Thursday, December 13, 2012

One mind, one body

Being sick in a developing country really blows.  You are isolated in an inhospitable environment, away from family and friends, with no access to reliable medicine or doctors within reachable distance, you must travel hundreds of kilometers to the capital to reach your Peace Corps Medical Officers (PCMO).  The travel is exhausting and sometimes takes days.  And when you are sick, sitting in a brousse for hours on end on bad roads takes a lot out of you.  I understand fully now why the medical examinations was such an extensive portion of my application process.  Everyone groans and moans about it but really its completely necessary to make sure that volunteers already with health troubles are put in accommodation zones such as South Africa or in Eastern Europe.  I rarely saw the doctor before joining Peace Corps except, most only during annual physical checkup.  I’ve underwent many changes in my health here in Madagascar.  Most of illnesses were mild in nature, however there was one health concern that lasted for an extensive period of time (four months and ongoing) which eventually caused me to be medically evacuated abroad. 

When I became ill in February of this past year the PCMO had me come down to Tana so that he could inspect what I was describing to him.  He cleared me after the exam with a packet of antibiotics.  I never knew that antibiotics were going to be my worst enemy and savior for the next four months while I suffered physically.  My issues ceased to end.  I went between clinics in two major cities in Madagascar and numerous doctors and examinations.  Every doctor would diagnose me with different maladies and prescribe me with the “appropriate” medication, but no one was tackling the cause but just the symptoms.  My distaste for taking medication was brought to a standstill by my desperation to get better.  At one point I was using homeopathic remedies and even considering visiting a traditional healer or to be exorcised by a small Christian cult whom are currently preparing for the end of the world this year. 

And finally after a taking a long series of ineffective treatments the PCMO’s and D.C. decided that they’ve dried up all the resources in-country and it was time to medevac me (medically evacuate me).  This meant that I would be sent to South Africa.  All PCVS with major health concerns in Africa who are unable to be address in their country of service are sent to South Africa.

What I’ve learned that it’s important to not only treat one’s physical symptoms but to also to assuage the psychological issues that concurrently arise.  I’ve seen numerous doctors in Madagascar , in the best clinics, and each would indirectly address me to one another without actually talking to me.  They would hand me a sealed envelope with the diagnosis with no discussion included unless I pushed for it, otherwise they would discuss about me to my PCMO vs. to me directly.  I felt more like a problem than an actual living person who needed help.  In the doctors defense I can see how this is a defense mechanism.  They can’t become attached or humanize every patient who walks in their door.  Personally I can see how I would get emotionally drained by that.  Really its not that different in the U.S.  Patient/ doctor relations aren’t always the most cordial but rather have an impersonal vibe.  However after this experience I feel that a doctor can remain professional and be warm and comforting towards a patient at the same time.  Actually I think it’s crucial in order to facilitate the actual healing process.  There must be trust between the patient and doctor.  Also to have people in support of you is indispensible.  Even though I didn’t have this support in-country, which made things very difficult, my friends and family from home reached out to me when I most needed it.  People always joke about being medevaced to be able to visit South Africa, however when you truly are sick the idea evokes less excitement.

 I’ve never even once amused the idea of E.T (early termination) but I was on the verge of ending my service in order to get the medical attention I needed.  Health is the most important asset we possess.  If we don’t have our health what do we have?  Nothing mattered anymore. I lost interest and motivation in carrying out my service and in social events.   Another thing that I’ve learned that it takes a long time for things to move in D.C.  There was so much bureaucratic processing that needed to happen in order for me to be medevaced, which was infuriating and lead to a number of breakdowns. 
I was very impressed with the clinics and doctors in South Africa.  When the doctor told me that I needed to undergo surgery I actually was relieved because she had confirmed to me what I already knew: that I was sick.  The doctors’ in-country couldn’t find anything wrong with me.  I’m sure in their minds I was being a hypochondriac- simply making up my issue in my head, but in their defense they’ve tried their best and they aren’t specialist.  I still rely on them a lot.  Finally I was receiving answers, being able to go on a safari wasn’t all that bad either.

As much as our PCMOs attempted to prepare us for our environments during our PST (pre-service training)  its really inevitable that we become sick.  Coming from vacuum air-conditioned environments in the States its no wonder we are more susceptible to becoming sick.  Our bodies are weaker than the local population.  Our skin flakes and burns easier in the sun than African skin; our stomach’s haven’t been trained to handle the microbes and germs in the water, air, dirt. 

o   Overall lessons:
§  Don’t take health for granted
§  One body one mind: need to take care of both as best as possible.  Because you only get one your whole life.  
§  Regular exercise, a good diet, and healthy coping mechanisms to deal with stress since you are living under sometimes physically trying conditions
§  Getting sick: it’s the name of the game.  Hey, no one forced me to sign up for Peace Corps. 
§  You must become your own doctor for the two years of your service.  I’ve learned more about medicine and health issues than I’d ever have to in the States.  You do a lot of self-diagnosis when you are in the bush by yourself.  
§  Just because a doctor tells you one thing doesn’t mean that its set in stone and 100% correct. 
§  If you know something is wrong with your body then you probably are correct, you live with it not your doctor,
·         Become aware of your body’s needs and/ or abnormalities, weaknesses. 

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