Where There is No Doctor is a wonderful book. In the United States we have this perception of doctors as these humans who hold this elite knowledge that can only be gained after years of education. While I am glad doctors are well-trained, I think many people use that as an excuse to not take responsibility for their own health. One reason this book is excellent is that it explains how and why people get sick, describes symptoms and treatment and provides a basic understanding of most medicines and their common uses. Ergo, an average person could theoretically treat most ailments and perhaps, in their spare time, mobilize a community to prevent many common illnesses (such as if one were to join Peace Corps as a Health Volunteer).
Another reason I like this book is that it is a hypochondriac’s delight. In a place where there is no Google, it is still possible to look up each and every symptom in order to decide whether the cough you have is tuberculosis or just the common cold.
Thus, when I rang in the New Year with a cold and a sore throat, I immediately consulted the book. Noting that had no fever, I prescribed myself salt-water gargles and Ibuprofen for when I could not sleep.
A few days later, I noticed I started waking up with goop sealing my eyes. To the book! I thought. However, finding nothing, I called the Peace Corps Medical Officer (PCMO).
“Well Jessica, it sounds like you have pink eye.”
“But my eyes are not pink and they do not hurt.” (I would know. I had, of course, consulted the book.)
“Either way you have conjunctivitis.”
Prescribes medicine. End scene.
Being in a small village, I have to journey at least an hour to get to the nearest pharmacy. (Have I mentioned yet that being sick here is more effort than it is worth?) So after my kind friend confirmed the medicine was available and purchased it, I hitchhiked to his village to pick it up and buy him dinner for his efforts.
Upon arriving home, I realized this medicine was not eye drops, as expected, but instead, eye ointment. Um…what?! To the book! So to my favorite book and possibly best friend I ran. After seeing eye ointment mentioned—It exists!—and looking up the drug in the green pages, I decide the medicine would suffice. That said, eye ointment is a nuisance to use. One must pull down their lower eyelid and squirt a Vaseline-like substance inside. One then must not blink said substance out and let it rest in a thin film as it slowly absorbed by one’s eye. Hopefully, one is a fan of temporary blindness!
Eye issues resolved, everything was fine and dandy, right? Wrong.
A few days later, upon realizing my throat was not getting better—it had been a whole week of creative soup-inspired cooking (Curried apple onion egg soup, anyone? What about spicy papaya pepper tomato lentils?)—I finally contacted the PCMO about it.
“Jessica, it sounds like you have strep.”
“But I don’t have a fever. AND I haven’t had a fever all week.” (Note: Fever is the most important strep symptom listed in the book.)
“Yes, well. You need penicillin.”
Prescribes medicine. End scene.
Still not convinced that I had strep, I texted a fellow hypochondriac (and friend).
-Is it possible to have strep without a fever?-
-Possible? Yes. Likely? No.-
I then explained my woes, my symptoms and the PCMO’s prescription, to which he told me penicillin wouldn’t hurt me and that it was already overprescribed. He makes a good point. So I decided to get the medicine. This time I went to the local district hospital, also about an hour away.
When I asked the chef de centre for the medicine, he told me that they did not have it, but they had the petit frère. He then told me that I needed a consultation in order to get the medicine. (Note: This is actually a good thing, since it shows the hospital will not just let anyone buy medicine; however, when one already has a diagnosis, it becomes a nuisance.)
Welcome to the Cameroonian Medical System (Please follow along using the provided guide and keep all hands and feet inside during the ride):
- In order to have a consultation one must have a carnet, which must be purchased at the caisse (see 1).
- After purchasing a carnet you must then go to the front desk (see 2) where they fill out your name, take your blood pressure and temperature (still no fever, mind you). As for the rest of the information such as allergies and chronic conditions? “Pas important.”
- You may then proceed to the doctor’s office (see 3) where the doctor will ask you about your symptoms. He then tells you that you need to go the lab in order to confirm your illness.
- This means you will go back to the caisse (see 1) to pay for the test. The cashier then will provide you with a packaged syringe.
- Syringe in hand, you head to the lab (see 4) and wait. And wait.
- Someone eventually will call your name and will take your blood.
- You then wait (and wait) for the results.
- When you receive your results you go back to the doctor (see 3) who announces that you are positive for ASLO and prescribes you a year’s worth of injections.
Confused, I stared at the doctor who then explained that ASLO was a bad bacteria and that some people needed injections for the rest of their lives. I nodded and then headed outside. In shock, I sank down under and tree and called the PCMO.
“Oh don’t worry about that, just get the other meds.”
(Apparently wanting to know what exactly everything means medically is a United Statesian thing.)
Still confused, I headed to Tibati where I vented the entire day’s adventure to some fellow PCVs.
“ASLO—like also, but misspelled.”
We google the test and discover that it is a test to see if your body has started making antibodies against strep (as it turns out I actually did have strep).
One mystery resolved, I headed to the pharmacy for the originally prescribed medication, some fresh veggies and glorious kossam (the locally made yogurt in the region).
At the end of the day I headed home and once again consulted my best friend, Where There is No Doctor, and solve the final two mysteries.
First, what on earth did the doctor prescribe you?
Answer: The treatment for Rheumatic fever. Ever wonder why it is important to take a strep test? Because without treatment it may develop into Rheumatic fever, which eventually can damage your heart. (But I strongly disagree with the doctor’s diagnosis, as fever is a notable symptom of Rheumatic fever and let it once again be said that I do not and have not had a fever.)
Second, why injections?
Answer: (or at least my theory). Cameroonians seem to love injections, or at least the hospitals do. For this attraction, there are probably two reasons. The first is that injections work faster. As many do not go to the doctor until they are gravely ill, injections are usually required. Secondly, Injections are more expensive and require a trained professional, thus, doctors can charge more for them.
Finally, I saw this cartoon in the book, which I think summarizes my day: