That’s a phrase I’ve heard several times in my few weeks at the clinic. My learning curve still feels as if it’s going straight up! I have so much to learn and to know! However, no one here ceases to be amazed by things that people come in with. It’s fun for me to hear a career missionary doctor with many years in this country say, “Now this is an interesting case…” and go on to discuss the signs and symptoms and the possibilities of diagnosis and treatment for a particular patient.
People are people the world over; so health problems familiar to us all—i.e. hypertension, diabetes, arthritis, asthma, broken bones, congenital anomalies (birth defects), etc—are present. However, we are in a climate that strongly encourages infections to grow.
Misunderstanding the causes of illness due to spiritual beliefs or traditions of the family may allow the condition to get worse before they come see us and those beliefs, traditions or family situations may limit their treatment of the problem. On the other hand, they may just “not want to bother us” so they put off coming, like one missionary who had an infected boil on his finger that we’re still treating two weeks later because he “didn’t want to bother us”! Or they may be in a location only accessible by a days’ walk out to a small clearing on which a helicopter might be able to land if the weather permits, as one of our missionaries recently experienced. All of these add up to some “interesting cases”.
But before you can jump into an investigation of the problems they present with you have the adventure of figuring out the “back story”…How did this happen? When did it start? Where have you travelled? How have you been treating it? What makes it feel better? What makes it feel worse? You have to love it when the story starts out with, “Eight months ago a bus naip (machete) slipped out of my hand and cut my foot.” Or, “Twenty years ago I started getting infections in my right ear.”
Sometimes the stories make sense and sometimes they don’t! One man came in with his thumb split open at the tip. He’d been cutting with a power saw and slipped. Makes sense. Another man said that “Fourteen years ago, he had been playing rugby and accidentally stepped where someone had spit on the field so now he has a cold.” (Huh?) On the other hand, a child has symptoms of malaria, recently travelled to a lowland area where malaria is present, shows low platelet count indicative for malaria but other lab values are vague, every test comes up negative (for malaria and other diseases) even several days later, microscopic study shows nothing even to the experienced eye of our doctor, and other symptoms are present that can’t be accounted for easily in any of the many diagnoses we’ve considered. Sometimes the stories of the problem make sense and sometimes they don’t!
One of the more fascinating was a very sweet woman with profound hearing loss brought in by her sister-in-law who would interpret into their Tok ples (tribal language) or phrase things in Tok Pisin in such a way that she would understand, making sure she could see her mouth moving, repeating as needed, etc. She came in to see if we could help with her hearing loss. Through some questioning, rephrasing and “storying” with them, we found out that she had had infection in her right ear for the past 20 years, which had been treated off-and-on with Amoxicillin (one of the most common treatments given here). This constant infection would diminish while she was on the antibiotic but then come right back when she had finished it. It also led to severe hearing loss on that side. Then two years ago she had been walking along a path when a man nearby was cutting down a tree but because of the hearing loss didn’t hear anything. All of a sudden the tree dropped, hitting her on the head, knocking her to the ground. She had had bleeding from her left ear for a few days afterward and had badly bruised and hurt her whole left side. Since that time, she’s had infections constantly in both ears and the hearing loss worsened. Another interesting point, many here don’t keep track of how old they are past childhood. When I asked this woman how old she was, her sister-in-law replied that they didn’t know because the woman’s mother had died. The woman herself didn’t know but could tell me that she was an adult when the ear infections started. During our conversation she also shared with us that due to the problems she had, no one had married her.
As the examination went on we began to piece together that she had been born with several congenital anomalies. One of the more obvious was that she couldn’t bend her left leg. The knee itself felt as if it had a large amount of overgrowth of bone and no knee cap. We opted to take an.x-ray of her leg and when we did, we couldn’t believe what we saw! The whole leg had formed correctly. …Except that the lower part of the left femur (upper leg bone) had twisted during development, leaving the upper half of the knee joint facing outward. The lower leg bones and hip were unaffected and in their expected postions!
In our interactions with this woman, we observed that she also had a few mental delays, though minor. Realizing that the health problems she had all seemed to point to several congenital anomalies, we concluded that the combinations of possible birth defects in the inner ear combined with 20 years of chronic infection may have made the hearing loss permanent. We decided to treat the double ear infection with strong antibiotics, though due to the chronic nature and the climate we live in, there’s a good chance that it would return. The leg we can do nothing to repair.
Hearing all of these things, this may seem a sad and disappointing visit with no happy ending, But this woman didn’t leave discouraged. She and her sister-in-law thanked everyone for seeing her and for the medicine. She said that she didn’t mind that she hadn’t married because that left her free to serve God in His church. She was so happy that God could use her there that she didn’t mind the inconveniences of having a leg that wouldn’t bend or ears that could barely hear. She was perfectly content that God had made her just as He wanted her to be. Instead of being discouraged or bitter, she was joyful, content, oh so loving to everyone, and happy that she could serve God and be useful to Him. No. It wasn’t a sad visit at all! Challenging, amazing and “interesting”! …But not sad.