I was a gynecologist, cardiologist, pediatric nurse practitioner, endocrinologist, urologist, lab technician, home health nurse... just to name a few. One of the biggest stresses from the day involved a diabetic patient of ours. He has been pretty sick for a few weeks, I transferred him to the hospital in Banjul. When they discharged him, they told him to come see me and sent him home with a vial of insulin. Thanks a lot. Friday was the day I had to start him on insulin injections. The oral medications just weren't being effective. How to explain to O J that he has to have a shot twice a day for the rest of his life? If he stops the medicine he will get worse again, but with it he could live a long time. Gambians are good at taking medicine until they feel better and then stopping it. Or taking it until the current bag of medicine, or in this case vial of medicine is gone. A refill before the medicine supply is gone is rare. I know, I try to stress it with my chronic patients all the time, but still they come after the meds have been finished for several days to weeks. It is a rare find to have some one return when there is still medicine at home.
Back to OJ, I spent time with him in the clinic discussing insulin and what it was going to do. I checked his blood sugar, we discussed his diet and then it was time for the injection. He went home when his questions were answered. I was on pins and needles, I told him I would be checking in on him in a few hours and stressing the signs of too low a blood sugar. I went to his compound twice that day. Each day since I have been morning and evening as I check his diet blood sugars and give his next injection. I told him it was important for him to learn how to give the injections. His reply was NO, I was the Dr. Ha ha. I asked him what would he do if I went on a trip... he wanted me to have one of my clinic employees do it. I told him no, he and his wife would have to learn. I asked what would you do if I died. he was shocked at that one. What here? In the Gambia? I said yes, God could decide to take me home. He didn't like that option.
Today (Monday) his daughter gave both injections. I am feeling a bit of a time crunch as I am suppose to go to Banjul on Friday to meet with a Dr and her family. They are coming to help out for almost a month. (yeah! and are considering full time service in The Gambia... pray with me!)
I can prepare the injections, but the family will need to know how to give them and what to do if his sugar goes to low. I will have back up available if he gets sick.
I broke up the day, Friday, with a mid afternoon trip to see an employee's son for a hernia referral. It was a hot day, but the car had air conditioning. Too bad I forgot about Friday prayer time (the men go to the mosque and my employee is male.) So as I arrived at prayer time, I sent him off and visited with the wife and family. It had been five years since my last visit to their home. It is a bit of a drive and the road is horrible. Teresa was my driver and we took along a young gal from NK whose family lives in the same village. So after my time at my employees home (and the imam had a lot to talk about) we had to go and greet her family. What is involved in greeting... I know it doesn't sound bad. I had to visit in the home of each of the elderly family members, her uncle, her mother and then we walked to her grandmother's home to greet her. We were offered lunch at each stop. NA was hungry and ate at her grandmother's. I was a bit worried about Gambian food (lots of oil) and a drive back home. My intestines are finally handling things but I didn't want to stress it, so I gracefully declined, promising another time.
Friday nights are a time of bonding for the SPTs (see previous blogs), dinner - pizza, and a movie. After my long day of clinic work and home visits I was grateful to sit back and relax. Joanne shared about her day... her job titles are also varied. One of her surprising ministries has come in the area of counseling. (You can check out her recent blog at http://www.gambiathoughts.blogspot.com/) You just never know what God may ask you to do. Good thing He will also give you the strength to DO IT! That isn't to say you will never have growing pains or failures. Joanne offered to give me private sessions on her couch instead of her office's empty chair. Nice friend!
Saturday the job hats continued. I made home visits, went to the market for the first time in months and worked on clinic finances. It was another long day. I need to teach this family how to give injections so I can sleep in. A morning person I am not!
Today I made home visits, did compound work (maintenance stuff) and continuing education. But the highlights were.... kids singing to me and five women came for a visit and we had attaya (hot green tea that has oodles of caffeine and served with lots of sugar) and Lae (hot sweetened milk).
It is Common Wealth day in the United Kingdom. Here in the Gambia it is celebrated in schools. the children dress up in the clothing style of their particular tribal group.. including hairstyles. They each bring food items in to share. Then they go around the neighborhood as a group and sing for donations to add to their party.
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