Friday, January 26, 2018

Life as a Missionary PT Part 2: Intake and Subjective History

This is part 2 of a series of posts about what my ministry is like.

Remember, I'm just sharing my personal experience with this particular hospital in this particular country. Other missionaries at this same center will have different viewpoints, as will missionary PTs serving in other places.

So what happens on Tuesdays when we run clinic? Well, we have to back up to the evening of the previous Tuesday all the way until early this Tuesday morning. When women come, they are sent to the main hospital's medical records area to "buy a card." This costs 650N ($1.82 USD) and looks like this:

This history is pretty common "A woman of 41 yrs old ____ by tribe from _____. Christian P1+0 none alive no education. Leaking for 240 months in a delivery at home no footdrop no previous repairs."

A medical resident/house officer will get a brief history, take vital signs, record her main complaint, then write something like "refer to VVF for proper management" At that point, she will keep her card and will wait around for the next Tuesday morning.

When she comes into the VVF Center, one of our aides will take her card, write on it her VVF patient number (we're in the 3,600s now!) and issue her a small green patient ID card which she will show on subsequent visits so we can find and retrieve her patient card. Everything is done her by patient numbers since we have so many women named Hadiza, Ladi, Mercy, Sarah, Talatu, and Kadija!

Then she'll be shown to the waiting area. All the brown patient cards are given to Ladi, our clerk, who will call them one at a time.

While waiting here, Ladi will tell them a bit more about what fistula is and isn't (some of our women have been told it's because they were cursed!) as well as what to expect during their visit. Then one of the female chaplains will come share the gospel or read a small passage of Scripture. After that, the women who are being discharged after surgery will come in and we'll have a "Freedom Ceremony" where they dance and sing!

One of the songs that they often chant while dancing in a circle (there's not much room when all the women are there!) is loosely translated as "Now that the urine has stopped, no problems, no problems!" Another favorite is "Ni Zan Je" which goes like this in English "I will go with Jesus anywhere, no matter the roughness of the road. I will go, I will go!" Read more about that song here.

Historically, another song actually written by a patient treated here was used more often. This article gives a bit more history about it: Fitsari 'Dan Duniya: An African (Hausa) Praise Song About Vesicovaginal Fistulas

After the dancing and signing, the women who are being discharged home (or to the hostel to await another surgery) will receive a "wrapper" or a 6-yard piece of brightly colored fabric they'll use as a wrap skirt.

But for the women who are coming to see us in clinic, they'll wait until Ladi calls their name and then they'll come into this room:

Ladi will go through a series of about 30 questions to ask about their medical history, family background, marital status, history of pregnancy/sex/menses, and find out what their main complaint is. Everything used to be entered on the computer, but now it's done by hand with Ladi asking the questions (remember that most of our patients are illiterate) and recording their answers on the form. Then one of us will go and type all that into the master Excel spreadsheet/database to be analyzed later.

In recent months, we've been especially interested in demographic information on our follow-up patients, especially their rate of divorce compared to time since onset of urinary leakage (and if there's any different between if they're in a monogomous or polygamous setting), and if their risk of divorce is inversely correlated to whether they've given birth a live child before or not. It's actually rather interesting to see what's going on in these women's lives outside of the actual fistula they're coming to see us for. Expect to see some published literature on this in the next year or so!

Then the women will sit in the hall just outside the exam room and wait until we're ready to see them.

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