OPD (Mis)adventures

We thought you might like a description of a typical day in the life of a Bangla-doctor, since we haven’t really delved into the medical side of our trip to much extent. Usually, we get up and have breakfast at 7am, then head to the hospital by 7:30 or 7:45. Rachel rounds on the postpartum patients, fistula ward, and GYN patients until 9am or so, and Eric rounds on male and female medicine patients until 10:30 or so. Maybe Rachel will have a case in the OR, a C-section or fistula repair or some such thing. Tea break with the other “white folks” from 10-10:30 if we’re free, and then it’s OPD for the rest of the day, aka Outpatient Department, or clinic. Here’s a picture of an unusual x-ray you won’t see in the US. Can you figure out the image?

Patients typically arrive at the hospital by 8am if they want to be seen that day. They line up at the hospital gate and a certain number of tickets are issued for admission—maybe 60-80 depending on if some of the doctors are in surgery, or have afternoon meetings or are otherwise unavailable. Then from 10:30-12:30 we see patients, write out treatments, and order labs/x-rays. All patients with lab results then get re-seen between 2:30-4:30 or so. These can be rather vague and frustrating visits from time to time, and Eric and I have had more than a bit of difficulty in the communications department. Let me give an example.

A young woman walks in to my cubicle/exam room and sits down, followed closely by an older woman who I assume is her mother. She clutches a large stack of papers in her hand (uh-oh, I think, lots of “outside treatments” and lab results that I probably won’t be able to decipher). I look at the white cardboard card issued by the hospital with her age, vital signs, and chief complaints, all scribed by one of the Bengali medics. It reads, “abdo pain x 1 ½ yrs.” Great. This could be anything.

“So,” I say through my medic/translator, “You’ve had this pain for how long?”

Long interaction between translator and patient. “Since one and half years.”

“Where is the pain?”

The patient gestures widely across the entire lower half of her abdomen.

“Does it come and go?”

“The pain is all the time.”

“Does it ever get better or worse?”

“Pain all the time.”

“What kind of pain is it? Sharp, cramping, burning?”

Long discussion ensues. “Pain is since one and half years.”

“But what kind of pain?”

“Pain is all the time.”

OK. I can see I’m not getting very far here. So I switch tactics and ask to see her outside records. I get a sheaf of papers stapled together from outside doctors. They are inevitably moldy smelling (like all books in this humid country) and covered in a mixture of Bangla script, which I can’t read, and medications in English scratch, which I can’t read, and even if I could they’re all brand names of medications manufactured in Bangladesh, very different than the names of meds in the US. I have my medic get a 1000 page manual of all the medications in the country and set her to deciphering, while I look at the lab results and ultrasounds. Something catches my eye—the ultrasound shows an ovarian cyst. And there are other test results from 3 days ago.

“Did you just go see a doctor three days ago?” I ask the patient.

Long discussion here, with much hand gestures and the patient’s mother keeps picking up a heart monitor rhythm strip (that looks completely normal) and handing it to me. I set it down, she picks it up and hands it back to me, repeat half a dozen times.

Finally, from my translator, “These medications,” pointing to the cryptic script on a piece of paper dated one month earlier, “do not work.”

OK. “But what did she see a doctor for three days ago?”

I get handed the rhythm strip three more times while the translator and patient talk. “She is having abdomen pain for 1 ½ years.”

I thought we had already covered that part. “These tests are from three days ago. Did she see a doctor then? And then why is she here today?”

Finally, about 15min into this visit, the translator says, “Patient has mass in rectum and she is here for surgery.”

What?!?! That’s not on any of the papers; in fact, none of them even mention the patient’s rectum. Finally, my translator gets another translator who speaks a bit more English. “The patient has a mass on her ovary and she is here for an ultrasound. The doctor sent her for an ultrasound.” Ah, now we’re getting somewhere.

I review the ultrasound—looks like a benign cyst. I put her on birth control pills and ask her to come back in one month for an ultrasound; it has only been three wks since her last U/S. That could have been much easier….

Granted, most patient visits go a little easier than this! But still, we commonly get chief complaints of things like, “Burning whole body for 3 years.” I don’t remember learning the differential diagnosis for that in med school… “Inside fevers for two weeks.” Now, this is apparently not the same as “outside fevers” which are really (probably) fevers. No one can quite translate the concept of “inside fevers” to us, but I think it’s generalized malaise. Eric commonly gets things like “pain since six months,” and when he asks how long they’ve had the pain, he gets an answer like “one week.” I thought it was for six months? No, pain “one week since six months”. This apparently has been figured out to be, six months ago they had one week of pain. No pain now.

It’s been an adventure, and we laugh about it every night. Hopefully God has given us the grace to understand enough to care for these people. And we look forward to being able to work somewhere long enough that we can learn the language, and someday communicate better.