Friday, December 5, 2008

Medical Personnel & My Preferences: Social Constructs

This is from awhile ago. After two doctors visits and multiple tests, it was concluded that I had a mild malaria infection. Nothing super serious but I had mild symptoms. I'll get tested again when I get home to be safe.

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I’ve been feeling kind of crappy for a few days. When I look at the timeline of my last run-in with a herd of mosquitoes along with the day I missed my anti-malarial dose, there is a chance I could be malarial. ICK! I’d rather catch it early than wait until my fever is ridiculous and I’m vomiting uncontrollably. I headed to the school health center. I briefly saw the doctor and he sent me for a malaria test. I had the little finger prick. It wasn’t a needle; it was a razor blade thing. The lab tech gashed my finger and smeared my blood on a slide. It was the most painful thing I have felt in a long time. After I nearly passed out, the results were in. I had a parasite count of 2. Not bad but officially malaria positive. I became a bit skeptical about the results when I saw how many other tests they did and the fact that my slide wasn’t marked. I wasn’t confident that the results hadn’t been mixed up. I was feeling bad, but I could explain it with other things. I decided to go to the IST Clinic to get retested.

On the way there, I found an interesting and slightly disturbing thought running through my brain. I want to go somewhere that I know I will be seen and asked questions about my care. I want to see a real doctor.” Having had several encounters with the student health center and a private Tanzanian-run hospital here, there is a lot I’ve taken for granted at home. I anticipate that I will be asked pertinent questions like, “What are your symptoms?,” “How long has this been going on?”, etc. Or after I have explained what is going on the practitioner asks follow-up questions to make sure that he/she has an accurate picture of what I described.

I’m at the place where my feeling awful has me looking for an answer and I’m finding myself wanting the system I know and one I feel will fix me. With this thought, every sociology lecture I’ve sat through this semester came rushing to my mind. My version of health care is my social construct where I have my expectations of what the practitioner should do and the things that I should do or say to help him/her treat me appropriately. Those same roles are no where near the same here. (Having written about this before, the important distinction that I think I need to make here is that this time around, I am seeing the situation from a broader social perspective not a comparison contrast of what I know.) The role of biomedicine is relatively new in Tanzania from a historical perspective. People are slowly coming into the system. The rural areas have made a slower leap towards modern medicine. Medical pluralism is still very common in the city as well as the rural communities. More people than will admit still see traditional healers for treatment. There are several seemingly vibrant practices not far from campus. The idea of an informed patient is not something that is embraced. The thought is that the doctors and nurses are the smart ones. It is the patient’s role to listen and do only what they are told. There is very little expectation for anything for much else than the doctor spending less than five minutes with you and sending you home with a large packet of pills. The expectations of lab tests and physical exams for anything else than obvious wounds are minimal at best. My brain has been programmed by years of treatment in the American system that when I go in with various systems, I will usually have some lab tests performed and a physical examination. The doctor is to play the role of detective not dictator of disease. It was and still is a challenge for me to see this system as well as be a patient it in without applying my cultural biases and expectations. This is further compounded by the amount of knowledge I have regarding the American medical system because of my major and personal interest.

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