Trust Me, I’m A Doctor

Gus Ruchman - Senegal


January 7, 2011

Back in October I took an adventurous cab ride to the Clinique Madeleine, a medical facility near the seashore in downtown Dakar, to have lunch with two recent college graduates working for the World Food Program. As we discussed their new professional lives and the one into which I would soon be thrust they had one piece of advice for my work in the coming months:

“Fake it ‘till you make it.”

They were half right.

I have been a medical intern at the Poste de Santé for two months. My first day on the job was a Thursday, a weekly event at the Poste de Santé as swarms of mothers bring their infants into the Salle de Soin for an assortment of vaccinations. Assuming that, as I had been warned in Dakar, my status as an American somehow qualified me to participate, I was immediately invited to pick up syringes and start injecting.

I politely declined, pointing out that I am only a student, do not know how to vaccinate infants, and had no desire to treat health as a game.

Je ne veux pas jouer avec le santé.

I spent my first couple of weeks observing consultation, work in the pharmacy, procedures in the Salle de Soin, and attempting to build the medical vocabulary necessary to understand what I was being told.

Man dinaa jàng, ndank ndank. I will learn, slowly, slowly.

It all started with the TDR, an efficient “rapid diagnostic test” fo a common strain of malaria that is having tremendous impact on the treatment of the disease that continues to ravage many African nations and plays a central role in a complex web of social, cultural, medical, and economic problems in many developing communities. The test boils down to a simple finger prick, and I was soon performing these by the dozen.

I began to work in the Salle de Soin, the room where injections and TDRs are given and wounds are bandaged, among several other procedures. Every day I tried to walk the blurry line between learning by experience and helping effectively, and being ethically responsible in a job where mistakes can have serious consequences. As far as many patients were concerned I was an educated tubaab able to heal. To the staff I was an intern like the others that regularly spend periods of time at the Poste to gain work experience before entering the larger medical community in Rufisque or Dakar. In a sense I was “faking it,” but always conscious of where over-eagerness could turn help into harm.

Now my days are different. I arrive at 8:30 am, greet every single person in the Poste (an extensive process), grab a pair of gloves, and get on duty in the Salle de Soin. I clean and bandage wounds and infections, perform TDRs, and prepare IV bags for malaria patients. I consider some of my most important work my constant voluntary washing of the few trays that are used and reused for holding cotton, bandages, puss, dead skin, blood, clean and dirty needles, Quinine, tweezers, Betadine, and the list goes on. Of course I separate my sterile and contaminated materials into separate trays, but not everyone does (yet), hence the washing. I still refuse to play with needles and will continue to watch until I am comfortable. I have other ways of being effective.

I often find myself staffing the Salle de Soin alone—either because everyone is “busy” or simply relaxing outside—but I am more able every moment. I have treated an elderly woman with three sliced off fingertips, several young boys (age estimate 7-11 years) with post-circumcision infections, a young woman (age estimate 20-30 years) with infected bubbles on her foot and heal larger in diameter than oreos, to name a few interesting cases, and, oh, I have done a lot of TDRs. When someone comes in with something I cannot do, I find someone who can so patients do not have to wait needlessly, possibly for hours. I refuse to let disorganization or laziness get in the way of alleviating suffering.

For those at home who are curious, since I do not just work in the Salle de Soin, I have assisted with several births (but no, I do not actually deliver the baby) as well as post-birth cleaning and stitching (I have declined to do the stitches), as well as a handful of circumcisions (I declined to do the slicing). I ask extensive questions of everyone and write several pages of notes at the end of every morning. I have returned weekly to the hospital of traditional medicine in Keur Massar to work in the field tending to and harvesting medical plants, in the “laboratory” watching old men find their way through hundreds of incomprehensible plant powders to mix the perfect concoctions, and learning about the patients, doctors, and treatments available there. I have visited several facilities in Rufisque as well as the barely functioning clinic in the nearby village of Noflaye, in which I have laid the foundation for a professional relationship with the one doctor working for the 2000 person population.

Work can be slow. Work can be routine. Work can be frustrating and sometimes very upsetting. Work can also be exhilarating, overwhelming, and entirely satisfying. Either way I sit down at the end of the day and just exhale. I am on the brink of commencing a new phase of my professional experience here, involving community health awareness work and the possibility of expanding into Noflaye. Only time will tell how these efforts will turn out.

A colleague told me to come by his house yesterday afternoon before I headed home. When I found him shortly before sunset he brought me to his room and presented me with an extraordinary gift: a white doctor’s coat. It was entirely too generous, I informed him, but in the spirit of Senegalese teranga he insisted that I take it. Dare I say that I have somewhat integrated at this small but important health center in the rural community of Sangalkam? Dare I say that I have earned just enough respect to be considered one of their own?

I am faking it just a little less, and now at least I look authentic.

Jerejëf—I thanked him again, taking my leave—wante defe naa dama war a dem. Bëgg naa ñibbi balaa timis. Ba suba, en sh’Allah.

Gus Ruchman