I looked at it and felt slightly queasy but tried not to look too pathetic. Rudi cleaned the wound and then covered it with antiseptic ointment and a dressing. He asked me how I had found it.  I said it had been fine, both sets of un-sterile fingers crossed behind my back. This turned out to be the right answer because the patient was coming back tomorrow and I was instructed to check and clean the wound before calling Rudi to see it.  No soft intro then.

Back in my room, borrowed from one of the doctors who was on leave, I wrote down my notes on patient 1 and reread the section in the manual on wound cleaning and swellings just incase I really had to do it myself tomorrow. Rudi came in with a file. “Your next patient” he said. “Take a medical history and then be prepared to present what you find”. At that he ushered in two adults and a small child and closed the door. I checked the file to see what notes I could find and found it almost all in Afrikaans.  I looked at the parents and smiled weakly.  They looked back at me expectantly. So, what seems to be the problem with your (I checked the file) daughter, I asked. “Well doctor” they said. Shit I thought, they think I’m a doctor, this is really bad. I put my hand up and told them I was a medical volunteer doing some basic medical training, and very much not a doctor. “OK doctor” they said. With a sigh I knew I was going to have to take off the white coat and stop wearing the stethoscope round my neck.

So day one and five patients later (absess, hayfever, tonsillitis, pregnancy, and exhaustion coupled with stress), my clinic duties were finished. I kind of felt I’d got the hang of medical histories and looked forward to practicing them again the following day. No one had laughed in my face or stormed out and demanded to see a real doctor. In fact, everyone had readily answered any questions I’d put to them and believe me, when you are taking medical histories you have to ask some pretty personal and searching questions. Feeling pretty pleased with myself, I jumped into the car for my ride home. Tomorrow you’ll be taking blood pressure and doing a general physical examination on your patients Rudi said. You’ll be checking for jaundice, anaemia, cyanosis, odeama and lymphatic problems. Then you’ll work with the nurses on urine analysis and taking blood. You’ll also be learning about HIV as 23% of the population have it.

Steep learning curve I said quietly to myself as I looked out of the window and watched the world go by. This is really going to be a steep learning curve.