This is from my journal, five months ago in Kutupalong Hospital, Bangladesh. There are some photographs of a few doors in this piece, but it is worth reading if you are interested in what it can be like working in a refugee camp.
The young man looked ill. His hair was plastered onto his forehead with sweat. The medical assistant asked him to leave so I could see a different patient. I said, “Wait a bit. He’s unwell. Let’s sort him out first. What’s his story?” Just fever.
Fever for ten days. Ten? Getting steadily worse.
What else? Nothing much. “Bish (pain)?” I asked him.
A headache, bellyache, a bit of diarrhoea, not severe, no blood.
Feels tired, not sleeping, poor appetite.
Helal, the medical assistant, and I looked at each other warily. I said, “Could be typhoid. All he needs to have is a slow pulse and it would clinch the diagnosis.”
Helal took the right wrist, I took the left. The pulse was far too slow for the height of his fever, a characteristic sign of typhoid. We nodded at each other. I remarked that it was a good catch and he prescribed the ciprofloxacin.
The patient he wanted me to see was a little boy with a painful, irreducible hernia. The last child with a painful hernia I sent to the surgeons actually had an inflamed appendix in the sac. He ended up having two operations for the price of one. So I have a low threshold for referring hernias in children. This little chap had so much intestine in his scrotum that you could see the peristalsis, visible movement of the bowel. It was so big that it was a struggle to fit it into his shorts. There was no clearance for him to pass urine properly. I made a clinical decision to refer him, even though it is stretching our guidelines to refer only urgent cases.
I see the most horrendous eye conditions. Every day, three or four people come to the hospital with incurable eye problems – penetrating injury by splinters of bamboo, blunt trauma, corneal ulcers and cancer. My last teaching session to the staff was on the subject of eye disease. I have a complete set of illustrations of the common eye conditions the doctors are likely to see, all photographed here in the hospital. I would like to say a word of thanks here to HughdeBurg, for his swift replies to my requests for ophthalmological advice. I hope that this will help to reduce unnecessary referrals to Chittagong Eye Department, six hours away by road. I have donated my personal ophthalmoscope to the clinic so the doctors can examine patients properly.
My day is often like this. I hardly ever see anyone who is not sick. Quite often, the doctors call me in to confirm that there is nothing more we can do for patients. They want me to be the one to deliver the bad news. The disease is too advanced or too difficult to treat in this setting. Patients suffering from end-stage kidney disease, a cirrhotic liver which is decompensating, cancers, heart failure, or ruined lungs from a lifetime of cooking with biofuel in a confined space. I feel I am a harbinger of doom.
Every now and then I see patients who have scraped together enough cash to pay for the opinion of a local specialist. Even when the evidence is incontrovertible, the specialist will never tell them they are dying or that they have incurable cancer. Perhaps it is traditional to do this, not to take away any slim hope of recovery. Maybe I am more cynical, thinking that a desperate patient will pay for more consultations and treatments as long as the stark truth is withheld from them.