Worms!!!!

I was in Lobatse today and spent some time in a local clinic with an MO from Nigeria. That the majority of out-patients we see have so-called “medically unexplained symptoms” is a source of both fascination and aggravation. Yesterday I was in a rural area of a district north of here where a Penn medicine resident and I saw about 40 pts in 2 ½ hrs, ALL of whom save one had the above MUS. I’ve ranted about this in the past but yesterday took the cake. To make a point with the staff of the outpost I resisted giving out meds and wound up Rx’ing just one antibiotic for impetigo.

 The MOs here see all the hypertensive patients every month for refills of their meds. Because this is a relationship based society the patients will say anything necessary to get the attention of the MO and get what has become the currency of medicine here and in all developing countries; medication. So virtually all patients leave with paracetomol (acetaminophen), and some Vit D tabs, Wintergreen oint for application to whatever hurts, iron supplements (see “Geritol”), and folic acid. Which of course reinforces the  behavior in the first place. So I had a woman (it would seem the average patient with this schema is 25-55 and female) return three times for meds when she was asked to refill her BP meds and informed that her (no less than) SEVEN somatic pains would go away in time, and without any other medical intervention. That we are told nothing resembling the truth is something I have become used to and have learned to rely on instinct and physical, and treat nothing I can’t see, feel, touch, or test. So the currency of medicine here is just that, medicine, not information by way of reassurance. And the truth is not a part of the equation. It was this way in Sudan but the patients may have walked for three days to see us and the trip alone had exhausted them, necessitating some form of medical intervention. Some days are more frustrating than others and today was that kind of day.

 I went back to the hospital at about 1230 and met a good friend of mine, Roger, who has been assigned to A&E and maternity. We discussed cases and as we were ready to head off for a mid-day meal he invited me to his home for lunch. We got there and were surrounded by elementary aged girlies playing with dolls, running around playing hide and seek, and women fixing a huge meal for us. Part of it was a dish of mopane worms. These are caterpillars that are harvested in the late Spring/early summer (read November and December) and dried for eating later. They are sold in bags at all local markets and stands. The Zambians (Roger’s nationality) are also famous for enjoying them and now a bald headed guy from Oregon is too. They are chewy, salty, gritty, and loaded with protein. We ought to give these out for all the somatisizers that plague our clinics. At least that way they would get something of value true proteinaceous value. So I get to check that one off my culinary list….

 Best of luck to our friends that are headed to masters nationals in Clovis, CA!  Just remember, it ain’t Fresno, it’s Clovis, so it could be worse. Seriously good luck, good times, good fun!