#49 - Shame Shame Shame

#49 – Shame Shame Shame !!!

They say (who ever “They” are?) …They say that things come in threes.  Well the proverb may well be true in today’s blog..  The health centre at Yam Island is managed by three health workers and a nurse.  Normally in that mix of staff there is a representative of both genders.  But while I am the nurse here, the usual gender mix is not there, for Yam has three male health workers, and me, a Murse.

Enter, the cultural ramifications of having cousins, and uncles (as health centre staff) caring for patients who are related via blood line, island adoption or marriage, and you have a complicated set of social mores that come into play in the day to day running of a clinic in a small island community.  Up to this point the presentation of a patient for a cough, cold, sores, or a myriad of other innocuous presentations, has not been complicated, the senior health worker usually sees the patient, speaking creole, elicits the main presenting problem, then relays that to the nurse for collaborative management.

I have so far dodged the need to see women with an issue of a more “personal/private” nature, because I have always worked in an environment that other female staff work, and I tend to do the embarrassing boy stuff, and she deals with the secret women’s business.  But all that changed this morning.  Not once but 3 times in the space of an hour.

As I said, these things come in threes right? ! 

Normally in a community such as this, a male nurse, relative or male health worker would not have anything to do with women’s business.  In the Islands they call it ‘Shame’.  A woman would say “It would be too shame for me to come to boy nurse”  The truth is that most island women would rather treat their own bodies the best way that they know how and sadly, allow themselves to get quite sick before they present at an all male clinic. 

My first was a 19 year old breastfeeding mother with a blocked milk duct.  She waqs in a lot of discomfort, and had a hard palpable lump near her nipple.  I could tell that she was uncomfortable with having to let me look at it and assess her, but I went about my business as matter of factly as I could and pulled in the female receptionist just ho have a chaperone.

No sooner had I wiped the sweat of my brow after that uncomfortable adventure then another young woman presented with an itch, and a discharge.  Way out of my comfort zone and wishing the world would open and swallow me, I assessed and asked the most embarrassing of questions about transmissible diseases, and contacts she had had with other partners, swabs were taken.  Urine tests were collected and medication for a host of afflictions were supplied.  The most nerve wracking experience, and again, you could see that the poor girl was distressed.  At this point I am ready to decompensate.  I pull my self together and the positive self talk starts.  “Robert, you’ve done it, you have crossed the dark line into the Oestrogen abyss, and nothing they can throw at you will be as bad as that”.

Well, Nope.  I was wrong.  One of the health workers came and told me that there is a 9 year old girl to see.  “what is wrong?” I asked casually, now battle hardened and bullet proof.  “I don’t know”, said the health worker, “…it’s shame”.

‘Are you kidding me!!’, I thought, surely this cant be that bad.  I entered the room, where there is a mother and a girl sitting on her lap, looking frightened.  “Good morning”, I said as cheerfully and up beat as possible.  I introduced myself and asked what the reason for the visit was.   The woman replied “Its my daughter, she has a worm”.  Ok.  I explained that where there was one worm there was probably more and that with a single dose of worm medicine, we can clear it all up.  Intestinal worms can some times be seen in faeces or at the anus in advanced parasitic disease.  It is not uncommon to have them collected in a jar and presented to the clinic.

But No.  It wasn’t going to be that simple was it?  The woman explained to me that the worm was not like others.  It was like a larvae of something.  The mother told me that she thinks that there was a second one, because her daughter is very itchy.  And to make matters worse, (and this is where I almost fell off my chair),

……the worm was in the front, not the back!!!   This poor princess has something hatching in her v…, in her V……, in her Vvvvery most intimate spot, and I am way out of my depth.  

Reluctantly I explain to the woman that I will need to take a look.  I allow the mother to assist her daughter to disrobe, and what awaited me behind the curtain, is the stuff of some tropical disease journal.  She had sores everywhere. With one in particular that was becoming cellulitic.  Suffice to say a phone call was made to the on call doctor on TI, I had no idea what I was looking at, but I knew that antibiotics were going to play a staring role.  The doc was great, she reassured me that my description was not unusual, and that the critical issue was to treat the cellulitis of the perineum aggressively.  So with a BIG penicillin needle in the bum, and a course of Fluclox, treatment commenced.  I gave mum some antiseptic soap, and some hygiene advice, and asked her to come on Wednesday to our fly in medical clinic, where a female doctor can do a more thorough examination.

So this place never ceases to amaze me what waits lurking behind the curtain, or revealed each new day.  More than ever I feel like a student again, and with each new experience, and each new triumph, comes a sense of awe, and satisfaction, that really sends the message home to me that I really am …living the dream.

Im off for a Betadine shower !!