A New Week

Sunday is the start of our work week here. I had a really good weekend with time to read, pray, and rest. And this week has started off great. More on that later - I wanted to share a few reflections on patient encounters.

Most of the clinic patients have problems with gastritis, back pain, headaches, cough – problems very similar to my patients back home. (Almost everyone here tests positive for H. pylori – a bacteria that lives in the stomach and causes gastritis and ulcers.) There is also a lot of depression and anxiety and almost everyone (patients and staff) has a story to tell about someone close to them who was killed in the war. Many patients are suffering from post-traumatic stress disorder. Unfortunately, there isn’t a lot of mental health care available. The residency program is trying to emphasize a holistic approach to patient care, including psycho-social problems. But it’s hard to provide any meaningful counseling in a short medical visit without adequate training.

One patient I saw, a beautiful 20-something year old woman, was suffering from anxiety, insomnia, depression and severe headaches. As her story unraveled, we learned that her father and brother had been killed ten years ago in a bombing. She was the oldest child at home and was now supporting her siblings and mother by teaching school. Not only was she carrying the economic burden of her entire household, but she continued to have nightmares, panic attacks, and constant anxiety brought on by the traumatic events surrounding her father’s death. She stated that she had been severely depressed before and had attempted suicide eight years ago but failed. Recently, her life had become more stressful; she was hardly sleeping due to anxiety, which undoubtedly contributed to her headaches, and her work was severely affected due to tremors, palpitations, tearfulness and worry. The resident prescribed medication for depression and anxiety, but she needs so much more than that. Her emotional pain is much deeper than medicine or a short office visit can cure. 

And her story is just one of many similar stories I have heard during my short time here. Years of war, instability, economic hardship and uncertainty, and lack of resources and opportunities have spawned an epidemic of PTSD, depression, despair, anger and hopelessness. Often these problems manifest as a variety of physical complaints. Patients who come to the clinic with headaches, stomach pain, nervous tremors, and the like will usually, when questioned, admit to suffering from stress, depression and anxiety. Yesterday I attended a community women’s clinic where I helped to facilitate a discussion about mental health concerns.  More on that later, but it was very informative and helped me to understand the situation of women here a bit better.

Interestingly, one of the residents keeps asking me to come talk to his female patients with depression, anxiety and family problems. He says that maybe if a foreign doctor sees them they will think the medicine will work better. My immediate response is, ‘what can I possibly offer when I don’t even speak the language?!’  But it has been interesting delving into some of the family problems these patients are facing. Some of it is just typical conflict between sinners. But underneath much of it, you can see the cultural and spiritual forces at work creating strife and frustration. I have prayed for wisdom to know how to respond and what to say in these situations. I have tried to convey that medicine alone is not going to fix their problems – that change from the inside is needed. In the short time available in the clinic visit, through translation by the resident, I don’t know what impact my words or questions will have. So please pray that at least a seed will be planted.

In the midst of political, economic, and emotional turmoil, there are still many people here who demonstrate hope and a desire to not only see things change but to be a part of the effort to create a better future for their country. I am moved time and again by the personal stories of the residents and faculty who truly want to make a difference and help those in need. Although it is difficult for them to return to their home provinces due to continued unrest, they still hope and long for a day of peace when they will be free to go home and help heal and rebuild. I would love to see them truly empowered to love and heal and build through knowing the true Healer.