A Virtual Doctor in the Field

Volunteer Doctor Ian Cross has been spending the past few month in Zambia on one of his regular rotations supporting Mfuwe Rural Health Centre in Mambwe district, Eastern Province, and enjoying being a user at "both ends" of our service!
He shares this anecdote from the field, interacting with Volunteer Doctor Caroline on a case at Kakumbi Rural Health Centre.

Kakumbi Rural Health Centre

“This little girl came to see me three weeks ago with a firm swelling just under the angle of her jaw. It had been growing slowly over the past two weeks, which made mumps unlikely. It was not very tender. She had received a course of broad-spectrum antibiotics which had not helped. I decided to get some help from an overseas expert, and type her details into the Virtual Doctors app on a dedicated smartphone.

The expert was puzzled as I was, but recommended a course of antibiotics which were too expensive for the mother to buy. The expert had also offered a “cheaper option” of two antibiotics together, which I could provide for her, for two weeks.

A fortnight later, I was passing through the waiting area when the receptionist said, “Your patient is here waiting for you.” The little girl now clearly had an abscess the size of a hen’s egg on her jaw. The skin was thinning and it looked ripe for incision and drainage.

I asked which clinical officer was happy doing surgical incisions and I showed her the little girl. “How would you manage this now?” I asked.

“First, I will inject lignocaine local anaesthetic into the skin,” she said.

I told her that it would be excruciatingly painful to inject anything into the thinning skin over the abscess. We needed to do this as quickly and efficiently as possible.

Already, the little girl had an inkling of what was coming. I lifted her up onto the couch in the treatment room and spread a paper towel under her neck. I cleaned the skin gently over the abscess with an alcohol swab and allowed it to dry. The little girl started to wail and scream, and the clinical officer asked me to do the deed, while she watched.

The clinic has no scalpel handles so I just used my fingers to grasp the blade. The CO held her head, her mother held her arms and body. As quick as I could, I sliced open the abscess, creating a tsunami of bloody pus. Usually this provides immediate pain relief as the pressure is released, but this little girl kept on screaming. I stepped back and allowed the CO to ensure all the pus had drained. The CO said to me, “Do you know what she is saying? She is saying I HATE YOU! I HATE YOU!”

Some doctors spend a fortune on lollypops which they hand out to children as bribes. I don’t, partly because I am a cheapskate, partly because I don’t want to be responsible for dental caries. Also, the children come to expect it. Instead, I offered the little girl my pen. She didn’t want it and refused to touch it. Her mother spoke sharply to her, probably something along the lines – “That’s a very nice pen, you can use that at school, take it!”

She took it, and glowered at me. I told her (via the CO translating) that I was very sorry that I had hurt her but I was only trying to make her better. If I had hurt her, she could hurt me. I took her hand and used it to gently slap the back of my hand. I pretended to cry in pain and her face changed in an instant to joy. She smiled and laughed as I whimpered, all thoughts of her minor operation gone. I know, showmanship, but it got the job done, right?”