May 28, 2012 – A Day of Free Medical Care – by Carol

The situation: One of the students at school had what I believed to be a pretty bad epileptic seizure. She was limp and completely unresponsive to touch, talk and people moving her body. She was having medium convulsions, swallowing weird and was cold to the touch. While I was freaking out about it – several teachers told me she sometimes does this when she is angry and can’t get her way. This girl is the one of the best highest achieving students in the school and the teachers sounded completely absurd.

One teacher insisted this was an African curse. She didn’t deny to me that she may be seriously ill, but suggested that a traditional healer could dip her in water or fire and “cure” her.

There are no ambulances or I would have called one to take her to the hospital. Her parents eventually came and told me this has happened before and a doctor told them it was nothing.

She was at school today although she looked drained and puffy. I explained what epilepsy was and told her she should go to the doctor and go home. She asked if I would go to the doctor with her because no one ever explains things right to the doctor. After getting permission from the Peace Corps, her parents, and the school (3.5 hours) we walked down the road (no transport offer from anyone) and I paid for a cab to the hospital.

Free Health Care: We stood in a queue to check in, about 15 minutes. We got yelled at by the check in host and every single other medical person we saw, because she did not have her medical records. In Botswana each patient is responsible for keeping their medical records and people are supposed to bring the records to the doctor/hospital/clinic.

Intake sent us to see a doctor. The intake to see a doctor queue was 20 minutes. They told me we must go to the youth clinic instead. They would not listen to what we needed (there are only nurses at clinics) and refused service. We left for the youth clinic.

The queue at the clinic was only 15 minutes. The nurse in charge told us they only treat medical problems nurses can treat and the girl will have to go back to the doctor queue. This time they also yelled at us for not bringing a parent. While the same sort of rules exist for parental/guardian consent and confidentiality as the United States, none of these rules/laws are adhered to. So I wasn’t that concerned and told the nurse I would work it out with the doctor. (Can you imagine a teacher from school taking your child to the doctor for medical treatment and everyone agreeing it is ok to talk to the teacher instead of the parent?)

I asked that she take the time to write-up the incident as that would be my “official medical record”. I suggested that the girl had epilepsy, and the nurse wrote it down. The nurse became angry when she heard the girl was unconscious for 5 hours and her parents did not bring her to the emergency room. She told me I was a good person and the doctor would probably work with me.

Back to the doctor queue. We are number 67. The doctors are now seeing number 21. It was 12:00 PM. I was told, by another patient, it was unlikely I would get service today, but those of us that did not get service today would be first in the morning queue.

The Order: Someone else told me to talk to the head nurse about “the order”. The head nurse explained that if a patient has a job he/she can cut into the line at the sixth space. Also if a patient is a student he/she can cut at the sixth space (even when the people from the day before are still waiting). However if you are a prisoner you can go first because no one wants to wait in the room with the prisoners. I was glad to hear there is one place that being a student has a value!
When we tried to get into the sixth space in the queue, all chaos broke out with people furious that we were cutting. They yelled that I should have come first thing in the morning!!! The head nurse had to restore order and physically make space for us in the queue. (Total 1.5 hour wait)

Finally we get to see the doctor. She reads the nurses “report”, which was my description of events and says, “Ok, she has epilepsy.” While I was feeling pretty good about getting this girl some medical treatment, I am starting to get a lump in my throat. No doctor in America has ever, EVER confirmed my own amateur diagnosis. In fact they often laugh at my outrageous assumptions. Now, without tests they are going to give her the diagnosis that I suggested/guested.

I asked if they would be doing any tests, and the doctor said my description of the event and the girls’ assertions that this was the 6th or 7th time this has happened, made it sound exactly like Epilepsy. Now I was sorry I had read all about Epilepsy on the internet just hours before coming so I could give such a good description. I said I would feel a lot better if there were tests.

The nurse checked her pulse, temperature, blood pressure and weighed her. Then the doctor wrote what she called a “very strong prescription”. I again asked about a blood test and just threw in that we get blood tests done nearly every time we go to the doctor in the U.S. She told me the girls parents should have brought her last night during the 5 hour-long seizure – that would have been the best time for the test. Ok – but is that it? No other chances? Should we just hope the meds are fine and bring her in during the next seizure?

She said she will schedule a blood test for the next day. Then the girl asked if she could get a heart test too – because she thinks she has a bad heart. The doctor tells her that her pulse was fine. The girl says, “When I get scared my heart beats very fast.” The doctor then agrees to an EKG. By this time the lump in my throat is beyond huge. I am fearing my good deed is turning into a medical nightmare. I didn’t have enough of a doctor/science mind to have taken high school chemistry.

I say a little prayer – a pleading to God – please don’t let anyone take me serious. I remembered I always exaggerate all medical incidents in the US because the doctors there put things into the correct and trained perspective. But here it seems my word is Gospel.

The problem: This is another culture problem for me. In America I can say anything, and everything, and people just take what I say as “something Carol thinks”.  Here people are respectful and they listen and act like if you had the nerve to say something it is probably well thought out and meaningful. Especially if you say it with confidence and authority.

I must learn to step down – be quiet, be more humble. “Thinking out loud” is never taken as speculations.

The Pharmacy:  We go to the pharmacy queue, another 45 minute wait, to get the medication and the pharmacist says the prescription has to be wrong and gives us the pamphlet in 6 point font from the pharmaceutical company and tells us to go back to the doctor.

We get to skip the queue, which only makes everyone angry a second time. The doctor we saw is gone and so we see another one. He ponders the prescription for a while and asks a lot of questions, which were not asked before, about history and intensity and details of the seizure. He declares the first prescription completely wrong and writes a totally different thing (Please God, Please God – be watching down on us). Back at the pharmacy, she again says it is wrong and we go for a third re-write (cutting in the queue for the third time). Finally we get the pills I have no faith in what so ever and I take her home to her parents.

Good Parents:  She has good parents, but they are not very educated. I explained everything to the mom, and she asked why the doctors never told her about the epilepsy and instead told her that her that her daughter had too much wind in her lungs. I am afraid to say that I think the doctors affirm what you tell them you think is wrong. Her mom will take her to the rest of her appointments, and I am so glad that her parents will take care of her from here. Maybe their silence is better for her than my guesses.

The one good thing: We didn’t pay for any of this. But I am worried about that saying that goes, “You get what you pay for”, is right.

I hope I did the right thing. I again, wish I had the resources that are always available everywhere in the USA. I could have taken her to the emergency room and got “free treatment” there too. They send a bill, and maybe a collection agency – but she would have care, and a diagnosis from someone besides a person that couldn’t hack a chemistry class.

My desperate conclusion:  Please, God, make it be ok.