Listening through both ends of the stethoscope - A patient encounter, Part 1

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There are two ends to a stethoscope, and it matters which is which. At least I used to think so.

I once put on a stethoscope with the earpieces turned around (for these two-ended diagnostic tubes are also two-sided). I was a first-year medical student, and there was no reason for me to know better. Still, I recall vividly my feelings of embarrassment and awkward self-awareness after I had unwittingly demonstrated to the patient and mentoring physician in front of me that I had no idea what I was doing.

In well-meaning words with a slightly demeaning tone, the teaching physician explained to me that, because of the anatomy of the human ear, if the earpieces are in backwards, the doctor cannot hear. I believed him at the time, but now I know that he was wrong.

[As those who have read this blog before know, my patients are HIV positive children. Due to the humanity and diligence of scientists and advocates, in recent years, these children have had access to life-saving medicines-so-called ARVs. By some miracle, it is my job to help them take these medicines, and take them appropriately. The result is that, once on ARVs for several months, they are rarely sick. They have HIV but are on the correct and merciful zone of the healty child-to-AIDS spectrum. In other words, when I listen to the hearts and lungs of these children, they are essentially all normal.]

As a pediatrician, I was taught by many men and women in white coats to place the forked end in my ears and to place the end with the bell and circular disk on the patient. Then, yesterday, I began use the patient's end of the stethoscope, and I gave the patient my end. In other words, I asked the kids to listen to my chest.

In doing so, I learned that I can listen...and hear...through both ends of the stethoscope.

To be continued…

One hundred and one Botswana destinations: #1 Soweto

Km 26 (or ~mile 15), photo courtesy of Dr Andres Gomila.

In my previous blog, written from Swaziland (http://www.pediatrician-in-swaziland.blogspot.com/), I listed a couple dozen local destinations that were worth checking out. Here is the first in a series of destinations that can be reached from Botswana.

Soweto (Johannesburg, South Africa's SOuthWEst TOwnship) is actually equidistant from the border of Swaziland and Botswana, about a five hour drive from Gaborone. Last weekend, with a group of friends, I ran the Soweto marathon. For those who have not run 26mi and three hundred and something yards, I can now tell you that it hurts.

I wrote my name on my shirt so that the people of Soweto might cheer me on...and they did. Though pronounciation varied from "Ree-on" to "Ree-yon" to "Rye-ann" "Hy-ahan" to "mlungu" (the last one simply means "white person"), 30 seconds did not pass without my hearing my name. I received no less than five hundred such cheers, maybe more.

Soweto is an historic place. It is home to an estimated 65% of Joburg's residents. Over past decades, Soweto's citizens were pulled there by the need for cheap gold mine labor and pushed by forced removals from legally-designated white areas.

Civil rights were fought for an won here. The June 16, 1976 Soweto Uprising led to the deaths of 566 people and, in their aftermath, economic and cultural sanctions were imposed on the nation (and its the apartheid government) from abroad, while Soweto and other townships became the stage for violent state repression. Since 1991 this date and the schoolchildren that were killed have been commemorated by the International Day of the African Child.

It is humbing to run a marathon, for at some point strength whithers, pain dominates your consciousness, and your legs, well, they just stop working. More humbling still is that, when it comes down to it, I know little of strengh and pain compared to those who call Soweto home. Nonetheless, they watched me slowly pass and shouted "Goooo Ree-yawn!" "Good work Mlungu." "Do not give up!" "Go! You are almost there!"

On one particularly difficult hill late in the race (around mile 22), an older gentleman came from behind me (for I was being passed by many at that stage) and took my hand. He clasped it with alternating, interlocking fingers. "We are going to do this together." he said. "We are going to run up this hill."

And we did.

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[I have several other images from Soweto that I will share once I find my camera, which is arond here some place. Stay tuned.]