Of what use am I as a doctor if I cannot assist Daavi Julie to come to practical terms with her health status? Daavi Julie, by the way, is that special woman who in the poor hungry early 80s, walked determinedly to my boarding primary school, bearing food and a bulging pregnancy. Between that time and now, a lot of water has passed under the bridge. She is no longer the tireless woman I knew. She no longer has that quick step. And she no longer boasts of that erect bearing.
In due course, life has thrown its curve balls and with it its health affiliates, the first of which emerged while I was still a medical student. Freshly diagnosed as a hypertensive, Daavi would simply not accept this, let alone comply with her prescribed medication. She virtually rubbished every admonishment from me. She was not hypertensive, she refused it, she would be fine, God had healed her … Had I a better appreciation of the bio psychosocial model as I did a decade later as a public health physician, I would not have wondered why a whole headmistress of a Junior High School would prove to be such a stubborn patient. But recalcitrant she was, leaving me quite frustrated.
On one of her trips to Kwahu, I reminded her about the morning’s antihypertensive drug. No, she will not be taking it today. Its frequent urination side effect was too much of a terrible inconvenience given her travelling circumstances. I said a lot, but to no avail. And then she came into contact with Legon Hospital’s Dr. Timothy Senunyeme, long before he became a Specialist Obstetrician. What I had failed at miserably, he accomplished with distinction. Instantly, my mother became a transformed patient. She now fully accepted her condition, fully understood what it would take to manage it and was fully committed to total compliance with the medication. Every day, I thank God for senior colleague Timothy’s life. Today, over a decade later, Daavi regularly chats with poor Timothy on smart phone application WhatsApp! I say poor knowing the kinds of messages Daavi can flood unsuspecting individuals with ever since she discovered the pleasures of internet-enabled mobile telephones!
On appealing to her to have mercy on Timothy, she promptly replied, “You know I’m now glued to WhatsApp and can’t live without it. It provides me with the kind of interaction that I need now…!” and this from a retired pensioner!
When Daavi’s back pains started, I thought this time, my word would carry more weight. Painkillers may suffice for a while but over the long term, significant weight loss should be our target. Not on my word! After multiple treatment regimens without any real commitment towards addressing the underlying root causes, we started considering and then discarded surgery. Given the impracticality of prescribing rigorous physical exercise, we again discussed dietary control. Very quickly, Daavi pointed out how she has long stopped eating after 600pm. What about the fufu? O, not much. Really? Is it not this same Daavi Julie who is given to calling me every now and then with the message, “My son, there is some fufu ready. Won’t you pass by and …” And haven’t I on more than one occasion succumbed to the sumptuous invitation to sample her everlasting culinary delights? And while at it, have we not had a long running battle about mild salt content leading to her eventual total repentance?
But how were we going to convince Daavi to embark upon the kind of radical dietary reforms that would lead to such significant weight loss that would simultaneously address the severe backache? Sometime last week, she met Dr. Osei, Consultant Orthopedic Surgeon who helped Daavi to return with great insight into the underlying causes of her back ache and more importantly, the determination to make drastic dietary changes; reduced portions, more vegetables, light soup preferred to groundnut, no late eating… As I listened to Daavi now preach in her own words with renewed fervor, I burst into laughter. Everything I told her that she had dismissed, she had now fully accepted from her new Specialist doctor!
As I thank God for wonderful doctors like Timothy and Osei, I am reminded that there are social and psychological dimensions to ill health and its effective management. Convincing a patient to comply with lifelong medication when the patient has not quite accepted that there is ill health or that the constant headaches are due to raised blood pressure, amounts to an unfortunately limited view on our part as physicians. Lambasting a woman for bringing a child late to the hospital when her community has defined what “hospital illness” is and what it is not, reflects our own shortcoming, not hers. Giving every patient a certain type of medication without an enriching conversation on how that particular medication affects or diminishes the quality of their lives reflects our attitude of asking patients “What is the matter with you” as opposed to “What matters to the patient.” You are worried about her medication compliance. She is worried about being able to attend a funeral!
Today, I have accepted my fate. If I want to give my old lady medical advice, I am better off routing it through my colleagues. After all, none of them is the discredited prophet that I now realize I have become.