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Tuesday 9 September 2014

Visiting a problematic client

When a doctor from a klinik kesihatan called me a few weeks ago to refer a case to me, and asked when I would be free to visit, I purposely chose a date after our family day. Giving myself just a one day break, I told him I should be ok for Tuesday 9th September.

Family Day was over 2 days ago. And I totally forgot about my visit to the klinik kesihatan. Luckily a nurse called me up yesterday to confirm if I’d be coming.

So off I went this morning. Since I had never been to the area before, I had to depend on my old faithful GPS to show me the way. And since the place I was heading to was a klinik kesihatan, it was listed in my GPS. Frankly, if not for the GPS, I probably wouldn’t be too confident about driving to the place. The last 15km was a small winding road with palm estates on both sides of the road.

When I got to the place, first I had quite a lengthy discussion with the doctor and the nurse. I was informed that this patient of his, Siha, had started missing her appointments since June, giving all sorts of excuses. They then started sending her medications to her house. Even the doctor himself went to visit her at home, trying to coax her to continue going for her appointments, and to never miss her medication. But Siha eventually got fed-up with the visits. When the doctor or any of the nurses tried to talk to her, she’d just keep quite. Even when she talks, she’d just say a single word, just a yes or a no, or if her answers came in more than one word, it’d be “tak tau”.

Siha’s present marriage is actually her second marriage. She was infected by her first husband, an active IVDU when he was alive. One of her children from her first marriage had also been infected with HIV. The son, who is 19 this year, had been going for his appointments with the paediatrician earlier when he was younger, but the moment his appointments was transferred to the adult clinic, the boy started missing his appointments and stopped taking any medication.

Siha also has a 3 year old son from her present marriage. The boy has been confirmed to be negative. Apparently Siha is now the second wife of a hot-tempered guy who doesn’t even have a permanent job. From what I was told, Siha’s first husband, when he was still alive, told this 2nd husband to take care of Siha when he’s “gone”. The doctor suspects that Siha may be facing financial problems, especially since the husband actually depends on his first wife’s salary (the first wife has a job) for a living. Siha herself is actually an orang asli from a nearby kampong.

Anyway, when we first got to Siha’s house, the door and windows were closed. The condition of the house was quite bad, with quite a lot of the top part of the window panes missing, and the wooden window sills rotted. Before the nurse knocked on the door and gave the salam, initially she thought she heard someone’s voice inside. But the moment she knocked, whoever was talking suddenly became quiet. No matter how hard the nurse knocked or called out Siha’s name, there was no response. Obviously Siha didn’t want to open the door. I guess she didn’t want to listen to any more “lectures” as to why she shouldn’t miss her appointments or her medication.

After a while another nurse from the nearby klinik ibu & anak came. She had been following up with Siha and the 3 year old boy from day one and is already a familiar face/voice to the boy. So when the boy heard the 2nd nurse’s voice, he opened the window. He got a scolding from his mother for doing so. Anyway, with the boy opening the windows, we could see inside. It was just a small house anyway, and there was no way for Siha to hide anymore. Reluctantly, she opened the door. The moment I asked if I could go in, she told us, “Apa-apa cakap dengan suami saja!” It looked to me as though she was afraid her husband may scold her.

I told her I didn’t want to talk to her husband. I wanted to talk to her so I could determine what sort of help I could give her.

True enough, she didn’t talk much at first. But as I started to talk about her children’s education, she began to give more-than-one-word answers. When I asked if her 19 year old son (the hiv+ boy) was working, at first she didn’t say much. She just told me he was somewhere else sleeping. But the moment I asked if the boy would be interested to further his studies in a field he may be interested in, suddenly Siha’s face lit up. “Dia memang suka tengok buku”, replied Siha. That’s her way of saying that her son loves to study. The nurse who accompanied me was pleasantly surprised to see a smile on Siha’s face.

Looks like I managed to hit the right note. I didn’t want to go into her appointments or her medication. Not just yet. She seemed quite comfortable talking about her children’s educational needs, so that will be my main topic of discussion with her for the moment. Later, after I gain her trust, hopefully, I will slowly try to get into the other matters.

Siha promised to ask her son if he wanted to further his studies. When I left my number with her, at first she said she didn’t have any phone, then suddenly she remembered, “Eh, Hairul (her son) ada.” Unlike previously when she’d just ask the nurses to contact her husband if need be, this time, she seemed eager to get her son to contact us direct.

Siha also started talking about the problems at the house she’s staying in. Other than the poor external condition, it seems almost every electrical appliances at her house is no longer working. The only one working is the fluorescent light at the main area where we sat.

Hmmm… why hasn’t her husband been taking care of that I wonder…

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