Clinic

On busy days the clinic sees about 30 patients. It seems that most days are busy, but sometimes only 10 or so will come. Public health announcements over the radio make an astonishing difference. The Women's Health Program or some other NGO or government agency will announce something along the lines of 'everyone who experiences abdominal pain should see a doctor.' So people will show up that day saying they feel abdominal pain.
The clinic is equipped with one exam room, one room for births (which they use for exams), an injection room, and a waiting room. Everything is completely covered in a layer of dirt and the waiting room is accentuated with wasps. Patients come in, have their blood pressure and pulse measured and a patient card prepared by a nurse, and wait in plastic chairs for one of the two rooms to call them in.
Once in the exam room, the patient's experience differs dramatically from what I'm used to in a doctor's office. One of our nurses will stay behind his desk throughout the exam. He doesn't usually touch or examine the patient - just listens to their description and prescribes medicine. The other nurses tend to be more thorough. If you are called into the delivery room you will probably be asked to lie on a bed draped with a quilt that hasn't been washed in ages. Numerous pregnant women, women with STI's, and vaginal discharges, and other mysterious abdominal pains have lain on it before you. On one side of you lies a shelf stuffed with donated gauze, band aids, Q-tips, sutures, and soap - all in widely varying conditions. On the other side lies a bare exam table where women give birth. The woman's family is in charge of cleaning the table after the delivery - so it too may be in widely varying degrees of cleanliness. Other patients will wander in and out of the room whether you are dressed or not. The door may be kept open during your exam. It's hard to tell what patients' reactions are to everything. Going to the doctor is a novel mysterious experience for most people. There's definitely no sense of invasion if someone wanders in during their vaginal exam. I think I have yet to see someone ask a question to their nurse.
One of the volunteer nurses implemented hand washing stations - bowls of clean soapy water. I think she and I are the only people using them. I've seen mother bathe their children in them. I've also seen a nurse touch an infected eye and then palpate a pregnant woman. The underutilization of existing supplies and knowledge is stunning.
The clinic isn't set up to do basic lab testing, so diagnoses are made on a best assessment basis. They give out antibiotics like penicillin, flagyl, ACT for malaria, aspirins, anti-diarrheals, and iron for anemia. There is a government hospital and a private surgeon who we refer cases to.