ECU Field Journal: Africa

Marie's Blog from Lambaréné, Gabon<-- back

Oui Docteur, d’abord tout, la santé!
September 28, 2008

I often hear, “Oui Docteur, d’abord tout, la santé!” which translates “Yes Doctor, my health comes first!” This seems to be an ingrained response for patients here. If you ask them if they could cut back on smoking, drinking, eating, or whatever the case may be, this is invariably the answer. In using this reflexive response, I know patients are telling me what I would like to hear, and it does not frustrate me the slightest. Rather, I catch myself grinning at their response. I know they mean well and are trying to acknowledge my request. Life is so much different here that such behaviors may be the least of their worries.

In an area that is laden with parasites communicable by wind and earth, poor water quality, and primitive living conditions, the focus on health is much different than in the United States. In my Western attempts to keep up my health, I often jog around the hospital and through the villages. I must say that I never feel more out-of-place, more awkward, or more the center of a spectacle than when I do this. As I am running, hoping to improve my cardiovascular health, the people here are carrying buckets of water from the river to use in their homes. My presence sometimes feels almost anachronistic during these moments.

I have been here long enough that my follow-up consultations are returning to see me. It is with these patients that I realize how far I have come in learning Gabonese medicine. The prime example came with a 20-year-old woman who first came to me with a history of intermittent episodes of shortness of breath, chest pain, heart palpitations, and fatigue. The differential diagnosis is very long for such complaints. It could be many things. Upon further questioning, she revealed occasional episodes of constipation. When asking if she had this problem before, she said that she had a few years ago. She said, “I went to the village doctor and he gave me some herbs. I was a little better after seeing him, but not really.” I did not find anything remarkable on physical exam, so I ordered blood tests to look for anemia or even infection and then a chest X-ray and electrocardiogram—as the prevalence of heart and lung problems are quite high here. In short, the results revealed mild anemia, but not much else. We sent her home with vitamin supplements and ibuprofen and told her to rest at home. Three weeks later, she returned with much the same symptoms. Only now, the answer seemed obvious. I ordered a stool test and discovered she had ascariasis, a parasitic worm. It explained her history, but you see, when she first presented three weeks ago, I had not yet developed my worm radar. I wonder how many worms I missed before now!

Now that half of my stay here in Gabon has passed, I can already see how I much I have learned, in and outside of medicine. I have had the opportunity to experience so much of the culture and made so many new friends. The day we must say au revoir will be bittersweet. I thank everyone for their support and e-mails during my time here. It is being able to share this experience through my online journals that makes this journey so memorable.