Thoughts from a crazy shrink

It’s been an incredibly busy start to the week. My patient numbers continue to explode and I am confronted with difficult, challenging cases on a daily basis.
I’m still struggling with my own emotions. I find myself crying at least once a day. I had dinner with the Pon’s last night and they provided me with a lot of comfort and reassurance. They are incredibly beautiful people who have such strength and faith that it’s hard not to be inspired by being in their company. They have decided that I would benefit from being part of a family for the rest of my stay and they have organised that I will have dinner with them and their children every Monday. I am sure this will help me a great deal.

It seems rather ironic, that in the face of my own emotional crisis, I have been given the rather unwanted role of psychiatrist here at Good Shepherd. I hate psychiatry, almost as much as I hate orthopaedics and I simply detest orthopaedics. However, if anyone seems to show any hint of an emotional disturbance here, it suddenly becomes a “medical” problem and the patient is passed onto me- much like you would pass on a bad smell.

I had a female referred to me from the gynaecologist. She had been admitted with pelvic inflammatory disease (a medical term that softens the real diagnosis of sexually transmitted disease). Anyway, she was behaving in a rather disruptive manner and she was referred to me with the provisional diagnosis of being “psychotic”.
It was with a sinking heart that I went to interview her with my nurse who would act as a translator. Let me tell you, it’s extraordinarily difficult to take a psychiatric history from someone who does not speak English. It is near to impossible when you have underlying cultural differences that make it difficult to determine whether something can be deemed psychotic, or just a little cultural difference that may be considered completely normal here in Swaziland. Anyway, I was able to elucidate that this woman had HIV, she had just lost her job and her husband (who had kindly given her PID) had just run off with another woman. Now I ask my female readers, who wouldn’t be considered a little mad having to experience all of this? Was Lorana Bobbitt ever considered psychotic? If you ask me, it’s perfectly reasonable to be a little emotional having to deal with all of this. Obviously, my opinion does not count here in Swaziland (yet people continue to ask for it). My prescription of an antidepressant to try and help her sleep at night was not considered adequate psychiatric help and I was forced to refer her to Swazilands only psychiatric service in Manzini. I wonder what the psychiatrist there thought when he received a letter with the opening line- “I’m an Australian medical doctor who does not speak SiSwati and does not yet have an appreciation of cultural norms”…….

My second psychiatric consult was indeed much sadder. It was a 15 year old girl who had taken an unknown quantity of an unknown substance to try and kill herself. Thankfully, she did not suffer any deleterious medical effects, but I was asked to see her to “sort out her emotional state”. I found out that she was hoping to take her life because her family could no longer afford to send her to school and she desperately wanted to continue her education. She saw no hope for her life if she couldn’t receive a decent education. Welcome to life in a third world country. In western countries, we have adolescents who desperately try not to go to school. Kids who have no respect or appreciation for education. It made me sick to the stomach. I knew I couldn’t help this girl. I have already spent a good portion of my money paying for Elsie’s (my housekeeper) daughter to finish school. I simply cannot afford to pay for another girl. Instead, I wrapped this girl up in my arms, embraced her as we both cried and then continued on my ward round, trying to alleviate the suffering of a country that is desperately ill.