I’ve had cause to reflect this week, about whether I did the right thing, and also about the challenge of looking after people whose culture and life experience is so far removed from my own.
A Batwa lady came to hospital. Her admission note described her as ‘elderly,’ though it also noted that she was 55. She was very small with an active and expressive face. She was short of breath. (for Batwa, see another entry about Kids – I’ll post this soon – the Batwa are original indigenous forest dwelling pygmy population locally – they are disposessed and even more disadvantaged than the local population.)
We made a diagnosis of pneumonia and settled her into a bed on the ward, with an oxygen mask on her face to help her breathing and a drip for her antibiotics.
By the next morning, she was lying still as a stone, curled up on the bed, hunched under a blanket. Her daughter was with her. ‘’We want to take her home’’ the daughter told us. But she had an eminently curable condition. A few days of antibiotics and a little bit of oxygen would turn things round and she would be well enough to go home. The nurses prompted the daughter to give her some bananas. ‘’Look, we just need to make sure she has enough to eat and she can get better. Let’s keep her here on the ward,’’ we said. The daughter acquiesced.
By the next morning, the patient was refusing to take treatment, and refusing to speak. Her daughter was in tears. ‘’We want to take her home. She is already dead.’’ Once again, we explained that she was not at all dead, and that treatment would improve matters. Taking her home would likely result in her dying as her oxygen levels were too low to be sustainable without oxygen.
Her daughter said she would consult with her brother about what should happen. And they agreed that the patient should stay in hospital.
Meanwhile, the patient appeared to deteriorate. I arranged some tests. Nothing very abnormal.
When I came to the ward this morning, I was told that the lady had died in the night. Her daughter had been at her bedside.
What a sadness.
This was a lady of the forest, and she died with a roof over her head, away from her home.
According to the nurses, the Batwa always want to take their family members home if they are dying. And this time, it hadn’t happened.
I felt as if I missed something important. The lady had died, had given up trying to live. Her family had seen this, and I hadn’t. Perhaps I should have listened better when they told me that she was ‘’already dead.’’
When I look at the forest, I try and imagine what It feels like to have this disorientating tangle of lush vegetation as your home, to understand its rules and know its reference points as the Batwa do (or did}. I find it almost impossible to connect with how that might be. And so, it feels as if this community lives by rules and experiences that are so far outside my own that I lack the usual reference points I use to help me think about the needs of my patients.
There is so much still to learn.