RPN 19 published May 1995

9. `Yit hae'

Dr Tom Solomon sends this account of daily life from a clinic at one of Hong Kong's Vietnamese refugee camps.

`And how long has this sore throat been troubling you?' I ask wearily. Khiem Duong, unperturbed, glances at his watch: `Oh, about an hour.' After the routine examination and brief reassurance, I reach for the pad and write out yet another prescription for paracetamol and cough linctus. This must be my hundredth of the day. The week as a locum GP in one of Hong Kong's refugee camps is proving difficult but not in the way I expected.

My next patient, a three year old child, has a headache, runny nose and sore throat. From the notes, I can tell that this is her third visit in six days. On each occasion she has been given a five day supply of paracetamol and cough linctus. How can they have run out already? What are they doing with it all? Her mother's answer is that she has vomited some of the medicine up and so had to take more. I cannot argue with this although my interpreter confirms my suspicion that paracetamol and cough medicine are the currency of the camp.

I attempt to reassure Lop Vuong that his runny nose will get better on its own and no medication is needed. But Phu, my interpreter and guide in this most difficult of working environments, gently steers me towards another prescription. I am thankful. We have done the right thing.

There is something marvellous about breaking every rule I learnt at medical school. `Shouldn't you be trying to change things, if it's bad medicine?' asks my expatatriate friend and host. But who says it is bad medicine? Can the refugees help it if there is no chemist? If they have to visit the doctor for even simple medication? Why should I try to deprive them of their visit to the clinic their one distraction in a tedious day during which work is forbidden. Even if they sell the drugs or exchange them for a few cigarettes, should I deny these desperate people their few small pleasures? Isn't the job of a doctor to do whatever he can to help, not hinder, his patients?

Of course, not every consultation in the clinic is trivial. Skin infestations, tuberculosis and chest infections are common, as in any overcrowded community. And, as always among refugee populations, the birth rate is very high.

Towards the end of the week my attempts to use the few Vietnamese words I know create great hilarity. Several patients leave in giggles, forgetting the drugs they came for. I was never taught this as a way to avoid unnecessary prescribing.

My last patient Te Dunh complains of `Yit Hae' a Chinese expression interpreted as a vague feeling inside that things are not quite right. After an extraordinary week, he is not the only one to complain of `Yit Hae'.

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October 1996