Follow Ups = Happy Days!

I love that I get to work in very remote places! Unfortunately that often means that I have very few follow up visits with my patients. But in this post I want to share about 2 follow ups I’ve had this year!  The first one is oh so good and really happy! The second one is awesomely good, but sensitive stomachs, please abstain from reading ;)

This year I took the Primary Health Care School to Oro Province! (If I had favourites.. Oro Province would be one of them!) It was my fifth time to the province and we targeted the mountain areas around Kokoda, my third time there. One Sunday we went to church in Papaki. Although I hadn’t done clinic in Papaki before, I remembered walking through the village and across the river to reach Eiwo on the other side. I remember Eiwo for two things: 1- a cool cliff to jump off in wet season! 2- a girl called Ethel* with Pott’s Disease or Tuberculosis of the Spine. You might remember her…!
OLYMPUS DIGITAL CAMERA Spine TB
I showed a friend in the village a picture of Ethel and asked if he knew of her. He recognized the mother and said that she was currently visiting in Papaki! He sent word for her and within 5 minutes, Ethel, who was also visiting was in front of me!

When I saw her in 2013, I was unsure of what would happen to her. She had already gone 5 years without treatment and she didn’t have too much longer before getting paralyzed if left untreated. Leaving her with nothing more than health education and a referral letter to the hospital for treatment, I prayed that her mother would take her to the city for treatment. Most of the time I don’t get to follow up… so I tell myself as I leave a village, that everybody was granted their miraculous healings and fairy tale endings! Naive, yes, quite possibly, but the only way I can see what I see on a daily basis and keep going.

Seeing Ethel all grown up, taller and bigger than before and NOT in a wheelchair, made my day! Our time in Eiwo 3 years ago wasn’t in vain! Ethel’s mother believed that she could be healed and made the hard sacrifices to get to the city and complete the whole 9 months of TB treatment her daughter needed! And Ethel got her good ending :)
3 years later

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First seeing Ethel launched me on a journey with Tuberculosis and understanding my role in “Ending TB in MY Lifetime”. I remember walking back to our village after clinic that day and having a long discussion with Philip about health promotion and the need to increase health awareness surrounding Tuberculosis as well as the need for mobile diagnosis! I’ve always held the picture of Ethel as a reminder that something needs to happen for TB. And now I can also associate it with the fact that health promotion does work and that sometimes the most seemingly helpless situations can be turned around with a little faith!

Alright! Sensitive stomachs, this is your warning ;)

The next story is about a patient I had in Ajeka! Before I write about the patient, I must tip my hat to his wife! The most loving and dedicated person I’ve ever seen… who accepted to put up with way more than anyone should ever!

So this amazing lady comes to see me and says “Angie, you’re back!” (Who is this lady!?) “I have to bring my husband to see you.” (Oh no!) Her husband, Jack* was seen in 2013 for a “boil” on his buttock. Instant flashback!

I, unlike some of my students, highly dislike when I need to ask my patients to remove their pants… I unfortunately tend to have a very good memory for things I’d rather forget… When Jack came to see me, he had had this boil for over 20 years! taken many antibiotics and never really improved. The right thing to do, was to give him a fair assessment and look at the thing… unfortunately. I had to remove the dressing his wife had put on the boil in order to see… as I removed the dressing, a scab pulled off and let pus along with tiny maggots ooze out of his wound. What a sight! I haven’t forgotten yet! At the time, I put him on Flucloxacillin, a great antibiotic he hadn’t had yet, and referred him to the hospital for surgical draining.

When his wife said that I had to see him, I was so sad! How & why should someone have to suffer through 25 years of but ulcer!? And poor wife!!! I immediately thought the worse… He hadn’t gone to the hospital and sat on his infected ulcer all this time… His health card surprised me with multiple trips to the hospital since my first consult, which is a good sign! He did get surgery, yay! But then, it got infected… according to the book, at the time of the last visit, things were in a good state.

So why did he need help? Did it get infected again? Dr. Thomas!!! A case for you :) He was surprised I had seen this guy before, and I was pleasantly surprised to find out that his sore was completely clean!!! I remembered what it looked like in 2013 and expected worse… but to my surprise, there was no inflammation, no redness, no puss, no worms, nothing but a small hole! Mind you that wound was tunnelling to the anal canal making a small fistula, but it was a minor surgery to fix the whole problem. And this reference in the wife’s hands was a guaranteed good outcome :)

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