Try hard as we may, we may not be able to save everyone in the rural area. No matter how well intentioned we are, some cases must be referred. She looked worn out, tired and walked with a stick. From a distance my surmise was that of an old groggy lady. She was guided straight to the emergency room where I followed closely. I realized she was only 25. She looked over 60. The complaint was that of a progressive swelling in the abdomen that started from the right flank and increased to occupy the whole abdomen. This had been on for over 4 years. There was a mass on the lower part of her left neck just above the collarbone. She was chronically ill looking, her eyes appeared white and sunken, the facial muscles were all wasted and one could count the bones on her face. She was just coming from a traditional herbalist who was managing her. He had been giving her some concoctions for weeks now and only permitted her to come to us to be transfused as he had diagnosed her of being anemic, warning her to come back as soon as she had been transfused. She wasn't pale clinically. I took a cursory look at her, examined and decided this wasn't a case for us to manage. She had a chronic ailment. Whatever the mass in her stomach, I reckoned was a renal(kidney) one, it had sent secondaries to the lymph nodes in the neck. Very poor as they appeared, I felt sad I had to refer then to the tertiary center to be managed. Very sad because she would spend a fortune for diagnosis alone before proper treatment, something she doesn't have. I regret because one of our major aims at rural doctor initiative has been defeated. We aim for patients to get AFFORDABLE standard basic health care within their communities. I watched them leave the facility depressed and helpless. They probably will go straight to the herbalist and continue with the care they can afford. My consolation is that we were able to give them the best advice possible. Several smaller clinics would have admitted them to sap from them the little money they do not have without any definitive treatment line.
In the end, the rural doctor initiative seeks to bring equity in health care for the rural populace. Health care referral system is a vital part of efficient health care delivery. The rural doctor initiative… Everyone deserves good health.
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