I was nervous that I wouldn’t be able to go to the clinic after an armed robbery of SHAWCO volunteers in Khayelitsha the week before, but we received news that we would still be able to attend clinics. I arrived at the bus tonight at 6pm as usual, hoping to have some interesting patients. I didn’t even realize until we were on the road that I had gotten on the bus that goes to Masiphumelele, a township in Fish Hoek. It was one of the most beautiful drives I’ve had in my life, winding through mountains as the sun set over the ocean.
We reached the clinic as the sunset ended, and unloaded our supplies. I shared a room with two other students, and after seeing some children on the patient list we immediately claimed ourselves as the pediatric room. Our first three patients were kids. Ages two, five, and seven. All three of them had a similar rash, which we later discovered was a fungus that is easily treated with a topical cream.
The two younger children also had fevers, bad coughs, and sore ears. I was able to do the physical examination of the kids, which involved looking at throats, listening to breathing, and looking inside the ear. After we had finished taking their history, we had a long wait until the doctor could consult with us and give a treatment plan.
Unfortunately, children ages two through seven are not the most patient age group. After only a few minutes of waiting they started to get anxious and upset, the youngest started crying. I realized this was my chance to put four years of working with kids as a swim instructor to use. I grabbed some gloves and turned them into balloons, drawing faces on them, and gave them to the kids to play with. We spent the rest of the wait playing volleyball with the balloons, and by the time the doctor walked in, the children were not acting ill at all. The two younger kids were diagnosed with viral respiratory infections and just prescribed symptom treatment. After being with the kids, I realized how much respect pediatricians deserve. Not only is it so sad to have to see children in pain and sick, but also it’s so much harder to get normal tests done with kids, who often have their own idea of what they’re going to do and don’t follow instructions.
Our next patient was an 18 year old girl complaining of a heachache. She didn’t have any unusual symptoms, but we had a lot of time to kill before we could get her to the pharmacy for some painkillers, so I was able to practice taking her blood pressure and also doing a neurological examination, which tests the functions of all twelve cranial nerves. It was a good review of my neuroanatomy, and also gave me some extra neuroscience skills, something I’m always hoping to gain.
The Doctor came in and we explained the headache. She immediately leaned over to me and asked if we had looked into any social issues at home. At first I didn’t understand what she was saying. She then left, saying she needed to go check if there was a specific medication at the pharmacy. While she was gone, we asked the patient about any stress she was under, boy problems, family problems, etc. but she said nothing else was wrong. She also said she had missed school that day and would need a note to be excused.
The Doctor returned from the pharmacy and told me to write a prescription for a placebo pill. At first I thought she was kidding, why would you prescribe a placebo? I then realized that the girl only wanted the note, and a minor headache really didn’t need any medication, but I still felt wrong giving a placebo. In my mind that was lying to the patient, disrespecting their trust. I took her to the pharmacy and they ended up giving her Panado (South African equivalent of Advil), which made me feel much better.
Back on the bus, we told the rest of students about the placebo prescription from the Doctor, and they all agreed it was ridiculous. We had to give one of the students an HIV test on the way home because he had been pricked by a needle a few days ago. The students joked about doing the test, and acted like it was no big deal that he may have contracted the disease. In my mind, getting HIV is one of the most serious things that could happen to you. This just goes to show how common it is to see HIV in South Africa, which is a sad reality. The test came back negative (luckily!) and so the rest of the ride home was very fun with the usual cookies, juice and discussion about patients we had seen.