It is a hot mid-September morning. The malaria season is at its peak. My office, which serves as the admissions and emergency room, is very hot and humid. A mother rushes in with her comatose six-year-old child. She is crying. Looks sick and pregnant herself. She talks. I do not understand. I am the doctor. Her last hope for the child. She looks tired and covered with dust. She must have traveled far. Probably from across the north bank of the river. Walked a bit. Rode on a mule cart part of the way. Waited a bit for the ferry or the canoe. Then took the bus ride to our hospital. Possibly.
Meanwhile, her child is ill. She is worried. Can I help? I check the child's blood sugar level, which measures all right. I take a thick blood film for the laboratory to look for malaria parasites. It will take at least 30 minutes to get the result. She looks at me. Any hope? I try to reassure her. She does not understand. She speaks. I cannot understand. Language problem. As usual.
Obviously I need an interpreter. I rush to look for one. He talks to her. She looks dazed. And the child is comatose. I need to know the history. The doctor. Last hope. My interpreter tries to communicate in the three major dialects. She still cannot understand. She can only speak "serakhule," he tells me. We have to look for someone who speaks her language. To take a good history is very important. That is what Osler taught. I think.
Another patient's mother volunteers to interpret. To help. To know. She understands "serakhule." I ask the first question, looking at my interpreter. Eye contact. He translates to the interpreter who volunteered. Looking at her. She now turns to my patient's mother to ask her. In their common language. I do not understand. She does not look at me. And eye contact is very important. And I am the doctor. Better than the traditional medicine man.
The child has been ill for 5 days, I am told. Headache, fever and refusal to eat. Had several fits, then gradually deteriorated into coma 2 days ago. The father had traveled. She did not have transport money. No medicine at the health center, said the village clinic worker. Child very sick. The mule cart driver charged very expensively. The ferry was delayed at the terminal. She could not have come earlier. She could have. She wanted to. And I am to help. I examine the child. Comatose, febrile with mild pallor. No neck stiffness. Enlarged spleen. Very bad malaria, I think.
Quinine. Intravenous glucose. I sympathize. Mother looks more worried. Did I shake my head? I cannot talk to her. She can only listen to the volunteer. Looks at her. I want to communicate. Show empathy. Imperturbability. Listen. Play my role. Doctor. We wait.
Blood film showed several hundreds of malaria parasites. Quinine given. Blood sugar okay. Malaria. 1994. And the child dies. And the Hubbell telescope is in space. Billions in research. The mother cries. My interpreter leaves. I am defeated. Frustrated. I cannot communicate.
And another child is rushed in ... .
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