Sunday, 24 September 2017

The children raising children


When it comes to rural medical practice in Uganda, one of the things that fascinates me is the alarming teenage pregnancies. This leads me to a story of one of my patients who came to the health facility I work in (Kapelebyong health center 4, located eastern rural part of Uganda), a 16 year old girl with her mother in law. (Yes her mother in law, its crazy!!) They came to the facility with the complaint of failure to carry pregnancy, ever since she got married 2 years ago (It means she got married when she was 14 years!!). It had been her 3rd time miscarrying her pregnancy. And this time they decided to come to the hospital for guidance.

When I first saw them I thought it was a mother who had escorted their daughter to hospital for a consultation. But she spoke out and said this girl is failing to conceive. I was very disturbed, It was already running in my mind that this is a child and marital issues should not be in her mind. In fact by what I could see she needed to go to school or she needed to be in school. Her family had already handed her over as a wife to her boyfriend who is also 16 years but he was in school at the moment. (In this rural area boys are usually favoured to continue with their education because in their understanding when a girl marries she joins the other family leaving her old family behind, so any investment in her would be a waste of time!!)   This angered me more because I knew the parents probably made her marry earlier so as to secure a bride price mainly because of the financial situation they have at home.(Poor families are more likely to marry off their daughters earlier to get bride price and this is just so sad!!)

But given the situation it is a rural area in Africa where the community still thinks educating a girl child is useless because she anyway leaves the home and gets married into another home. And marriage comes with a bride price. 

Of course I advised them to come back to the facility the next time they get pregnant. Starting a battle with them and nullifying the marriage was out of my jurisdiction as a medical doctor in a rural area guided by cultural norms.

But this comes to the main issue, many children in the rural area I work in are raising other children. It is sad but I have seen girls as young as 14 years of age getting pregnant. Sometimes the mother and child come to hospital to give birth at the same time. And it becomes worse because by 20 years, most of these girls have given birth to at least 2 children. So you can imagine when they are 30 years of age? In fact by 30 most of the women have at least an average of 8 children!! This is really sad.

Of course as a rural doctor we have started outreach programs to schools encouraging children to remain in school especially girls. But it has come under a lot of pressure and still many girls are also being put under pressure by other girls (their own peers) who already have children of their own. They usually ask questions like, “why are you wasting time? Do you want to spend all your time in school?”

It is a sad situation but the trend is now showing that a young mother is more like to bring the sick child to hospital more often than an older mother.



It is a battle we are fighting quietly. I am really interested to know if this happens in other countries. Any one who can share with me what they are doing to save their rural girls???




Me with some of the rural children of the young mothers on an outreach!



SOME OF THE OUTREACHES ENCOURAGING CHILDREN TO REMAIN IN SCHOOL. ESPECIALLY THE GIRLS..

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I am Dr. Etonu Joseph, Junior medical doctor from Uganda 29 years of age, I've been practicing for 2 years in a rural area in Uganda in a county called Kapelebyong county. I Started my work when I was 26 years old in the facility. Iam the only doctor there covering the health of 89,000 people. Being a very rural area very few doctors attempted to work there but so far i am the one who has lasted the longest in the facility..The people I serve are the humble indigenous rural people of Karamoja and also Kapelebyong county..I graduated in 2012 at the University of St. Petersburg Pavlov,the Russian Federation. But i started working in this rural area in late 2014. I ride a motorcycle to work because the roads are soo bad in the rains that sometimes it rains on me! BUT I LOVE MY WORK and I have learnt a lot from the people I serve.

Sunday, 10 September 2017

Simplicity


Fábio Schwalm

Home visit in the late afternoon
Hi Dona Ana, how is going the hemodialysis
She responds:
Well, at first it was difficult, I had a bad time ... now I'm fine ... I spend the four hours praying
while I pray
And eating?
Better now I can eat more
And how can we help?
She hold a list in her hands:
What is Damascus?

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Fábio Schwalm is a Brazilian rural family physician. He works in Brazilian South in a city called Barão. He is learning to write and grew in a rural area working in the smoke farm. 

Sunday, 27 August 2017

The day that I dealed with death peacefully

 Andressa Cavalcante Paz e Silva


“When the rain falls down / What brings it back? / Opens the resurrected cloud / From white to black / It's a second birth / For dying skin / In my coffin...” 

(My coffin - Jon Foreman)


I’ve been thinking a lot about this story. Maybe, for some people, it couldn’t be a “Success Story” because in the end the patient dies. But, as a wise once told: In life, it is the journey that matters. So, I’m going to tell you a rural success journey story.

My story begins with a young girl going to a home medical visiting in a little rural area called Curuá, in Baixo Amazonas, north of Brazil. This girl was attending Medicine classes for four years in a College School in Rio Grande do Sul, a state located on the opposite side of Curuá, south of Brazil. However, this story is not about her. This story is about the day she understood the real meaning of Rest in Peace. This girl is me.

It started out with a “Hi, good morning, mrs. Maria. Have you called out for our visit? Let me see how Mr. Manoel is going.” and them the medical interview continued.

-Thank you for being here, doctor, he is not so well. He can’t speak anymore and It is being pretty difficult for him to walk. Also, he is refusing to eat since the day he had this strong diarrhea.

- Oh, and how was this diarrhea, mrs. Maria? You see if he is suffering of pain? Tell me more about it. - The student asked.

- It was last week. It’s been 5 days since the only episode. Oh and those black stools were so so smelly as I’d never had seen!! And in the last two days he is totally constipated. We tried so hard to give him food… We even tried to lay down some pasty food and in his lips and mouth, but the only thing he wants is water and sleep. We are trying so hard to give him the medications another doctor prescribed us, as well as those nutritional supplements. Now he isn’t suffering of pain, but we are worried about inappetence.

Mr. Manoel, an elderly man aged 77, was clearly dehydrated, hypotensive (80x40mmHg) and in the neurological exam we found out Glasgow 10. When we touched his belly during the abdominal exam, his face showed heavy pain. In our hypothesis we conclude that maybe Mr. Manoel was having an upper digestive hemorrhage. 

Unfortunately (or fortunately), the medical conduct wasn’t totally accepted by the family. First, we suggested moving the patient to Santarém, a place with a hospital, in which he could do exams to confirm the bleeding and treat specifically. Nevertheless, the logistic for all transportation stuff and maintenance of the patient and the family in Santarém was really difficult. 

Actually, even if there were no problems at all, Mr. Manoel’s family had already decided he would die at home. “We can’t send him to Santarém… A couple of weeks ago when he was a little better he said that If we ever try to send him to another place instead of here, he would come to haunt us after his death for sure!” - they said. In summary, the elderly man was medicated with some Oral Rehydration Solution and referred to the doctor of the city, as I was only in an observership. This experience was really different and meaningful for me. The empowerment of that family caught my attention and I started to think about empowering my parents and my relatives to understand the finite of life and to embrace palliative care too. Mr. Manoel get better in the consequent day after drinking the oral rehydratation solution, but after two days he died at the crack of dawn. 

So, I’ve been thinking a lot about this story. Maybe, for some people, it couldn’t be a “Success Story” because in the end the patient dies. But, as a wise once told: In life, it is the journey that matters. I guess Mr. Manoel’s journey through death was peaceful and I guess he will not come back to haunt his family. 



Photo by: Keith Dalmon Ferreira
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Andressa Paz is a Medicine Student living in the South of Brazil. She loves listening to stories and rural ones are her favorite. She had her first contact with rural and remote Medicine in Kat Kalen - Haiti and then in brazilian Amazon area


Sunday, 13 August 2017

The Elderly Lady and her Chicken


Dr. Etonu Joseph

It was a usual day on the ward in the rural facility I work in (kapelebyong Rural Health Center,in north eastern Uganda), as I was doing a ward round. Like other normal days it is characterised by children having malaria and usually I review them to make sure the dosages are right and they receive the right treatment.
This particular day I noticed a chicken walking through the ward and of course I was furious(given that infection control is very important) why would a chicken be moving through the ward. Then I chased it out. The African local chicken are quite fast and of course it got away.
Surprisingly after sometime I noticed the same chicken coming back to the ward. This time I asked the nurse on the ward what was wrong with the chicken.
She then revealed to me that the chicken is for one of the elderly patients on the ward. “It has even laid eggs and it must be trying to come back to lay another one”, the nurse added!!!
This made me even angrier. How can a chicken just want to lay eggs in a hospital!!!
I matched to the patient with my eyebrows up and I noticed next to her was an old sink that was not in use, with a box and about 11 eggs. The chicken had already laid 11 eggs!!! I asked her in shock, ‘’why is your chicken laying eggs in the ward?” She replied to me, I was admitted to be in hospital for 2 weeks and unfortunately I stay alone at home. This is the 3rd time my chicken is laying eggs and the 2 previous times I wasn’t home to protect it from the neighbours who stole all the eggs. I am not willing to take any chances this time so I have decided to carry the chicken to hospital with me this time, she humbly replied. I told her that unfortunately chicken are not allowed to live in the hospital next to patients because it could cause diseases and she just kept quiet. She looked at me in confusion as to why the doctor wouldn’t understand her concern.
She put me in a dilemma I couldn’t send this lady back home because we needed to monitor her meds and it was unfortunate that she stays at home alone and all her children had moved to the city, like most of the elderly women.

We ended up having to organise for her a separate empty room to be with her chicken.

I am still wondering whether it was the right decision. What would you do in the same position?


Above you can see the eggs in the broken sink!!


Above you can see the patient’s bed!! Next to the sink!! With the chicken seated on the eggs below!!




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I am Dr. Etonu Joseph, Junior medical doctor from Uganda 29 years of age, I've been practicing for 2 years in a rural area in Uganda in a county called Kapelebyong county. I Started my work when I was 26 years old in the facility. Iam the only doctor there covering the health of 89,000 people. Being a very rural area very few doctors attempted to work there but so far i am the one who has lasted the longest in the facility..The people I serve are the humble indigenous rural people of Karamoja and also Kapelebyong county..I graduated in 2012 at the University of St. Petersburg Pavlov,the Russian Federation. But i started working in this rural area in late 2014. I ride a motorcycle to work because the roads are soo bad in the rains that sometimes it rains on me! BUT I LOVE MY WORK and I have learnt a lot from the people I serve.

Sunday, 2 July 2017

Its just God's miracle, we are just medium...


         Hello friends.Me Dr.Suhas and my wife Dr. Prerna are specialist by degree but generalist by choice.We both have humble rural background and upbringing.Hence after our post graduation we moved to rural set up for practice as we believe we have many dues towards society and community who helped us to be a good doctor.
        In rural peripheral setup you have a new day new challenge.There are many stories till now in one year. 
But the most interesting one is the 28 year female diagnosed with unexplained infertility for 8 long years. She was investigated & treated at several Super speciality setups at Mumbai, Pune, Nasik, Malegaon, Aurangabad. 

     She even underwent multiple times for diagnostic laparoscopy, hysteroscopy, IUI, IVF & her male partner was also treated for low sperm count in last 8 years but failed every time. Spent lacs of rupees for treatment but every time result was unsuccessful. Husband being rickshaw driver, due to mental frustration gave up hope on for not being able to  become a father. 

               Interesting fact is that the couple was none other than our hospital staff worker's son & daughter in law. 
After we started practice in rural setup, the staff told the story about her son & daughter in law. The couple meanwhile consulted us. Selective investigations were done as all the previous investigations were normal. We studied the case very thoroughly and with help of expert opinion of Dr. Prerna the patient conceived within a month. Her UPT came positive for the first time. 

           The happiness which we saw on her face was priceless. After proper care of thorough 9 months pregnancy she delivered a male child on 23/4/17. Staff worker's son literally cried with happiness. He told us that we are everything for him. And we told him its just God's miracle, we are just medium...

Author
Dr. is Dr.Suhas Pawar is (MS Gen.Surgeon) and his wife Dr.Prerna Pawar MBBS,DGO.They run a rural hospital named Saibaba Hospital, Satana,Nashik. Both belogs to humble rural background and are passionate to provide all super speciality services to rural people in there own community.This shall reduce there trouble to cope up with city urban life.



Sunday, 21 May 2017

The police protection

Dr. Etonu Joseph 

It was a usual afternoon at Kapelebyong Health center 4,in Uganda, like everyday during my work I see all patients with different conditions.Some of them are brought by a policeman and this would be because of assault or even rape sometimes.But this day had i saw a police officer,a gentleman well built and strong sitting in the waiting area waiting to see me. As usual because I knew he had other day duties. I allowed him into my doctor's room. I expected him to be accompanying the usual cases of rape or violence but was I wrong.

Entering the room he closes the door behind him and he sat down. So i asked him "What can I do for you?" He replied it is I who needs help, "yesterday night I was attacked by my wife and she was bitting me with her teeth" He showed me all the bite marks on the hands and the back. I felt for him because 1st of all he is a Man! And also a police man. And being in the village many men usually beat their wives and sometimes they injure them so badly. But it was very humbling to notice this policeman keeping himself calm. And he did not beat his wife(Being physically strong He didnot even fight back). I advised him to get help for his wife because he was not safe living with her.

But it got me suprised that if a policeman can seek for help on the abusive nature of his wife.Then that means he loves her and it could also mean that he respects the rule of law.But it also got me thinking as we call police for help, who helps the police when they are in trouble..?

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I am Dr. Etonu Joseph, Junior medical doctor from Uganda 29 years of age, I've been practicing for 2 years in a rural area in Uganda in a county called Kapelebyong county. I Started my work when I was 26 years old in the facility. Iam the only doctor there covering the health of 89,000 people. Being a very rural area very few doctors attempted to work there but so far i am the one who has lasted the longest in the facility..The people I serve are the humble indigenous rural people of Karamoja and also Kapelebyong county..I graduated in 2012 at the University of St. Petersburg Pavlov,the Russian Federation. But i started working in this rural area in late 2014. I ride a motorcycle to work because the roads are soo bad in the rains that sometimes it rains on me!  BUT I LOVE MY WORK and I have learnt a lot from the people I serve. 

Sunday, 14 May 2017

Isolation


Caruaru - Mayara Floss @ruralices

Mayara Floss

I need to call Emergency.
There is an emergency in the rural unit.
"But doctor, there's no phone."

Caruaru 02/17

Mayara Floss 
Undergraduate student of medicine at Federal University of Rio Grande (FURG) - Brazil. She Co-creator of project 'Health Education League'.  She is the creator of the Rural Family Medicine Café to provide a forum to discuss Rural Health – a forum for students, young doctors and experienced professors and GPs from all world. She is the student representative of the WONCA Working Party on Rural Practice. She also co-created with Pratyush Kumar the project 'Rural Health Success Stories' and writes a weekly blog of Popular Education, Arts and Health - the Ferry Street of 10.