4th April 2012
Any OUSU people reading this
won’t be surprised that, having covered womens’ health, I’m moving on to
disability. It’ll be the Malawi welfare state next.
I was curious about the attitudes
to disability here from the moment we landed – as well as the obvious worries
about accessibility issues from a personal point of view, I was thinking about
the inevitable crossover between medical care and the spectrum of impairment.
I’m happy to admit that the way that disability is treated here is completely
different from what I was expecting.
Let’s start with accessibility.
Trick question – which hospital is more wheelchair accessible; the world class
John Radcliffe Hospital, Oxford, or St Martin’s Hospital in rural Malindi? OK, ok, to be fair to the JR, I assume that
St Martin’s Hospital is all on one floor due to lack of resources, rather than
through concern for those of us who can’t manage the stairs. That said, I was
very surprised by the amount of ramps at both St Martin’s and Nkope and all of
the stairs are both wide and shallow, meaning that a wheelchair bound person
could probably get around without too many problems. Again, I’m not sure that
this is deliberate, but it is quite refreshing. From my point of view, however,
the massive downside is that every hard surface is made of smooth concrete. In
wet weather (it’s currently rainy season) this makes the whole place an
absolute death trap. Oh well, you can’t have everything.
In terms of the attitudes to
disability, my first experience was, of course, how people reacted to me. For
anyone who doesn’t know, I often use a walking stick, particularly at work.
Having already asked one of the nurses about the prevalence of female doctors
in Malawi (there aren’t many), I was fairly certain that I would be the first
disabled doctor that many people here had encountered, and I’m pretty sure that
they don’t watch House. To be honest, people seem to find it about as strange
as they do in the UK. The big difference is that everyone is quite direct about
it. As Dan mentioned previously, the idea of privacy isn’t such a big thing
around here, which means that no one hesitates in asking me why I use a stick.
I have to say, I much prefer this approach. It makes things a lot quicker, just
for one thing.
Something that I’m still not
entirely sure about is the management of mental illness around here. I thought
that we might come across an obstetric patient who suffered from psychosis or
post-natal depression, or that there may be mental illness in some of the HIV
patients, for instance, but so far we haven’t encountered this. It may well be
that these sort of illnesses manifest themselves differently due to the
cultural differences, or that I’m missing things due to the language barrier.
I’m not sure. What we have seen, however, is the management of a patient with a
learning disability. A woman came to antenatal clinic, 16 weeks pregnant. She
had been complaining of symptoms of pregnancy and movements in her abdomen, but
she wasn’t able to understand the fact that she was pregnant. The nurses
clearly had a protocol for managing this sort of thing; they had insisted on
her being brought by a guardian, who helped explain the whole process to the
patient. Dan and I were impressed that the nurses took the time during the busy
clinic to make sure that the woman was receiving the required antenatal care,
despite the difficulty of the situation. However, the issue of consent loomed
in both of our minds – how had a woman with an impairment significant enough to
render her incapable of understanding the concept of pregnancy become pregnant
in the first place? Concerned, we asked one of the nurses, who explained that
she was married. It would appear that the issue of capacity is not one that is
necessarily considered around here, and both of us were very uncomfortable with
the whole situation. That said, we are relieved that the patient in question
appears to be receiving a lot of social and medical support, and hopefully the
situation will be managed appropriately.
Danni
