It was near the end of a busy day at our makeshift clinic in Kenya as patients were shuffled through the stations of our strategically placed benches. We weren’t taking in any more patients, which landed us in that blessed hour when most people were done with their jobs for the day and could play with children outside, enjoy the breeze, good company, and stunning view of Lake Victoria on Pride Rock, or just wander around the clinic, as I happened to be doing at the moment.
Then the child walked in, who taught me a little bit about how to be a doctor.
School had recently gotten out for the day, which meant a wave of shrieking children had just sprinted down the road to play with the mzungus (“white people,” “foreigners,” or, in a word, us). A man tapped my shoulder and pointed to a boy in tears on a bench near us. He told me the boy, who we’ll call Ben, had been walking home in tears and said he had a headache, wondering if we could do anything. I told him I would find out. The man left and I assured Ben I would find something to make him feel better. He quietly cried on the bench in the noisy, busy clinic.
Headache. Just go get him some ibuprofen, of course. There seemed to me hardly any reason for him to go all the way through lab to get his vitals or trouble the busy doctors, trying to wrap up the la
st patients of the day. My sister used to get bad headaches all the time that would make her cry. Ben did have on a big, puffy winter coat on while I was sweating in a light t-shirt, but I paid no mind to it, as many of the Kenyans bundle up during this cooler time of year. (“cooler” meaning upper 80′s)
I walked over to the pharmacy and asked them if I could have a couple ibuprofen to give him, and they suggested I check with Dr. B first. Sure. I went Dr. Baker (code name: Mama Lisa) and quickly, between patients, point to Ben.
“He has a headache. Could I just give him a couple ibuprofen and send him on his way?”
Mama Lisa looked up, and, being the careful person she is, asked me to take his temperature first, just to make sure.
Ok, that’s fine. I didn’t have anything left to do for the day, so I took Ben under my wing. I retrieved one of those coveted little thermometers from the lab and pressed it to Ben’s temple.
WHAT?!? How is he walking home from school right now? Why is he not wrapped up in soft blankets on a couch, TV on and cell phone within reach, in case he needs anything from Mom? I would be.
I walked over to Mama Lisa as she was straightening up from listening to a patient’s heartbeat, and simply showed her the thermometer.
“Ok, get him a full treatment of malaria meds and let’s start the first one now.”
I brought Ben over to the stage at the end of the room, the the raised area in the simple, rectangular church over by the doctors and the pharmacy (“pharmacy” in our case meaning several benches arranged in a square where several students work all day to put prescriptions of medicine in little baggies for the patients). We laid him down, estimate his weight from the other malaria-riddled kid laying next to him, and got that medicine down his throat as fast as he can swallow.
I lightly rubbed his back and asked him his basic questions for the progress note. What’s your name? How old are you?
My heart dropped even more to hear that he is an orphan.
That he lives a good 45-minute walk away, and I would have assumed the least, given him the bare minimum, and sent him off.
I sat on the ground next to Ben, rubbing his back through his puffy green jacket. Outside, the afternoon showers began, and the horde of energetic and laughing children and Baylor students playing outside piled into the clinic. They crammed themselves into the opposite half of the church by the door, where intake usually sits, a giant mass of smiles among light and dark faces, backlit by the strong late-afternoon sun shining through the rain. If poor Mama Lisa had been planning on using her stethoscope on any more patients, she certainly wasn’t now.
That was one of those moments on the trip for me, and I thought about what had just happened.
So often I think I assume the least of people, both patients in the clinic and people I meet in real life. Sometimes I scribe for Dr. Baker and see patients come through that I think just made up a malady, or are making a big deal out of a small one, to get some attention from the mzungus, and some free medicine. And every time, Dr. Baker carefully and compassionately gives them the benefit of the doubt, an open ear, and a thorough physical exam. To everyone who knocks, the door is opened.
It all reminded me of the quote by Plato,
And Hebrews 13:2,
Don’t forget to show hospitality to strangers, for some who have done this have entertained angels without realizing it!
Doctors have a decision to make about how to approach their patients, the same decision we all make about how to approach anyone we meet. What conclusions do we jump to? How much grace do we spoon out to strangers?
Yes, as a doctor, my services will be taken advantage of- no matter where I practice. But you give everyone the time of day. Because somewhere in the mix of those clamoring for medical care, you might just find a Ben. And who am I to say that everyone else doesn’t at least need someone to listen to them?
For everyone who has taken Clinical Decision Making, the question is this: would you rather be sensitive or specific? For everyone else- would you rather give care to everyone who needs it (and risk giving care to those who don’t need it) or only those who need it (and risk ruling out someone who does)?
As for me, I hope to model myself after the Great Physician- the one who compassionately listens to all our undeserving requests. The one who paid attention to the people that everyone else passed over. No one was too undeserving or unimportant. That’s the kind of caregiver I hope to be.
And as for Ben… I sat by him in the clinic as the medicine began to kick in. I got in contact with one of our translators that lived near him and could make sure he made it home. We loaded him up with water and snacks, and took him toward his house on the van as far as we could, while I grilled the translator escorting him home to make sure she knew the instructions for Ben’s medicine so she could tell his grandmother. I got daily updates on his health from that translator, and a week later, watched him get his name called at the feast and stride, beaming, in front of the crowd of mzungus to receive his gifts.
There are some rough, uncomfortable moments when you go set up a clinic in Africa. But it’s worth it.