‘My Best Day as a Physician’

September 29, 2010

How three humbling weeks in Senegal changed my perspective

I’m a general internist, a solo practitioner admittedly lacking the talent to gain wealth by working “smart” but overshadowed by an addiction to work “hard.” Needless to say, leaving my office is an expensive endeavor. So when I was invited to participate in a three-week humanitarian tour to Senegal, Africa, the decision to leave was not easy. It would be expensive, but it would become the most humbling, rejuvenating, and satisfying medical experience that I have had. It would collectively become my “best day” as a physician.

Dakar, Senegal is a historic and beautiful city of 2.5 million with an equal number of gaunt goats and skeletal birds rummaging through plethoric piles of refuse. The locals don’t seem to mind. Some appear hard-working, others comfortably complacent (not much different from home) but they appear to be happy in rather dismal surroundings.

After traveling six and a half hours east of Dakar our small group of “medics” (two physicians, two PAs, two dentists, and an ophthalmologist with a handful of excellent support staff) arrived at the remote village of Linguere, central Senegal. Linguere welcomed us with 118 degrees Fahrenheit, the sparse shade was more comfortable at 108 F but challenging to find.

An agricultural campus became our quarters - an impressively modern structure compared to the surrounding mud huts. There was no electricity, no air conditioning, no comforts of home, only cots set up in 10-foot by 15-foot rectangular rooms. The blowing sand penetrated the vented windows and open doorways leaving at least a quarter-inch buildup on everything we owned. Surprisingly, the building had a restroom with showers, but without regular running water. Scattered buckets containing nonpotable water were used for flushing the toilets. The showers, we were told, occasionally worked if there was adequate pressure within the well. With diligent testing I learned that there is pressure between 4 a.m. and 4:30 a.m. - a steady trickle that I selfishly kept secret for several days.

As each of us evaluated roughly 100 patients daily there were many symptoms suggestive of parasitic disease (headaches, abdominal pain, diarrhea, bloating, fatigue) and everyone over 2 years old and not pregnant was treated with prophylactic Albendazole. Blindness was a problem - traumatic cataracts from the hot, dry, blowing sand - but the malnourished children truly tested my emotional fortitude. There was no obesity, but surprisingly, a few overweight patients (many with goiter) - desirable, as it represents affluence. Affluence in rural Senegal means having your own donkey to pull a cart that isn’t considered your next dinner entrée.

Anemia was also prevalent, presumably due to dietary deficiencies. Without a lab for confirmation, objective clues of conjunctival, buccal, and palmar pallor made the diagnosis. We gave out thousands of vitamins containing iron, a temporary fix at best.

I cared for a 3-day-old baby boy, born at least one month early; unfortunately his chances of survival were slim. Many women will bear five to seven children hoping that two or three will survive. Age five seems to be a mortality milestone - 60 percent of children won’t make it this long.

What absolute satisfaction to see the smile of an 8-year-old girl after a golf ball-sized sebaceous cyst was removed from her forehead. This unsightly mass caused her family significant embarrassment; she was hidden from the community, an outcast and likely never to be offered in marriage. Now resected, her hair will grow, cover the hairline incision and the family will have to explain the eight-year absence of this natural beauty. On bended knee and with hands raised, her parents praised the work of me and my colleague, Dr. Isaacs.

As remote as Linguere appeared, 30 kilometers south truly defined “the middle of nowhere” - Dodji, Senegal. The clinic/hospital where we were asked to work was small, filthy, and filled with flies. Next to the three-room outpatient clinic was an outhouse (a ceramic squatting tub for employees, visitors, and patients to share) and adjacent to this was a three-room, filthy inpatient ward. One of the small rooms housed two women preparing for delivery, one woman no more than a few hours postpartum lying on the concrete floor with newborn forced onto her breast, and two other women lending support. The few-hours-old baby was frail, thin, quiet, and in need of significant support to live. I extended myself with greetings, congratulations, Tootsie-Rolls, and smiles. A simple smile (maybe it was a laugh at perhaps the only white man they had ever seen) appeared to mean a lot to these women. I was asked my name and honored that the newborn baby was immediately named after me, “Darin Abdu,” as the first male to extend a hand of friendship.

In spite of pitiable circumstances, I felt a sense of great accomplishment. The multivitamins, antiparasitics, and ibuprofen won’t have any lasting curative effects, but allowing a child to live one additional day, removing a skin lesion that changes a child’s social status, and witnessing genuine gratitude will be forever rewarding.

We were joined in our camp by U.S. Marines training in Senegal with the local police and acting as a deterrent to Al Qaeda recruiting efforts. They were an impressive sight to see as they rolled into camp in five-ton trucks and Humvees, battle-ready with flak jackets, combat helmets, and M-4s in hand. They were dirty, dehydrated, and fit - tough young men proud to defend our country.

Due to another sandstorm our shelter was again filled with fine silt - blanketing everything that we possessed. It didn’t bother me. I was almost ashamed to have an iPod, cell phone, and digital camera - comforts that the local residents will likely never enjoy. With the Marines in camp, I didn’t know what would happen with my early morning “trickle” shower, but it didn’t matter, I’d already had my “best day.”

Darin B. Brimhall, DO, operates a solo internal medicine practice in Henderson, Nev., spending a considerable amount of time in clinical research as the medical director for Novum Pharmaceutical Research Services and also acting as the medical director for St. Rose Hospice Services. His scant free time is spent with his five children riding motorcycles in the desert or searching for new slopes to snowboard.

This article originally appeared in the October 2010 issue of Physicians Practice.