Week 3-Chest Pain.....

At the end of our time at section 19, a woman ran up to ask us to take her mother to the clinic.  She runs one of the Shebeens or informal beerhall.  It was 4 pm and the nearby clinic is probably closed.  As we drove up, 15 or so folks are sitting and drinking homebrew in a circle, some still in their blue caneworker uniforms.  There are kids gathering oranges into a wheelbarrow to ferment for more alcohol.  The health motivator takes me into a mudhut where there is a large woman sitting on the bed wincing in pain.  NCamsile, one of the health motivators, translates that the woman is having chest pain that radiates up her arm.  She has been out of her bloodpressure medication for a while, and none of her family has paid the money to ride the bus to the pharmacy 20 miles away.  Now it looks like she may be having a heart attack.   She has her medical history, a thick packet of notes scribbled in English that detail multiple chronic conditions, sky high blood pressures, and a history of non-compliance.  One notes says, “patient advised to lose weight.”  Being overweight, is at the end of a long list of this woman’s problems, the first of which is living next to a beerhall, where folks have either been too intoxicated or unwilling to leave their business to get her the care she needs.  She has had this pain all day.

    We drive down a dirt road to the clinic, which is already closed for the day.  The woman’s daughter calls for the on call nurse.  A complaint of chest pain doesn’t receive response it might in a western emergency department.  The nurse walks slowly into the clinic, “ I am so tired she tells us, and you should move this woman to Siteki Good Shepherd Hospital (an hour away.)”  The hospital will likely be closed before we get there.  I wander into the completely unsecured pharmacy room.  There is no aspirin or blood pressure medicine.  There is no EKG machine, no blood is drawn, no xrays are ordered.  The nurse reviews her history, takes a blood sugar and blood pressure, which is very high and gives the woman a shot of valium.  Meanwhile our patient’s daughter has wandered into the clinic pharmacy and helped herself to some medication. 

    I feel pretty helpless; I’m a pediatric nurse practitioner trained to work with labs and equipment and fully stocked pharmacies.  Corine says, “ I am taking this burden off of your shoulders; the family had all day to take her to Good Shepherd.”  What is our response, what does it mean to be a good neighbor or a competent medical provider in this setting?  How do we protect the most vulnerable, the elderly and children in the absence of any consequences for abuse and neglect or any social safety net?  How do we react and maintain compassion in the face of such huge problems and overwhelming need?