MarySmith’sPlace – Afghan adventures (8)

The morning of the clinic opening Ali Baba had to lock the door to prevent eager patients from disrupting breakfast.

Too nervous to eat, Hussain checked for the hundredth time that all was ready. He’d asked me to sit with him in the clinic, write the prescriptions and make notes of things which needed to be changed. It would also be a good way to improve my Dari.

Hussain gave the signal for Ali Baba to open the door. Immediately, half a dozen men pushed and shoved each other into the consulting room, all talking at once. Using some pretty persuasive shoving himself Ali Baba eventually succeeded in evicting five of them and the victorious winner sat on the floor, beaming happily.

Hussain urged him to sit on the folding metal chair provided for patients. He, himself, was ensconced in a chair more appropriate to his exalted position.  It was a monstrous wooden armchair of peculiar design and proportions, “crafted” by the village carpenter to Hussain’s specifications. In fact, he very quickly realised it was totally out of place in the clinic and swapped it for a folding chair, which must have been less intimidating for patients.

The examining couch was of equally generous size, and so high that patients required the help of a chair to enable them to reach it. It became a useful diagnostic aid and Hussain often had to hide a smile as a patient who had been complaining of dreadful, incapacitating pains and weakness all over his body would suddenly leap with remarkable agility onto the examining couch.

An average of between forty and fifty patients arrived each day during the first week. This left little time for other work – accounts, reports, supervising the building work at the new clinic. As yet Hussain did not have any leprosy patients on his register but that would soon change.  He would inherit all patients living in Jaghoray who, until now, had been receiving treatment from the leprosy clinic in neighbouring Malestan.

Slide01 (Custom)

Hussain at work in his clinic

Many of the patients who came in the first weeks came mostly out of curiosity, wanting to see the foreign “doctor”. I tried in vain to persuade people to stop calling me doctor. Others came because, at last, they had a health service on their doorstep – one which dispensed free medicine. The clinic’s primary aim was to control leprosy in the area but because of the stigma attached to the disease we knew the people would not be happy about a clinic opening only for leprosy patients. We needed to keep people on our side if we were to be able to trace and treat everyone who had leprosy and could do that by prescribing medication they needed.

One major problem was that many of the patients, who showed up in the early weeks, had an obsession for medicines.  Injections were number one on the list of preferred treatments, considered to be the most effective (if it hurts it must be doing some good?), next in favour were syrups followed by multi-coloured capsules. Antibiotics in the form of plain white tablets such as Penicillin V were not thought to be of much use and aspirin or paracetamol were not even considered to be medicinal.

Hussain valiantly resisted prescribing unnecessary medicines but he was going to have to fight hard to win that battle. His entire reputation as a “good” doctor rested, not on effective health care, but on the amount of drugs he prescribed. In such a close-knit community, holding on to such principles in the face of plummeting popularity was going to be tough – especially for someone like Hussain, whose ego needed constant boosting. Occasionally patients became angry and abusive if not given a prescription, as though Hussain was denying them something that was rightfully theirs.

The days slid by quickly. I no longer reached automatically reaching for a light switch when dusk fell. I’d stopped trying to flush the latrine. I did wish it was possible to flush if only to hide my embarrassing pink poo. Some months before, while working in Karachi, I contracted tuberculosis and had been taking treatment (including Rifampicin, responsible for the pretty poo) ever since. I kind of knew that after nine months of regular treatment – and I was very good at “eating my medicine” every day – it was safe for me to stop. However, I also knew I should wait until I could have bloods checked in a laboratory so I was waiting until that could happen.

Unfortunately, I’d found I was sharing my room with things that went bite in the night. These proved to be tiny mites which lived in the mud walls. Ali Baba sprayed my room thoroughly with an insecticide lethal to all insects – and, presumably mankind, as it had long been banned in the west. Even by bedtime fumes still lingered but I did get a good night’s sleep. After two nights, though, the invaders returned in force to feast on foreign flesh and only if the room was sprayed every other day did we prevent the little horrors from enjoying me for their midnight snacks.

A constant battle also had to be fought against the horrendous flies which swarmed in the moment a window was opened. Baqul would organise fly eviction crusades. Everyone used their patou – the large shawl worn or carried by all the men, required for keeping warm, carrying shopping, wiping noses and a hundred other uses including fly evictions. Each member of staff charged around the room flapping their patou wildly at the flies until, unsettled and giddy, the flies would eventually find their way out of the windows.

The alternative, rather gruesome, method was to add some black Baygon powder to a saucer of water.  The flies found this concoction delicious and would swoop down to gorge, only to be seen moments later struggling in their final death throes. A saucer full of a couple of dozen dead or dying flies floating in black slime was a revolting, but horribly fascinating, sight.

Slide06 (Custom)

Threshing wheat – a timeless image and much nicer than flies in their death throes!

31 thoughts on “MarySmith’sPlace – Afghan adventures (8)

    • I don’t think you can buy it here, Pete. Ah, so you are familiar with the pink poo phenomenon! On a different topic entirely, I’m on holiday and saved up the last two episodes of Dublin Murders to watch last night. I really wish I hadn’t bothered. The series started with such great promise, too.

      Liked by 1 person

      • Pink tears, pink wee, pink ‘everything’! 🙂
        I think Dublin Murders was too ‘clever’ for its own good. At least it thought it was, but we didn’t agree! 🙂
        Sarah Lancashire has been very good in ‘The Accident’ on C4. But then I have always liked her.
        Best wishes, Pete.

        Liked by 1 person

  1. Yes that phenomenon of it it hurts it must be good for you seems to be creepinginto UK medicine too. The coloured pill thing might also be taking hold – on of mine has recently changed from white to yellow.

    I must try the flailing scarf technigue on my flies next summer 🙂

    Liked by 1 person

    • Aw, thank you, Robbie. TB is a killer in Afghanistan, too, and I was afraid to stop the medication too soon in case the bacteria became resistant to the antibiotics. That’s one of the biggest problems everywhere nowadays – resistant strains of TB. Once treatment is started patients feel so much better quite quickly and, especially if they have to find the money to pay for the medicines, they often stop the treatment. Then, they become ill again and it’s the stoppng and starting treatment which allows the bugs to mutate and become resistant.

      Liked by 1 person

    • The project was funded by a combination of charities including CARITAS, German Leprosy Relief Association, MISEREOR and at some point the World Health Organisation, especially for TB. He did try not to ‘dole’ them out but prescribe only when necessary – not easy.

      Liked by 1 person

  2. Reblogged this on Smorgasbord Blog Magazine and commented:
    I am just catching up with my blog reading and if you are looking for a fascinating series, look no further than Mary Smith’s Place. Mary is sharing her experiences of working in Afghanistan in a leprosy clinic, and if that is not intriguing enough you should head over to find out how they dispensed with mites and flies.. Mary is a warrior and there is no way in a million years would I be stoic enough to handle that kind of working environment…and if you have not read her fabulous book No More Mulberries… buy it for yourself and enjoy. thanks Sally

    Liked by 1 person

  3. Pingback: Afghan adventures (8) ~ Mary Smith | Sue Vincent's Daily Echo

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