By Volunteer, Dr. Apple
The door opens and color fills the room as the Maasai family enter. Seated in a wheelchair, the patient is rolled into Dr. Jacob’s room by her son, also accompanied by her daughter and two-year-old grandson. All are surprised and immediately put to ease as Dr. Jacob welcomes them in their own language. Quietly the story is told of how over two months ago the patient fell while gathering wood for the fire. She has not been able to walk since the fall and continues to have significant pain. All too often, patients and their families seek care only after long delays and/or exhausting attempts at traditional medicine to heal. Dr. Jacob efficiently gathers further history and proceeds with his examination, all while addressing the patient and family with kindness and compassion. Concerned the patient may have injured her hip, he explains the need for an x-ray, being mindful of how even the meager cost of this diagnostic test may overwhelm this family. The x-ray is able to be quickly performed and a diagnosis is made. This 57-year-old woman has a very serious hip fracture, suffering all these weeks since her injury. To those of us in medically resource rich countries, this delay seems unbelievable.
Though a diagnosis has been made, Dr. Jacob knows further challenges exist. Though thousands of hip surgeries are performed daily in many well-off countries, surgeries like this are frequently not available or affordable to many of the patients served by FAME. After consultation with several of the FAME doctors, Dr. Jacob returns to his patient to discuss options. The best care for the patient would be referral for orthopedic surgical repair of her fracture. However, Dr. Jacob knows this requires traveling more than four hours from their home and will be very costly, an expense this family may not have the resources to undertake. He listens carefully as the patient and family begin to grapple with this information, deciding they will need to return home to discuss this information with the entire family. Knowing there are occasions where charitable organizations visit Tanzania to perform such surgeries free of charge, Dr. Jacob gathers the patient’s contact information and pertinent physical exam features to pass on to Dr. Frank, in case he is notified of such a program coming nearby. While the patient is still in the clinic, it is learned there currently is a low cost orthopedic program several hours away that might be available to the patient, so this information too is provided to the patient and family. At least there may be hope the family and community could afford the surgery at reduced expense. Realizing the patient and family will need time to reach a decision and that surgery may not be an option after all, Dr. Jacob proceeds with obtaining crutches for the patient, realizing that navigating with crutches on one leg will be almost impossible for this woman with a painful hip fracture who lives in the natural surroundings of a traditional Maasai boma.
As the patient is wheeled away to head home, we have a few minutes for reflection before the next patient arrives. While the treatment options for this patient are very limited as compared with much of the world and it is discouraging to know successful treatment would likely return this patient to an active life as opposed to a life of virtual immobility, for today we have done the best we can for this patient. Sometimes the best we can do is to provide compassionate care to the patient and family, mindful of the complexities of their lives ……… and maybe offer a little hope.
Note – In the five weeks I was at FAME, I helped with the care of two patients who both arrived with hip fractures which were several weeks old. To those of us in medically resource rich countries, this type of common occurrence seems incomprehensible, but is a daily reality at FAME.