Morning in the clinic starts really slow but it’s already full of people. They are not necessarily patients, also in the mix are relatives who stays with their sick but are staying on empty benches and hallways with their small sack of belongings. They come from different parts of the district and traveling around can be an excursion — there’s only one vehicle available per week and lucky if you could catch it on time.
But one set of patients come not far from the hospital. They are from the camp maintained by UNHCHR. They are Liberians in Sierra Leone land. They escaped from their country at the height of the civil unrest and settled there for good number of years and still no clarity if they will ever be repatriated. There are talks, but my staffs been saying it’s been talk for the longest time they can remember.
“Good morning Adama” I said when I arrived in the clinic. “What’s our case load today?”
Adama, was my senior physiotherapist. Very efficient, reliable and inquisitive colleague, replied “we have people from the camp coming”
“I see, anything I need to know about them?”
“One client. He’s been with us since a long time but we can’t seem to make him well”
“What’s the case?”
“We don’t know really, hard to explain. It would be good if you could see him and make proper assessment and diagnosis, then you can tell us”
I told you, she can be stern and direct and I like that. I am in the hot seat.
The morning preparation continued. We made plans for the week including technical training before it become a crazy day, I was there to provide that aside from practical demonstration and monitoring of rehabilitation treatment.
“Here’s Abdul D, he’s the one I am talking about” says Adama when a group of new clients arrived in the clinic.
I saw this tall, lanky man, with a permanent scowl on his face and a very straight back. He walks as if a string is pulling him upright and someone is holding it from above. By this time I am familiar with the people in the hospital and of Sierra Leonean that I can see the difference in his feature. Abdul was tall, thin and his face is longer, Sierra Leone men are shorter if you are from the west coast and taller as you get closer to the border of Liberia and rounder face. He’s English was more clear though the manner was similar to my staffs, maybe from the long time being in Sierra Leone camp they adapted their way of talking.
“Hello, good morning. How are you today?”
He doesn’t respond. He’s looking at Adama as if waiting for her to translate what I just said, while he sat in front of me very stiff.
Adama intervened and introduced me instead. I was planning to do that myself but she sensed that the client was not responding to me so she decided to “break the ice” and get the conversation going. I explained who I am again and what I do and will do with him.
He seemed to relax and started telling me his problems.
” I have this pain in my back and it never go away. I’ve come here before (the clinic he means), but they cannot seem to cure me of my pain”
The usual thing I do would be to ask patients to point the area and to re-enact the movements that would elicit the pain and measure. Next would be to ask what he does to relieve it.
“I feel the pain all the time. Even when I am sleeping or when just sitting in front of my house. There’s no way to relieve it, it’s always there. Medicines have no effect.”
I started to ask the history, to better understand where the problem was from and see if it was a case for us or refer it to another specialist.
But remember I am in Sierra Leone, specialist don’t exist especially in the hospital where I worked. There are medical organizations like MSF and MDM but they also have their own case load and refer patients to us. Still, I have to be sure.
Abdul arrived in Sierra Leone during the height of the civil war in Liberia. To escape with his family they crossed from the borders of Liberia to settle in Kenema, a good 1 hour away from Bo. They carried with them their life’s possession and their young children, he has 5 and his parents and crossed dangerously, walking for days with other refugees until they reached the camp. Him and his wife with the family found refuge in the camps run by UNHCR and settled there for good.
He claimed that when they were trying to escape being caught he fell several times and as tradition in Africa, they also carried their life possession on their heads to free their hands to do other things. He thinks that because of the move and the difficult journey he got injured and continue to suffer. He was crying when he related his ordeal. I felt sad, really I don’t want to put people in that situation but it’s the “necessary evil” for me to understand more. I threaded very carefully, selecting my questions very well and kept a clinical view of everything.
Sierra Leone was also on civil war around the same time, so imagine how uncertain life was for everybody back in the early 1990’s and to maintain a camp of foreigners while people from Sierra Leone has to go to Guinea to take refuge themselves has to be difficult.
The war was over, the country was left in ruins and people have either been killed or maimed and those in Guinea returned and re-settled in their hometown while the people in the camp remains. Until I left in 2007, the talk of repatriation was still uncertain and that makes people living in the camp on the edge all the time.
After the interview, I asked Abdul to lie on his back and do special tests. He won’t do it, he said “it’s very painful, too painful”
“Can you lie on your stomach?” “Yes” and he moved very very slow and his face was like paper being crumpled, I confirmed he’s really in pain.
Upon inspection, you can see the muscles on his back being taught and hard to touch. When I pressed on some part, he would either shout in pain or just simply cry. I also realized that the extent of the problem covers not just one part but the whole back including the hip area.
I pondered, pondered hard. The case would be very difficult, but something has to be done. And all my staffs eyes are on me waiting for me say the word they wanted to hear — a diagnosis. I have none.
Unless I see an x-ray, consult with a specialist, I can have a very clear diagnosis and therefore design a treatment plan, but we have none of those. Radiography services was available but patient cannot afford them if they are even working. There was no orthopedic doctor in the country (that I know of that time) and it would also cost money.
But at the back of my mind, the case I had in front of me was not a case for physical rehabilitation. I was even suspecting he’s faking it.