(Another update letter story, here for blog readers who might not get those letters.)
Her name was Trash. Had I been more in-tune with what little Bambara I know, or perhaps not in such a frustrated hurry, I would have noticed that on her chart. As it was, she came to my door in the midst of a busy morning. To add fuel to the fire, she was persistent, a bit feisty, and she lied right to my face. She told me that Dr. Dan had sent her to me so that I could do a dressing on a wound that she had. Having just talked with Dan, I knew this to be a lie. (Not uncommon around the hospital when people are trying to work the system.)
I chastised her for lying, then took one look at her wound and knew she needed surgery. Looking at her chart, I realized that she had started treatment at our hospital, when the wound was smaller and more manageable but had skipped all of her follow-up appointments for two weeks. In my medical eyes, she wasn't winning any brownie points.
I tried to put her back in the consultation system to make sure she was seen by the physician with whom she had had the follow-up appointment. I even asked one of the nurses to personally see that she was taken to the right office. However, thirty minutes later she showed up with a note scrolled on her chart that she should see me for a dressing change. The writing was not that of any of our doctors, so I knew it to be another attempt to work the system.
I was truly frustrated, but fortunately medical ethics that are drilled into you in American healthcare insist that you don't have to like the person or feel nice, but you do have to take care of the problem. So I grumpily went about solving the problem. I took her to Dan and we told she would have to stay and have surgery that afternoon, after everyone was done being seen in consultation for the morning. It was evident that she wasn't happy with this solution.
When we were finally ready for surgery, she was nowhere to be found—a quiet, but definitive statement about what she thought of our solution to her problem. So it was quite a surprise when she showed up again a week later. Again, she came directly to me, instead of going through the proper channels. I decided that this problem needed to be handled by a Malian, if for no other reason than I was losing all patience.
So I took her to Rebeka, one of our Malian physicians and explained the situation. I left the room as Rebeka was asking her why she had skipped out on all of her appointments. I was relieved that the responsibility was off my shoulders, and felt like exacerbatedly saying, "People! Hmmph!"
Fortunately after I closed the door, Rebeka noticed the woman's name. Realizing there must be more to the situation, she began asking questions. Her tragic life story unfolded—she was born to a mother who had lost all her other children. Convinced that demons were to blame, she named the little girl Nyama (Trash) to show them that the child had no importance. She was neglected in her childhood, given just enough attention to survive, so as to prevent the demons from thinking she was valuable and taking her away. She was married into an unhappy situation, money was tight, and when she developed this infection, the husband wasn't inclined to help her get treatment. She skipped all her appointments because she didn't have the resources to get to the hospital or pay her bills. Manipulation and lying were the only options she felt she had left.
When I heard her story I was heartbroken and humbled, but was very happy to hear that Rebeka convinced her to stay at the hospital, have surgery, and finish treatment. (Financed by our fund for impoverished patients.)
I was reminded of Philippians 4:5, "Let your gentleness be evident to all. The Lord is near." Please join me in praying for women like Nyama who are in such difficult situations. May they receive treatment, love and dignity at our hospital. Pray also for us as workers that God would give us eyes to clearly see the life situations of our patients.