Yesterday we conducted a community health fair and saw 232 people from 8 am to 3 pm. It went great in terms of the showing and our efficiency. The hardest piece was communicating the concept of a health screening to the people. Since there is zero preventive health in Afghanistan, people don’t get the idea of shots, etc. ahead of time (before acute illness), much less the concept of a “health evaluation” that gathers data rather than treats their problems. Dr. Wagima, the female director of the outpatient clinic (Afghan native) did a great job of explaining this to the patients, but it didn’t stop them from meandering around looking for another person in a lab coat (like me) to pester about muscular pains (from lifestyle, not illness) to get medicine for. Although we are running some reports of this data, we are mainly brainstorming how to modify the screenings ask more direct questions and to revamp some of our hypothesis (there is much less anemia than we thought – at least coming from this one community). The most encouraging piece of the whole health fair, I must admit, was that a group of 12 high school girls who came to volunteer (and who we coerced into translating even though they were incredibly timid) and became very excited about becoming community health workers as a consequence. Some were even professing an interest in the medical profession; really, this is our dream: to have young people get excited to take our work back to their communities in a sustainable way for years to come.
Medically, stuff is crazy. In PEDS ward we have 2 patients with liver problems. One has a cyst that needs an operation. His belly is swollen and discolored. Unfortunately, the child’s father has grown inpatient with our differential diagnosis strategy and search for a clear understanding of the kid’s problem. He’s demanding meds and eager to return home. We worried this afternoon when we noticed the father and son on the steps of the hospital appearing to be preparing for their 17 hour walk home (luckily they returned for the surgery later). The other child has a belly rivaling the beer belly of any 40 year-old baseball fan (at the age of 6 or 7 – age is nominal here, no one knows when they were born). Jerry and Chris (our pediatricians) are unsure of the diagnosis as of yet – it could be a cyst, liver tb, hepatic hypertension or metastatic cancer. It’s incredibly sad to see. There are just so many abnormalities. Many, like club feet and gastroschisis, are likely the result of poor genetic combinations (such as first cousins marrying). Then, there are the deformities caused by the lack of access to good health care. This was the case with a little girl of 4 who I screened yesterday. Annie (our nurse) noticed that her spinal column was misshapen…then, as I laid her in the baby basket for her weight I noticed her poor responsiveness: she was the first child not to squirm or cry. Even when I laid her on the scale and her mother’s hand slipped from under her head causing it to clunk against the wooden scale, she only gasped a 2 second cry then immediately returned to sleep. (She was admitted to the ER, and, shockingly enough acted completely normal 1 hour later with perfect reflexes. Our docs got from the mom that she most likely caused the child to overdose of meds that she picked up from the pharmacy…on a side note, this is a HUGE problem here. There is no need for a prescription to get medicine. Just walk up to the pharmacist and ask for what you want and you’ll get it 90% of the time).
Culturally, many things are different. When I take women’s blood pressures, I must divert my eyes from theirs and not even look into their face. Many are ok rolling up the sleeves of their burkas, but some act flustered and cover the bare skin where my stethoscope is not with the drooping burka of their other arm. Some look ashamed and cover their mouths. It’s as if they know their husband’s mind and fear his standards of modesty – even when apart from them. Luckily, I haven’t made the mistake of offering my hand to a women yet, but I did forget about crossing my legs out in front of me (showing the bottom of your feet is a sign of disrespect). At lunch, the men and women sit at different tables and converse separately. And, of course, my beard is only a small culturally sensitive piece of the appearance puzzle that includes long pants and sleeves and a vest (and many times a turban).
Well, I hope this opens your eyes to some of what we are seeing and doing here. I hope to write more soon and maybe even include more photos.