OMG Krazy day...

OMG having one of those nutty days where every other person I see is a 'raised eyebrows' kind of consult. May I vent for a second, while at the same time sending a faasilasilaga to people who obviously have never or may never see me anyways so really quite pointless in aiding my frustrations BUT makes me feel a little better to say it...to the laptop....

PUH LEASE, and ESPECIALLY , if I have never seen you before/are related to you/are a work colleague acquaintance etc....don't come to see me and ask me for - A medical clearance....for ...one of your relatives ...who is now already overseas and cant come see me himself, to get a clearance to..wait for it...travel and live in that country that he already is in. OK, that's just dumb...like I really legally, need to physically see him measure his blood pressure and prove he aint got some fatal disease or TB etc..I can NOT just fabricate that crap. Please don't come and ask me for medical certificates for last week, when apparently you were rolling around in pain with some mysterious bug which has miraculously cleared completely now leaving me nothing to actually be convinced you were actually unwell...especially if you are not a regular client of mine and I don't know you..or your brother who couldn't come but you've come to get his pepa mai. I am not a paper pusher.

Please don't come and be rude to my receptionist at the front, this office, is not your village...you may have everyone at your beck and call when you are sat in your throne at your village, but here at this medical center, the receptionist is not your fai- feau , she is not obliged to run to the shop at the front and buy your coke, and when she politely tells you she cant leave her desk/cash register unmanned, it is not fitting for you to lose your marbles....please dont pester her to harrass me to get prescription meds without a docs review or a prescription...especially for things that could potentially kill you...e kasi a le mea e ave ai enquiries ga o le ofisa leoleo faamolemole lava.

Please don't ever come to see me , to get that medical letter that you need apparently, to "kala your NPF" because you have decided to build a house but NPF say the only way they will release NPF savings early is if you leave the country permanently or , if you are disabled permanently and are verified by a doctor that you can not physically work anymore. When you walk into my office with a mouth full of instructions without so  much as a twitch in your eyelid or a limp...you can work. Full stop. You don't get to just tell me " I haven't worked for 30 yrs, last job i had was when I was 20, so I know I cant work anymore" ...Mate, it aint as simple as that. OMG...and then please don't proceed to have an argument with me about this and my job...my job is most certainly not to- receive a mere 20tal from you, and then aid in your illegal fiasco to release thousands of trallas from the NPF..mate, this thing on my head...yea you see it..its called a brain...not a mirror.

OMG...and please last but not the least. I am not a vet. Full stop. One day, your antibiotics and BP pills you keep feeding your dog, might be bad/the wrong dose/the wrong thing altogether to give him..and he may die...and I kinda don't want to be part of that. Full stop

good bye

GOUT and morphing peoples personality.

Gout. Ever since I arrived in Samoa, more so in Savaii, it has amazed me how little people understand about GOUT and its management. It doesn't surprise me that from their own childhood education they may have never heard of it (ie health education in schools is minimal..down to the basics only ie. the birds and the bees and stds and thats it) But the fact that they GOT an attack, got seen by a doctor and got started on painkillers - kinda blows me that at no point did someone NOT tell them about uric acid, and Allopuriol. 

For those of you who have not heard of or know anyone with- gout is a type of arthritis caused by a build up of an acid called URIC ACID.Many meats and foods are high in this acid so heavy consumption of certain foods brings on an attack. These attacks can be severe and debilitating. It may not look so bad (ie a red joint of big toe) but don't be fooled, this baby will make grown men cry...What baffles me is the number of people on rescue remedy only. Wait for gout attack (which may be as often as every week- ie imagine 2 or 3 days of every week being incapacitated by a sore foot which can not even touch the floor for fear of excruciating mind blowing pain resulting in 2 or 3 days of absolute dysfunction (ie in bed all day) ) and then Voltaren Voltaren Voltaren. To make matters worse, along the way  someone may have slipped them some "Superman" pill..also known as steroids ...also known as Dexamethesone resulting  in a quick but FAKE improvement of pain due to its powerful anti inflammatory effect. Anyways, my point is these remedies treat the PAIN only. And not the culprit- uric acid. Which means that these individuals just run these vicous circles of not treating the cause but treating the symptom of  pain only, at the same time  abusing Voltaren and Dexa...which later results in CUSHINGS SYNDROME (another illness) Hypertension , Ulcer (from Voltaren abuse) and kidneys that are SHOT.

What I am battling now- is explaining this to patients who have done 10 yrs of this. And now look at me funny like Im lying to them- Allopurinol?? (the treatment remedy which over time can rid excess uric acid from the body and thus improve and hold off gout attacks forever if you are compliant ) what is that?? Are you sure? no ones ever mentioned that to me before?Oh wait a minute, thats that tablet you take once a day?yea it doesnt work I took it for 2 days and it did nothing to the pain (Where I then explain it does not treat pain and still get funny looks)  Why do you want to stop my Voltaren addiction?? and worse yet- WHY are you not giving me DEXA??arrhhhh.... where I worked overseas..we were forbidden to prescribe dexamethasone..this was reserved for specialist consultant only in clinic or for admitted patients in hospital. IF you were bad enough you'd get Prednisone (hospitalised  patients get- Pred is a weaker Steroid) but never Dexa. In Samoa , there is a dexa craze. Every time I see someone on it, they almost always have the Cushings Side effect , and when you decline giving it to them again, they mutate into these angry stubborn begging beings- ie. "Please please please give me dexa, I can not live a normal life without it!", I promise I wont take it until absolutely necessary (which when out of my site is like, everyday according to the patient)  bla bla bla. Sometimes, the husbands send the wives in to get it...and they do the exact same thing, whine, complain, beg, lie....from - but this is my husbands standing order, and who and who said he needed to take it everyday, to please my husband will beat me if I dont come back with it...and then I find out, that he initially got it from a friend of a friend who shared some of his- ….OMG , but that is a norm in Samoa.

Honestly, the sweet little old lady in a muumuu suddenly gets all huff and puffy and angry when I don't prescribe these things, and the men just go bezerk...they pull out every excuse in the book like its a life and death matter and then give me the "I'm a Matai" look and just do as I say line..sorry bro..not gonna work- my policy is FIRST DO NO HARM....it is  most certainly not  a life and death matter...you walked in here without as much as a hobble...you don't need Dexa!!

Seriously, getting people off these terrible rescue remedies that lead to a continued vicious circle of attacks (and not to mention terrible side effects)  and onto the needed Allopurinol is just a mission. You'd think I was dealing with a drug addict trying to come off morphine or something. 

Thats not to say there aren't people who Allopurinol does not work for- like any drug, there are some who it doesn't work for, for whatever reason, as well as those who get bad side effects. But for a lot of people, this drug would really do them so much good if they only gave it a good go. 

I've made a pamphlet now, that explains it all. Prevention, treatment, etc....seems like when you give someone a piece of paper it seems a little more truthful then when it comes out of my mouth. I tell myself not to take it personally as I think many people think I am younger then I actually am (thanks for being vertically challenged! )  and so I guess are a little less trusting of a young doctor maybe?? Anyways...I've also had patients come in Absolutely gobsmacked at the improvement since starting Allopurinol. Like seriously these people did not think they could ever live normal lives again, and now can...so that is pretty satisfying. I just hope that more and more people learn about this and realise there is actually a treatment for this debilitating illness:) Thats all for now have a great week everyone!!

Things that have made me go hmmmmm....

As I write this , I am thinking to myself, hmmm...have I gotten over my hangover or not yet?? I can't really tell because I am a tad fuzzy and lightheaded and not really nauseas or migrain-ey...but maybe kicking my ass into gear and getting up this morning really helped:) We went to a small little get together with some good friends in Savaii last night. We almost didnt because we were both so tired from a hell-a busy week but told ourselves- how often do we really do anything in Savaii these days??  But it went on much later then we had oringally planned to let it go on til, and was an hours drive away from home so we got home well into 2am which for these two 30 yr olds who do 90 hour weeks...this was way past our bedtime:)

ANYWAY. So I woke up this morning and its my hospital day and thought- I am going to call in sick.BUT Ive been so slack in the last month and had so many days off my inner goodytwoshoes -always-wanting-to-help-others told me to get out of bed, wash my somos off have a coffee and a panadol and go to work. So I did. an hour into it, the other 2 collegues helping me in ED got called away and I got left doing OPD all by me weeself..me and the masses of grumpy impatient mingled with genuinely sick and dying but mostly all needy masses...just what I need to cure a hangover!

So in the last week- my daughter finished school. She had a prizegiving. She didn't get any prizes but she passed all her subjects- with 36/40 sort of marks:).  She actually sat an exam, actually  3 or 4 exams...with real exam papers with instruction sheets...she passed those...As much as a year 1 student  can. She is halfway there with her reading and can add  and multiply and knows all her shapes and colours. What more can one ask for right? Well, I could not help but feel like a tad of a failure. Seeing alot of relies and freinds FB pics of "first in year 1"...did actually make me look at myself and wonder if perhaps I had not done enough for my kids this year? Didnt spend enough time reading or doing work with them?too much work and not enough family time ? To be completely honest though what I think of more is that  I was a straight A student my entire life. From year 1 up. What I remember about myself is being rather introverted. I had a handful (and only a handful) of friends and did everything the teacher said. I never spoke back nor broke a rule nor perhaps even had a opinion of my own until I was in year 6 maybe?? I dont know  cant really remember , what I do remember is feeling like all my mum ever asked me was "how was school" and "what did you learn" and then we would go through this repetative monotomous routine of "fine"  and "stuff" and I remember thinking I couldnt hold any other sort of conversation with my mum  other then this sort. Then I remember the "do your homework" "you can do better" "listen /ask questions/ask for your books "etc etc like a drill sargent constantly pushing..it was a little suffocating ....

When my daughter started school I said I was not going to do the same. I would not be drilling her to do everything perfectly outstandingly all the time. I would have conversations other then about school and let her enjoy friends and the learning environment- the most important thing was to be wth other kids in a classroom because we have no other cousins  etc where we live while at the same time learning something. And that it was only year 1.....we'd get serious a little later. Now I am wondering if that was all an excuse to be lazy about it? perhaps I should have pushed harder. My daughter I think is surely the complete opposite of me. She is talkative and has a million friends including many of our guests at the hotel who have left. We've been told she is a bit effervescent in class and talks too much and runs outside alot and doesn't always do what the teacher says. Everytime I look at this girl she is giggling or laughing, she always has a sparkle in her eye and ...funnily enough, her hair even glistens coz she has some mean english-blood red/blonde streaks int here (all natural) which makes her look like this child of the earth and sun full of life and love. Im debating with myself now over whether this translates to - comepltely wreckless free willy type child evolving who I should be drill sargent-ing a little bit more...or wether this is fine..she is only in year one for goodness sake.

My siblings and I are a testament I think that success especially in school does not follow any one path. I was always in the top 3 places of classes right throughout my entire primary and secondary. Then went on to do well in uni and graduated and got an ok job. My brother on the other hand struggled in primary, he was always a 'concern' of my parents  and teachers a like in that he was 'behind' the others etc...when he got to secondary, it was like he blossomed. He started exceling in his subjects, went on to land top positions nearing the end of secondary then got a scholarship to NZ graduated on time and now has a pretty awesome job....so I tell myself that each is to his own path but I am sure there is a little more steering I will need to look at. Ok, just stroke your ego that way mmmhmmm:)

All the talk on rape and incest. Thank you Lani for your courageous letter and blog. I for one was in complete agreeance of everything  you said. What baffled me was all the idiots people who did not get that you were being sarcastic- and actually wrote to the paper saying they were insulted that you said to bite hard etc etc....like OMG. Annoyed the heck out of me but this is a real problem that needs real solutions. I can not imagine how many young girls lives are tainted by this sort of behaviour. If it were my choice, it would be a lifetime sentence ...for anyone with any degree of this sort of stuff. lock em up, make em work on maumagas for the rest of their lives  and never let them out. Ive seen these girls at the hospital, the ones who are subsequently left with an unwanted pregnancy, whose families dress them up to bring them to hosp for antenatal checks and will quickly tell you of some loving family that the baby will be given away too...they dont say anything about the uncle you see in the medical report int he file who did this to the 15yr old...and the 15yr old looks like  a walking zombie whos parents are trying to pass off as strawberry shortcake,...or mary poppins..or whose someone very happy and all fluffed up in a dress??thats what they try to do. It breaks my heart.  This makes me go hmmmmmm....

I went to my first Title Faamasinoga this week. If anything it was to learn a little more about where my children should know they came from. I wanted to listen and learn as I hadnt actually heard through any other means of the nitty gritty of our family.. Well I got a lot more then I bargained for because if anything it was bewildering. What Ive seen in the court is it sometimes mimics confession. Some of these people who greet you on the road everyday and share small talk with  who are all nice to your face...then get into the court room and suddenly its all emotions spilling like one sat in a confession booth- except that it is for all to hear!!- that person is faamaualuga and that one is fiapoto- you and you and you...these people are right there! staring at their family or their neighbour they had grown their whole lives up with...and now feel it appropriate to describe such bitterness that was never before seen??? Its Krazy stuff and I hope I will never have to participate as anything other then a keen listener trying to learn something about herself....I take my hat off to those that can stand there and take it with such poise and grace...that is something that surely comes with years of experience and patience.....something I am lacking at the moment!lol-mmmmhmmm

OK thats all for now cause I need to go home and spend time with the kids- til next time
ciao!

a long day at work..

I am pooped. And over the course of the afternoon, have realised that this uncomfortable-ness I have been suffering with, was a brewing urinary tract infection..shoiiiit...just my luck. As it was, I saw a patient with one and really wanted to say "me too!!" to her symptoms...but alas..I am sure that would have just been weird...right.

my rant for the day is-

The trouble with my job, is that sometimes I see people who I don't like. Some people just rub me off the wrong way, have eccentric personalities that I would not necessarily warm up to in a public setting (ie, you would not be my friend..sorry) some people are just plain rude, arrogant , and ignorant that I find myself squirming in my seat trying to hold back all my fiapotz moral teachings I want to slay this person with....instead , I am restrained to a "so what has brought you in now??"...SOME people are truly enemy-title worthy i.e took my parents to court -type enemy(!lol) who continue to bewilder me with even chosing to come see me...eh. Anyways, thats my trouble, my door is open to all and any. I am here to treat and help you get better and it would just be morally unjust for me to decline someone I did not like (even though I REAALLLLY want to sometimes hehe) , unfortunately I can not treat your manners, or your personality. Too bad for you.

The hubby seems to think I should or I could. Ie when someone really unacceptably rude sees me and I tell him about it- he always said "sa kakau ga e fai sa'o i iai" and goes all hype about them but the fact of the matter is- it would not be very nice for someone outside to overhear a verbal catfight in the office would it? Especially having a catfight with someone who is supposedly ill....now that is just not professional..so for professionalisms sake, I keep my peace and hold my tongue. But I always say, if you could hear me speak my mind (like truly and honeslty what I was thinking in my head) for a day  sometoooiiimes..(not all the time) seriously, it'd be pretty shocking.

You may be interested to know that my number 1) type of client...is..without saying names directly, a profession that would be profuse in Savaii. ie, every village has one, or two, or maybe three. They come in all sizes but mostly XL or XXL. You may be insterested to know that there are actually some size L and medium, but they are hard to find. I won't say exactly WHAT profession for fear of being struck down dead by lightening(!) but I am sure you get my drift.

So some of the rip-my-hair-out comments I have had to deal with in the last week with this certain kind of clientelle  are along these lines
"I went to see the specialist in Apia and they said I was all fine, but I'm sure there's something they are hiding from me, I'm sure I should be going overseas to NZ for treatment".....yea ok, why don't you just say you want a free holiday sponsored by Samoas medical budget
" I have no idea why I should have Hypertension and Diabetes, I know I am big but I feel healthy...I just don't get it and don't want to accept it" ok buddy, when you weigh 200kg, these diseases were invited, its called a disease  of lifestyle...just try to cut down the paelo loads of food...and exercise a little....if you start this trend, you are the key to 100 followers going in the same right direction.....

 Today  someone just barged in while I was just seeing someone out the door demanding to be seen cause he was in a rush...there's a sign on the door (which was the direct result of people like him!!) that says PLEASE DO NOT ENTER UNTIL YOUR NAME IS CALLED. This is because I need 5minutes to enter your name (provided to me a minute ago) into my computer and get myself organized maybe take a breather after back to back consults also I might need to nip out for a wee and don't like strangers in my office (which is an extension of my home sometimes) without me being in there....people just don't get it sometimes...apparently, I should work more like a machine/computer and just slug it until the power goes out....

Another earlier questions everything I did...ie "I'm going to start you on this blood pressure pill because your BP is too high, called XXX"- ARE YOU SURE THATS A BLOOD PRESSURE PILL?
then after my explanations BUT I TOOK A PILL BEFORE FOR CHOLESTEROL AND IT SOUNDED SIMILAR< ARE YOU SURE YOU KNOW WHAT YOU'RE DOING?- mate, Im not 5, I went to school got a degree worked for almost 10yrs before opening this office, you with your cholesterol laden eyes and tattood arms looks like you were a paugaka before you did what you do now and could use some of my health attention but if you think you know it all, please...don't waste my tired breadth..I don't mind keeping my suggestions for your health, to myself if they are not wanted...sometimes I don't know why people come at all(!)

Other times, some patients have really shocking backgrounds. Most of the time, it is not necessary to delve too much into what someone does, what they did etc we just need to know whats going on now and what other medical interventions they may have had in the past...but one time, I admitted a guy whos social history was a bit dodgey - could'nt really get a resident  village out of him etc...later on I found out he was a child molester in Apia who the village had banished back to his birth village (here in Savaii) even though he left at 2yrs of age  and doesn't have a house or family  here anyway...put him on the boat and he'd been hanging out at the wharf til a cut on his foot got infected....ae poo le a le mea e le o e ave i le ofisa leo leo ae just banish him to another dont-want-him-here poor island...for goodness sake...pe faavelvalea ea kagaka se..

So anyways, I've had a few days of this particular kind of clientelle day after day and what I have figured is that- it is immensly energy draining to put up with people you don't like , especially when you don't have a choice. Some of these people seem to really like seeing me and they come ALOT. Either they like seeing me or they think if they see me more often they will live longer...?? don't know so maybe what I need to be doing is- be less nice...especially about telling people they have an over-eating problem - who knows, ae ke'i lava le writer lea ua fula le maka mai se sensitive patient!!choohoo....