Bouncer Job

At the hospital, the outpatient department (OPD) is the first place patients go when they get sick during working hours. It is run by clinical officers who see all the patients that come in, prescribe medications, order relevant tests, and admit the serious cases. So they are more or less the bouncers for the hospital.

Clinical officers (CO’s) are people who have had basic training which is equivalent to an undergraduate degree in health science. What they lack in formal training, they make up through experience: a lot of the things they know, they learn on the job. The CO’s at Lubwe Hospital are very good at efficiently screening a horde of patients, picking out the ones with serious problems, and admitting them to the ward.

Because both CO’s at the hospital are away to attend workshops, I have been playing the role of CO for the last three days. In the morning, I arrive at the OPD to the familiar sight of a courtyard packed with crying children carried on the backs of their mothers, with a few elderly people here and there in the crowd. It is a rare sight to see men with their sick babies in the hospital. This is, after all, an area still steeped in the traditions of a male-dominated society. Child-rearing still falls squarely on women’s shoulders.

OPD waiting area on a slow day

I take the stack of patients’ files from the patient registration window and head into one of the clinic rooms with a nurse. With the nurse interpreting, I take quick histories from each patient, do abbreviated examinations, and decide whether to send the patient to the lab for a couple of tests, or send them on their way with a few days’ worth of medication, or as a last resort, admit them. Most of them have nothing more than a little respiratory tract infection, many of them come in with a self-diagnosed case of malaria, and diarrhea among children is so common, their mothers don’t even remember to mention it unless questioned specifically about it. It is so easy to just get into autopilot and write everyone a script for either an antibiotic or antimalarial or both. After a dozen scripts of the same things, I eye the pile of files, in which I seem to have hardly made a dent. I am constantly being reminded of how many people are waiting outside by the sound of moaning and crying babies. I try to go as fast as I can, but talking through an interpreter can be frustrating. Quite often, I ask what I think is a straightforward question, only to see a five-minute discussion between the nurse and the patient, with a one-word answer coming back to me at the end. Thus, history-taking can be a trying experience.

By lunch time, my ears are ringing from having tried to listen to the chest of countless sick babies who scream at the top of their lungs at the sight of someone in a white coat approach them with a stethoscope. Pediatrics is now inching lower and lower on my list of potential careers; I find it hard to think when babies are screaming next to me. I know, I have not done my pediatrics rotation yet, but in these couple of days, I feel like I might as well be a vet – the one who is sick is not able to say what’s wrong, all histories are collateral at best.

By now, I really come to appreciate the hospital’s two-hour lunch break. It gives me time to vegetate after lunch and clear my head so I can face the onslaught of patients in the afternoon, when my own energy gets into a lull.