By Denise Kavuma, Uganda:
At one point or the other, I'm sure we've all had to deal with rather spoilt children (and adults but that's a whole other Tolkien-sized novel on its own). As such, I'm pretty sure you can understand when I say that I sometimes want to hit the children that walk into my office. Granted it won't be the Mortal Kombat kind of thrashing but simply just to slap them around a little. It really grates on the nerves when a child starts trying to imitate a screaming cat at the sight of your white coat or when they kick and fight like I'm tearing out their tongue just because I produced my stethoscope. Come on, it's a steth; everybody wants one and here this child, is acting like it was wrought by the devil. Don't worry though, I have no plans to become a pediatrician so your children will not be in my hands…for now.
Now, it was this kind of child that happened to walk into my office that fateful day. A 12 year old chubby, angelic looking girl who was in some sort of pain. It took me all of 2 minutes to find out that she was a sickler and thought she was in a crisis. It was the house-help who'd brought her to hospital that day unfortunately (for the help) and, well, me in about another 5 minutes or so, I quickly learnt that this was the kind of spoilt child I just did not want to deal with (not that there's any kind of spoilt anything that I can stand).
Sickle Cell Disease is very serious and its mortality rate is very high in Uganda; the kind of pain these children go through is immense. That being said, this child was in very little pain that day and I was sure it wasn't a Sickle Cell Crisis she was experiencing. But, the little 12 year old girl started demanding how we should give her Pethidine as no other analgesic ever worked and she was very serious about it.
The help had no say in the matter and the girl's parents were nowhere to be seen (I later learned that the mother couldn't handle the spoilt-girl attitude and would leave the maid to ferry her child to and from the hospital). So there I was, trying to explain to a pre-teen girl that no, she actually wasn't as sick as she thought she was and she didn't need a strong pain-killer as a result.
She refused to listen to me; of course (I don't know what else could be expected from her) and went on to reveal how her mother sometimes gave her Morphine and Codeine at home.
These are opioid drugs and tend to be rather addictive; sickler or not, they are not drugs one should be administering from home but there was nobody to tell this to except the pouting 12 year old then staring at me.
Finding it a little silly to be arguing with the girl (finally, after I'd lost most of my dignity) I explained to her that we needed to insert an IV cannula before we could treat her and it would sting a little. She accepted and acted bravely for all of 3 seconds before she started wriggling like fish out of water and was just as slippery. There is an art to dealing with fighting patients; you have to try and incapacitate them without hurting them, otherwise, we'd all just slip on our rings and punch them in their faces to knock them out…and then some.
There we were, 2 nurses (one of them in mid-pregnancy) and a doctor, trying to soothe a 12 year old sickler not in crisis, so we could administer treatment. And we were failing. Just as I was starting to wonder whether I could don a mask, punch the daylights out of this irritating kid and then run off to let the nurses carry on the rest, the girl kicked the pregnant nurse right in the abdomen.
For a moment, we all just stood there in shock before the affected nurse quickly left the room. The little girl did not even acknowledge the implications of what she'd done (either that or she's way undereducated) and continued arguing. We finally managed to treat her and she left but by that time, the pregnant nurse was having some seriously scary abdominal pain which lasted the entire day. She was crying, we had little to say to soothe her and the annoying little girl was probably somewhere eating all the chocolate in the world.
It was incredibly frustrating, but thankfully, the pain disappeared and the nurse settled down enough to come to work the next day: Only for the pre-teen to return (with the maid in tow) complaining of pain again. When I asked her if she'd taken the medicine I'd prescribed for her, she replied in the negative, giving the reason that she'd just eaten at the time and couldn't swallow it.
The medication I'd written down was supposed to be taken after and only after eating.
I started looking for my boxing gloves.
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