An update re the french and medicine...

It's definitely getting easier - hurray!

I spent the first two weeks "á la consultation" (out-patients) where I was mainly observing the doctor see patients who were either coming with acute problems, often needing hospitalisation or follow-up appointments following a stay in hospital. The staff in "la consultation" are super friendly. Dr Youla comes from Guinea so he doesn't speak Wolof (the local Senegalese language) so the patients often needed a translator, this means- for the most part- I can follow the french. Quel-que-fois, other doctors were "á la consultation" who spoke Wolof, so I didn't understand much.

I was always encouraged to examine patients and ask any extra questions. Dr Youla often asked my opinion about patients diagnoses, what investigations to order etc. So gradually I picked up quite a bit. In general, the doctors and nurses are very patient with my french and comprehension difficulties! At the end of the day, well often about 2pm (!) we would often sit around and drink juice out of little bags together and chat. They never seem to be completely over-run with patients. Although a few times in the first two weeks there were patients who needed hospitalising but there weren't any beds left. In this situation, they would be referred to other hospitals in Dakar, to non-infectious disease wards.

For the follow-up patients, the ID service seems to have a good medical notes system. Each Wednesday there is a clinic to see patients who have recently been in hospital. There are about 15 patients scheduled for each Weds clinic and normally about 12 turn up. I wonder how this compares to the UK's "Did Not Attend" rate? An article from Sept 2009 (though not referenced) quotes a 11% DNA rate for NHS out-patients. So all things considered, in Dakar - the lack of post/telephone reminders, financial difficulties in getting to hospital, the cost of consultation itself and general awareness of what day of the month it is - a 20% DNA rate isn't so bad.

Last week, I moved upstairs to one of the wards - "La Lemière". There are 4 rooms, partitioned into 4 cubicles, so a total of 16 patients. There is one doctor - Ishmael, who is responsible for all the patients during the week. My responsibility "á la Lemière" has significantly increased compared to the first two weeks. I now have my own two patients who I see every day, as well as visiting other patients with other interesting signs. I update "le dossier" each day with "l'état general", suggest a care-plan, write "les ordonnances" (prescriptions) and requests for investigations etc. So my written french is improving fast as well as my understanding and speaking.

One of my patients is a woman of 38 years old who could easily pass for a teenager, (I find it so hard to guess people's ages here!) She is HIV+, known since Sept 2009, when she started ARVs. She stopped them in January because they were making her ill, instead she seeked a traditional healer for medicine, as a consequence her CD4 count has dropped to 3! Her family brought her to hospital last week because she couldn't move or speak (for the medics, GCS=6) She had a complete left hemi-paresis and meningism. The price of a head CT scan is 45,000 CFA (£60), the same amount would buy enough rice to feed a large family for a whole month, and the family weren't sure they could afford it. So we treated her for suspected toxoplasmosis infection and if those medications didn't improve her symptoms then we would think again... luckily after the weekend, she is sitting up in bed, eating, drinking, and asking to go home. So there are definitely success stories amidst the difficulties of healthcare in resource-poor settings.