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FROM IRAN Joy O’Hazy is a medical doctor from Belair in South Australia, currently on mission with Medecins Sans Frontieres in Iran. This first instalment of Joy’s letter describes a ‘day in the life of a clinic’. Life is interesting and challenging here. I have now worked three and a half months of my six-month contract here in Iran. Médecins Sans Frontières has been in Iran since 1996 establishing a medical service for Afghan refugees in Mashad, a city in the North Eastern province of Khorasan – which borders Afghanistan.
A nurse does triage and selects the worst cases, the under 5s and very elderly patients, and takes them into a second waiting room and collects their files from the registration desk. Nurses then record temperatures and the weights of the children. They then decide if the patient is to be accepted or not for a doctor’s assessment at the clinic. The clinical nurse in a separate room then tests blood pressure, pulses, and check their eyes and urine and gives injections. Doctors and the midwife have separate private rooms upstairs. They have a buzzer to call for the next patient and the crowd controller ushers the next person into the room. I have an interpreter, Neshat, who translates for me. The Iranian language is Farsi however 99.7% of our patients are Afghani and speak Dari. I am now able to understand quite a bit of the answers that they give back to the interpreter although Neshat is very important for interpreting the reports from various tests and letters. The doctors and nurses here in the clinic all work in English. There are only very basic tools available at our disposal – stethoscope, auroscope, tongue depressors and reflex hammers. Patients often have general body pain – headaches, aching joints and backs. Flank pain is a very common complaint too. With the kids it is often cough and temperatures. It is a complex business examining patients – especially the female patients over the age of nine years because they must wear their hejabs (tight head cover) and also a chador (material over their hejab from head to foot). It means any examination of the ears, neck, chest, and abdomen takes considerably longer. Most notes have nurses writing the presenting complaints and then the doctor write an abbreviated form of the drug name that they prescribe. My training taught me to always write the presenting symptoms, significant signs, the diagnosis, then a full plan of management – this means my writing takes up much more space and time than most. I am also keeping a summary of every one I see and keeping statistics for the whole clinic and so it is an endless task. In the end this means my consultations take a little bit longer than most doctors do but I’m still seeing 25 to 35 patients each clinic session! The crowd controllers often come around with glasses of hot tea for the doctors to keep us going. Joy O’Hazy, Feburary 2004 [Next week the mobile clinic… ]
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