The power of white

One of the things that I can't get used to here is how grateful the patients are and what huge expectations they have of me as a ferengi. Not all of them, but the majority. They are very keen for me to see their children, to offer a solution some how. I have been told on several occasions "thank you for coming", "thank you for bringing your medicine". In actual fact I'm not sure that I have brought much at all.

The thing is I still feel like a bit of a fraud here. I am learning huge amounts about the multiple pathologies the children have, and I'm beginning to get my head around the intricacies of managing conditions that I've really only read about such as malnutrition and tuberculosis. However the bulk of the day to day work is still done by the GP's, and more often that not they are advising me how to manage the baby with neonatal tetanus, or the child with massive hepatosplenomagly and ascites secondary to TB. When I think I don't know what to do I have to stop and think - what would I do with this at home - and often the answer is a battery of tests or a specialist consultation. For example, the baby with the encephalocele, well they need an MRI scan of their head and then a neurosurgical consultation, neither of which are available here. They are available in Addis but thats a 500km, 12 hour public bus journey away and there are no ambulances. Still with no viable alternative thats what we had to do. Sometimes I feel a little bit like a wizard without my wand. I know what would make so much of what is here better, but without the ways to make it happen I'm virtually useless.

Despite this the parents still think I have the answers, and they like me to see their children. Whether it is the white coat or the white skin or probably the powerful combination of the two together they seem to believe I will make a difference. So I do what I can. Right at the beginning of medical school I remember some one showing me an axiom of medicine: to cure sometimes, to alleviate often, to comfort always. So if nothing else I try to offer the latter, by explaining what's happening -albeit through an interpreter - and often that seems to be enough.

There are so many basic, basic things here that I would like to be able to change here, but encouraging the medical and nursing staff to communicate better with the patients is probably top of the list and it should be do-able. I can't plumb the water into the ward, but I can lead by example with communication and I think its beginning to rub off -slowly!