Week 5 (29/9/14 – 3/10/14)
“ANITA” (Not Pregnant and
Intellectual Disability)
Anita was a (slightly overweight)
teenage girl who was admitted to BPC as she had (IIRC) Amenorrhoea
for a few Months. Maria initially tried to clerk her, but gave up
partway through as she (Anita) was a seemingly very poor Historian,
and was apparently unable to give straight Answers. I decided to give
Anita another Chance and spoke to her that Afternoon.
Anita was with her sister (and her
sister's boyfriend). I asked her questions but like with Maria, she
was unable to confidently say “Yes” or “No”. I thought she
might've been delirious, and asked her about location and time, but
she initially couldn't answer it. Other people giggled during the
History-taking, and another Guy whispered her the answers but I told
them not to coz I was assessing her Cognition. Her sister ended up
offering a collateral History, but I didn't think it was an accurate
Account, coz I had a gut Feeling she was trying to manipulate the
Story to suit her personal Agenda.
An Abdominal Ultrasound was done which
showed an empty Uterus. A Urine Beta-HCG test was also ordered which
was negative. I told Anita and the rest that she wasn't pregnant.
What really surprised me was that Anita's sister looked really
disappointed, that she wasn't pregnant.
I couldn't understand why Anita's
sister wanted her to be pregnant, especially when it looked like she
had an undiagnosed (Intellectual) Disability. I mentioned that she
may have an (Intellectual) Disability, using the word “Aleijadu”
(disabled) but she (Anita's sister) got really defensive and said it
was because she only had Schooling up to Grade 3. I then asked Anita
really simple questions, like the colour of objects I pointed (Red,
Yellow, Black, Green), but she guessed those wrongly too. I briefly
discussed Anita's case with Maria who said that even if she had that
little schooling, she should be able to recognize “basic”
colours. I passed on Maria's Opinion to Anita's sister but she
immediately became silent and seemed upset. I reiterated that she
wasn't pregnant, and that if she was, there would be something seen
on the Abdominal Ultrasound by now.
I discussed the Disability issue with
the other Timorese BPC Staff, and they said that the term “Aleijadu”
is mostly in reference to physical Disabilities. They actually have a
term for stupid/slow-minded which is “Bilaan”, but it's sometimes
used perjoratively, like “Retard” in English. They all agreed
that a Grade 3 student would usually recognize those Colours. Even
though I didn't say “Bilaan”, they said that Anita's sister could
probably tell that I was implying it.
In the following morning's Ward Round,
Anita's Bed was found to be empty. Usually the Patients wait for Dr.
Dan's “official” approval to be discharged even if the issue got
sorted out in the afternoon, but this time they left prematurely.
I
felt a bit bad inside, like I was too blunt when talking to them. The
possibility of your relative not being “normal” can be shocking.
Also, Psychiatry and Neurological Conditions are also overall very
poorly understood in East Timor by the public. The Shock may also be
even worse if you were building up a massive Lie/Inaccurate
Justification the entire Time. Although Anita wasn't pregnant, I was
concerned about her in the long-term, especially when she is
vulnerable to getting raped, but we didn't bring the Discussion that
far.
Better
luck next time...
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