A few weeks ago Daniel called me into his office to see a patient who had come to the clinic complaining of shortness of breath. Sitting on the bench was a middle-aged woman with a huge tumor growing out of her neck. It was pressing on her throat, thus making it almost impossible to breathe. While there are many people who come to our health center with enormous goitres from lacking iodine this one was different. Daniel drained it and was fairly confident that it was cancer and if not removed soon, probably going to kill her.
When patients need care that is beyond what we can provide they either go to Bonga, about 45 minutes away, or the larger city, Jimma, four hours away. Daniel knew she would need more serious help and therefore brought her to see the health center director who would help her figure out the next steps to get her to the hospital in Jimma. We advised her to return to her town and request a “free letter” (when people are very poor the village chairman can write them a “free letter” which attests to their need to have treatment given at no cost), gather some money for her journey and to come with us to Jimma the following week. We weren’t exactly sure what date the car would be leaving so we collected her contact information and said we would be in touch once we knew for certain.
A few days later I was in her village on outreach and sent her a note letting her know that a car from Lalmba would be going to Jimma in four days. (Keep in mind that I am using my very limited Kafanono and hand gestures to explain who I was looking for). As I have written about in other posts, proper communication here is painfully lacking....with no home phones, cell phones, mail, home addresses or internet we often have to rely on letters passed on from one person to the next in order to communicate. As I have seen in other situations and again here-- it doesn’t always work so well.
Three days later a woman did in fact arrive in Chiri with a large neck tumor and eager to see what the doctors in Jimma could do for her. Unfortunately, she was not the same woman! Our note must have been given to the wrong person.... The lady did have a huge goitre for over 15 years and while we don’t typically take goitre patients to Jimma (its not life threatening) it seemed like it was the right thing to do considering the circumstances. Ironically, she didn’t have a free letter and so would have to return home and come back with one for our next Jimma run. So thus, we went to Jimma without any woman or any neck tumors.
Luckily, the real patient returned a week later, still breathing and ready to go to Jimma. Free letter: check. Family member to escort her: check. Correct tumor: check.
Ahhh, the pleasure of working in the developing world.
