Senegal 4: Consultations

The language barrier here is multi-layered. Despite French being the official language, most patients cannot, or will not, speak it. Thus it is necessary that we use translators to convert the patient's complaints, in Wolof, into an unusual form of French that is best described as child-like medical lingo. With a set number of questions, learnt by repetition, one can usually come to a reasonable diagnosis.

• "What is the problem?"
• (Invariably, patient touches whole body and speaks unintelligibly with a sour expression, which is now instantly recognised as "all my body hurts".)
• "Is it that you have the fever?"
• "At night, do you tremble?" (Simultaneous mimicking of shivering.)
• "Do you vomit?"
• "Do you cough?"
• "Do you cough some things?" (Accompanied by hand actions demonstrating the expectoration of sputum.)
• "Do you have diarrhoea?"
• "The urine is normal?"
• "Does [body part] hurt?"

Following a very brief examination, usually conducted in the chair, one is ready to produce the fruits of his/her clinical wisdom: "Probably, you have [medical condition]. But, it's possible also that you have malaria. Therefore I write the medicines for all the problems."

"All my body hurts" is not the only manner of presentation. Other common ones include:

• The patient who walks in covered in scratch marks and sores/bites/boils. He or she has usually been prescribed anti-fungal medicine before their buttocks hit the chair.
• The patient who sits and immediately rolls up one trouser leg to reveal a hideous ulcer.
• The patient whose eyes are bloodshot and rests head down on the desk for the duration of the consultation. This patient usually needs to come into hospital for "fatigue" (ie. malaria).
• The patient who intercepts me in the hallway to discuss his/her planned surgery, mistaking me for Ted, the surgeon, who is at least 25 years older and has a moustache.
• The patient who has pertes blanches (white discharge) or boutonnes dans ta vagine (lit. genital buttons). Just as in Australia, they are usually referred with great relief to the midwife, with the explanation that "I cannot do the exam for the women" (indicates to groin).

Vicky generally sees children, as they are easier to diagnose (for her), and there is always the possibility that they will do something cute, like dance, behave extremely politely, or scream at the sight of the white ghost (Vicky). Conversely, I have been seeing adults, and particularly the elderly, which is generally an excuse to see charming old fuddy-duddies with diabetes or "pressure" (as in, high blood). The elderly are revered here, presumably because they have beaten the odds of infant mortality, car accidents and malnourishment. They are the most friendly of the patient population, and they love to crack jokes. In Wolof, of course.

One particular octagenarian hobbled in on his stick and whispered: "I cannot hear anything."

I replied: "But you can hear me now."

He thought this was hilarous and shook my hand in a congratulatory fashion. "In fact, I can hear the rain." Cryptic.

Although it was not presently raining, this did not strike me as a major problem.

He clarified: "I can hear the rain. In my ears. All the time."

There appeared to be nothing overtly wrong with his ears. With confidence, I declared: "This is a problem because you are 80 years old. This is a problem of the old."

He laughed and shook my hand repeatedly, then began to make grand circular movements with his arms.

"I have been to other hospitals - St-Jean, Regional. Barthimee is better. And you - you will be a great doctor of the world!" He left to collect some multivitamins.

Another 80-plus-year-old was brought in by her concerned daughter, who prattled on for a good two minutes in Wolof to the translator, concluding with "Explique!" (Explain!) and nodding in my direction sternly.

Translator: "She has headache, fever. All her body hurts. And, it feels like there is a man, walking inside her stomach."

Me: "... So she has pain in the abdomen?"

(Prattle prattle. Explique!)

"Yes. But, she wants you to know: there is a man walking in her stomach."

I faced the frail great-granny, who patted her stomach and smiled. I prescribed some medicine for worms, but wondered if they would be better left to thrive in the intestines to help battle the man in the stomach.

On a similar note, Vicky was seeing a young boy with his mother. The mother began her opening statement, but while speaking, extricated a Fanta bottle from her handbag. The Fanta bottle was about a third-full of murky grey water, in which about ten live, off-white worms were writhing about. This admittedly made the diagnostic process much easier.