When I am performing occupational medical examinations, I have to use a spare room which has no door. This is why there is no door in this Thursday Doors post. Sorry.
About a fortnight ago, men in camouflage uniforms began turning up at the health centre insisting on having a medical check up. Most of these men were in prime condition and many of them had been working on anti-poaching duties for decades. “Why do you need a check up?” I asked them. A few just shrugged their shoulders and shook their heads. A few mentioned chaos in Human Resources or a reshuffle in the responsibilities of the departments of the Ministry of Tourism, National Parks and the Arts. Apparently, lots of paperwork had been misplaced or gone missing, so everyone had to photocopy their original documents for re-submission. This included a medical examination to be carried out by a doctor.
No one knows for certain how many wildlife police officers, storekeepers, plant operators, general office workers, supervisors, rangers, etc. there are in Mfuwe. Guesses ranged from 100 to 250. That is a helluva lot of medical examinations. Not only did these “big men” barge in on consultations with sick patients, they insisted on being seen as a priority. I talked to the nurse in charge, who agreed to take up the issue with his counterpart in the Wildlife Authority. “I will suggest that we should limit the number of examinations to five per day, first thing in the morning,” said Martin. I spoke to my boss, the District Health Officer, who said that any health worker could sign the forms. “But it specifies doctor,” I said. “Don’t worry about that,” he replied. In practice, the WPOs demand to see the doc.
Each day, about ten officers chance their luck, waiting for me just before 8am. If a senior officer comes along, he takes priority and jumps the queue. I try to get the triage health worker to record their height (we only have one measuring rod and it is in the mother and child health block), weight (the glass on the scales is so dirty and scuffed that I have to crouch down to make a reading), pulse and blood pressure (both our electronic sphygmomanometers died last week, so I do this by hand).
I can’t help myself from teasing the officers: “So, you are a Wildlife Police Officer? Have you arrested any lions for grievous bodily harm? Or have you booked any impala for exceeding the 40KPH speed limit?” Usually they don’t understand my warped sense of humour.
The forms look as though they have not been altered since Independence and ask me to assess their body type and their mental state. I ask them, “Are you strong?” and they all say yes. “Are you mentally stable?” and again, they all say yes. I asked one chap this morning if he was sure, and he said, “Decisively stable!” The door to the office doesn’t close properly (there is no handle on the inside), so the next officer in the queue watches what is going on. Sometimes I ask him if the person I am examining is mentally stable. This usually produces a guffaw of laughter. Especially if he is their boss.
Some men are grossly overweight with pendulous abdomens. I have to measure their girth and their chest circumference, expanded and deflated. None of them understand my order to “Take in a big breath and hold it; now breathe out fully.” The official form suggests that all the officers must have a chest radiograph, but this is neither possible nor justified.
I ask all the officers about previous serious illnesses but not one has confessed to having hypertension or HIV. One man needed to be accompanied by his son and asked me if I could sign him back to work after he was hospitalised with cerebral malaria. Sometimes, they will even ask me to prescribe their blood pressure medication at the end of the examination. About 20% of the officers over 40 years of age have elevated blood pressure when I measure it. I give them the usual advice regarding lifestyle changes and ask them to return for further BP checks. I write about this in the comments section at the end of the report, but as hypertension is asymptomatic, the officers don’t regard a blood pressure of 200/120 as preventing them from working.
There are questions on varicose veins, hernias, the state of their teeth, hearing and speech, but nothing about their visual acuity, which I find strange when their job involves tracking poachers and looking for snares in the National Park.
We have had no urinalysis strips for two months. The nurse in charge insisted that we use scarce health centre funds to buy some strips. Part of the medical examination involves testing urine. I refuse to waste urinalysis strips on asymptomatic, fit officers, so I just write “not required as has no symptoms.”
Finally there are some questions about patellar reflexes and pupil reactions, before a section marked “Comments”. I normally write “Fit”, sign, date and state the name of the health centre. We have one official health centre stamp, which has a central date. The numbers of the days of the month have fallen off, so I have to write that by hand. The ink pad is so parched that even with brute force I can only print a faded, illegible blue image.
I was taken aback when a senior officer asked me to use a darker stamp so he could photocopy the forms. At first, I thought he was asking to get “pre-stamped” forms which could be completed by anyone. Actually, he just wanted me to re-stamp all the photocopies of forms which I had completed that morning as the officers had made duplicates.
If it were up to me, I would abandon all occupational medical examinations as they are useless. I would introduce a more practical test – How fast can you run after a poacher? Can you sprint 100 metres in less than 15 seconds wearing full kit?
While I am filling in the forms, I make polite conversation. “Did you shoot the crocodile which attacked the 13 year old boy who was fishing in the Lupande River? On the news, it said his leg was allegedly in pieces.” No, they hadn’t located the crocodile. But they had responded to a distressed hippo which had strayed away from water and was sick. “We told the villagers to leave it alone, but they did not understand us,” said one WPO. “After we left, they attacked the hippo with machetes to get the best meat before it died and the hippo became very angry. It killed one of them.”
The atmosphere this morning was rather subdued. It transpired that, allegedly, a civilian (a teacher?) had visited a bushcamp, picked up a semi-automatic weapon and fired three shots into a wildlife police officer’s chest, killing him instantly. There was a large crowd of family members outside the police post at Kakumbi, waiting for the body to be recovered. I wonder if the shooter would have passed the medical examination, especially the mentally stable question?