Being a patient at Nyakato Health Center

*** The italicized text is told from the perspective of a patient and the normal text is told from the perspective of the student assistant****

Upon arrival at the clinic you wait at the Mapokezi (reception) window to receive your number. Assuming the power is working, Mariam processes and prints your chart. If you are a new patient a crisp white piece of card stock with your name, age, and address still warm from the printer is handed to Elizabeth, fondly known as Bibi (Grandma), who brings the chart to the triage tiki hut. If are you are a returning patient you must wait until Mariam has time to pull your chart from the shelves. Filed in manila folders with tattered edges, worn from being shoved in and out of the shelves so many times, the old patient records are kept in batches of 100. Mariam sifts through each numerical file until she finds the correct number. Your chart is pulled and sent off to triage.

In the triage tiki hut you await your turn for your most up to date weight, temperature, blood pressure, and pulse to be recorded. My favorite patients are the babies who are weighed in a gray sack with leg holes on one side and ribbon on the other. Once the baby is inside the sack you hang them by the ribbon onto the hand held scale where they remain suspended in mid-air, dangling precariously, until their kilograms are recorded.

From the triage hut you are taken to wait in front of the doctors office. If you are the student in charge of triage, every time you bring a patient to the doctors door, you must knock, wait for the infamous karibu (welcome) from inside, and then hand the doctor the chart. It doesn't matter who is in the room or what kind of procedure is occurring...patient privacy is a concept that has yet to ripen at Nyakato. The patient then sits on plastic picnic chairs outside the office, anxiously listening for their name to be called.

If you happen to be assisting the doctor for the day you better have done your hand warm-up to prevent serious writer's cramp. Not only do you take the history and write the physical exam by hand in the patients individual chart, but then the information is recorded in the government log book. On top of that if you are going to send the patient to lab you must re-write all of their data onto the lab form and then again on the prescription pad. It gets tiring!!!

After waiting outside for up to an hour you are finally called into the doctor's office. As you begin to reveal your aches and pains at least two other patients enter the room bringing their lab results back or a nurse pops in with a question, or by far my favorite interruption occurs when the local ice cream van arrives and sooner or later a dripping ice cream cone is handed into the doctors office. Slurping down the quickly melting ice cream Dr. Bon cuts to the chase. Do you have a fever, body aches, mouth sores, night sweats, a cough, nose bleeds, heart palpitations, vomiting, diarrhea, or abdominal pain? If you answer yes to any of the above symptoms, you can be assured that you will be sent immediately to the lab for a malaria blood smear. With lab sheet in hand you scurry back to the reception window. This time you fight for a spot in line to reach Mariam and pay her for your lab test. With the official stamp firmly etched on the bottom of your lab sheet you are off to the Maabara (lab). Fingers are pricked, blood is drawn, and lucky you if you need a stool or urine sample. The patient bathrooms are located outside the clinic about 100 feet down a well worn dirt path. After receiving your numbered specimen container from the lab you traipse to the choo (toilet) and then back to the lab again with filled specimen container in hand.

When you are the student helping in the lab your favorite jobs are the finger pricks and blood draws. It is unfortunate if it is your day to help in the back. Essentially you are on urine and stool duty. Every urinalysis is dipped, read, and a microscope slide is prepped. Now the urine is not that bad. Stool on the other hand, leaves room to be desired. More often than not you hold your breath as you open the stool sample container. Using a broken wooden dowel you scoop a small specimen onto the slide, smear it around in iodine, and then close the container and dump it into the trash can as quickly as possible. Jimmy,the lab technician, reads all the slides and writes the results on the patient's lab form. Everything is recorded by hand into Jimmy's lab book before you return to the door of the lab and call out the patient's name, often making a fool of yourself for your mispronunciation.

Results in hand you rush back to the doctors office where you simply stick your hand around the doctor's door waving your lab sheet until the doctor pulls it from your grasp. Sheet in hand the doctor shuffles the lab results back into the growing stack of charts on his desk. One new patient, one set of lab results. The never ending cycle continues.

When you are called back into the office to get your results you may not even sit down before you are handed your prescription and sent on your way.

Third time's the charm at the reception window. You pay for your prescription and then waltz across the entrance to the pharmacy window where Fridah counts out pills by the dozen.

A quick trip to the doctor takes at least two hours on a good day. However, you never hear anyone grumble or grimace. Instead the open courtyard waiting room is filled with friendly banter and children giggling. This is why I love the Nyakato Health Center, despite its inefficiencies.

Amit just posted a blog about our health education presentations so check it out!!

http://theguptaman.blogspot.com/