Overwhelmed

One of my patients, a young woman of approximately 16 is currently hospitalized due to recurrent high fevers and a severe pulmonary infection. When multiple different antibiotics resulted in little to no improvement, we moved to the diagnosis of tuberculosis and began treatment.

However, this morning, while preparing to do rounds on the ward, I was told that this patient was again running a very high fever. Upon examining her we found that in addition to her tuberculosis, she has a very swollen and painful left thigh. Her heart and respiratory rate were greatly elevated and she began convulsing.

After running a few quick tests and giving her a sedative, I added medications, spoke with the family and reminded myself to check on her at the end of the day.

When I completed work in the clinic, I spoke with Dr. Jacqueline Koster, who had been with me during the patient's episode of convulsions. She had visited the patient to obtain more history and at that time the mother confided that when her daughter began experiencing abdominal pain that morning, the family had desired to take her home immediately.

Apparently they have been greatly concerned and frightened that there is someone in the village practicing witchcraft and that their daughter is the target. When the patient began experiencing this symptom of pain in the “stomach” the family believed that the evil spirit was trying to eat her. This “tactic” of witchcraft is very well known, and some victims even choose to take their case before the Laamido (chief of the village) in order to punish the alleged perpetrators.

Whoa...

So...what lab test can I order that would give me that kind of information?

I sat in stunned silence wondering once again how I will ever break through the barriers of language, culture and spiritual beliefs that keep me from understanding these people I want so desperately to be well.

Every time I step on their cultural toes with my actions or mannerisms, every time they try to explain their symptoms in ways I simply can not understand...I wonder the same thing. When they come in to the clinic, having cut or burned themselves, trying to cure themselves of their illnesses, I just look at their scars or burn blisters and am reminded again of all that I don't know.

I'm chipping away at the tip of the iceburg, just hoping to treat what I don't fully understand.