Bush Doctor in The City. Vol 12

Bush Doctor in the City. Vol 12
The Bush Doctor was in a bad mood. He had just returned from a meeting with the new health commissioner who was brimful of heady ideas and ambitions. Eradicate Malaria in 10 years and Leprosy in 2 years.
‘Eradicate my nyarsh’ said the Bush Doctor on hearing this.
Though he hated Leprosy and was keen for its eradication, he wasn’t convinced of the commissioner’s credibility or sincerity.
The disease evoked horror and fear. You ran when you heard of Leprosy.
Many people had wives infected with HIV , Hepatitis and various other Viruses but no one wanted to kiss a leprous bride. The sixth year itch was who how the Bush Doctor referred to Leprosy. The Bacteria lives silently in the body for six years before manifesting as a numb pale rash.
The older Doctors were not bothered. They had seen many commissioners come and go.
‘Youthful exuberance’ whispered Dr Arugbo. He was the oldest practising Doctor around. To him everyone below 65 years was ‘youthful’.
The commissioner’s rhetoric was merely for the journalists present. Sound bites for the few people who read newspapers. He thanked the drug company from heaven as he called them,( Norvatis) for giving him the tools to do the job. They had provided trunk loads of MDT (Multiple Drug Therapy) to kill off leprosy (a task that must be done).
Suddenly, there was a presentation. The graphs showed that the highest density of Leprosy was in the Bush Doctor’s area. Everyone looked at him like it was his fault.
‘Twenty cases in that small Bush?’ asked the commissioner.
The speaker asked the Bush Doctor for a response.
‘I have only been in post two years. There were only twelve patients in the small leper colony we supervise when I started. Now we have twenty because eight joined after hearing about the excellent care we provide’.
‘You call having the highest prevalence of Leprosy in the area excellent care?’ asked the commissioner sarcastically.
It hurt. Here was a Doctor who three years his junior in Medical school lording it over him. And more so, this Doctor turned politician hadn’t practised clinical medicine of over 10 years now.
The Bush doctor almost screamed, why blame me for Leprosy? Is it my fault that after 4 years of taking Dapsone which proved ineffective, the patients have given up on western medicine all together?
‘Dapsone resistance has lead to poor compliance…’ the Bush Doctor began to mumble.
‘That is not good enough. You are failing in your duties. You should educate your patients about the new Dapsone, Clofazimine and Rifampicin therapy. Tell them I said Bang, bang, bang- Leprosy dey go’ said the commissioner beating his barrel shaped chest. They whole conference fell on each other laughing. As the Bush Doctor made his way back to his sit, he knew his heart had left the job. Given time his body would follow.
The Bush nurse walked into his office without knocking.
‘Why the face of thunder?’ she asked
‘Africa dies at the hands of Viruses yet they want to pursue Bacteria’.
‘Oh. This Leprosy thing. I saw the supplies you brought back’
‘Yes. Must be eradicated in two years. The jokers wouldn’t even take the medicine’.
The Bush Nurse walked across the tiny office and stood behind his chair. She massaged his neck.
‘Relax. I have an idea. We will get the Witch Doctor to dispense. Yes. Ground the tablets to powder, mix with palm wine and tell the Lepers the ancestors have decreed that they take this potent portion. They are mostly men so he can say their testicles will drop off in two weeks if they disobey the ancestral spirits. That should get their attention!’ said the Bush Nurse.
‘Ehen! Not only do you have magical fingers, you have a brain that works wonders. Mycobacterium Leprae; Bang, bang, bang, you don dey go’ said the Bush Doctor.
No such problem for the Bush Doctor in the City. None of his patients have Leprosy.
22-6-07. I.D. 50 year old female. Feeling low. Not going out. Anxiety. We discussed her thought patterns, moods and resulting actions.
I told her there was a relationship between Depression and a smaller than average Hippocampus (part of the brain that deals with Spatial recognisation). The significance is unclear though. Do you have a small Hippocampus because you are moody and sit indoors all day or do you get depressed because you were born with a small Hippocampus.
Incidentally, taxi drivers and migratory birds have large Hippocampi. (And we all know Taxi drivers are never depressed; they just keep on talking!).
Going out is an act of faith. An exercise in hope. A risk. A running attack into the future. The depressed have low hope and expectations for the future (short and long term) and so go out less.
If asked to go to another city for a party, the answer is No. They say No to everything and soon no one asks anymore.
Dressing up well is an act for the future. In the present there is the need for prophylaxis against nakedness and cold but in the future, there is the potential for the nice fitting clothes to get noticed and attract positive feed back.
Hope is needed to dress well and hope goes in depression. (Of course there are exceptions, so please don’t e-mail them).
The question is, should I ask depressed people to jump in the car, drive to a city they do not know, without a map or satellite navigation system, and go watch a comedy film? All this in the hope that their hippocampus might swell up.
I think I talked too much to this patient.
22-6-07. 40 year old lady. ‘What is wrong?’ I asked. ‘Everything is wrong’ she replied.
Issues in all departments. Lost son 14 years ago aged only 4 days. 2 daughter’s being difficult, husband upped and left two years ago and set up home with lady and now has a baby. Cannot loose weight. Low mod. Anxious. Ill mother. No time to enjoy life.
Life is hard.
She looks at me expecting to hear something.
‘You see, our memories are like a well arranged CD collection. Different genres of music are arranged together. No matter how long ago the track was recorded, when the CD is played, it sounds as clear as the day it was originally recorded. And once you start playing one country and western, you keep on playing other country and westerns’. Same with moods. Think about how rotten it is now and you remember how rotten it alway was.
Think about how good it is now and you remember how good life has always been.
Without trivialising you pain, I would not agree with you that ‘everything is going wrong’. I think, may be you just might be dipping into that memory store, feeling the shapes with your fingers, and picking out only a certain kind of ball’.
She wasn’t interested in anti-depressants. Wasn’t interested in counselling. ‘I will fight this myself’ she said. ‘Oh, no you wouldn’t’ I said in my mind.
She agreed to see the Community psychiatric nurse for at least one session of Cognitive behaviour therapy (CBT).
I think I have talked too much again.