Outpatient Department Quotes

Within the mental-health system in North America, the borderline victim of severe childhood trauma is usually blamed for her behaviour, which is regarded as having no legitimate basis and being self-indulgent; her trauma history is ignored and not talked about; and she is given as little treatment and follow-up as possible. At St Boniface Hospital in Winnipeg, many staff members expressed the opinion, in my presence, that borderlines and multiple personality disorder patients did not have a legitimate right to in-patient treatment, and the out-patient department would not accept patients with either diagnosis. (1995)

It was a sad fact that the commonest complaint in the outpatient department was “Rasehn . . . libehn . . . hodehn,” literally, “My head . . . my heart . . . and my stomach,” with the patient’s hand touching each part as she pronounced the words. Ghosh called it the RLH syndrome. The RLH sufferers were often young women or the elderly. If pressed to be more specific, the patients might offer that their heads were spinning (rasehn yazoregnal) or burning (yakatelegnal ), or their hearts were tired (lib dekam), or they had abdominal discomfort or cramps (hod kurteth), but these symptoms were reported as an aside and grudgingly, because rasehn-libehn-hodehn should have been enough for any doctor worth his salt. It had taken Matron her first year in Addis to understand that this was how stress, anxiety, marital strife, and depression were expressed in Ethiopia—somatization was what Ghosh said the experts called this phenomenon. Psychic distress was projected onto a body part, because culturally it was the way to express that kind of suffering. Patients might see no connection between the abusive husband, or meddlesome mother-in-law, or the recent death of their infant, and their dizziness or palpitations. And they all knew just the cure for what ailed them: an injection. They might settle for mistura carminativa or else a magnesium trisilicate and belladonna mixture, or some other mixture that came to the doctor’s mind, but nothing cured like the marfey—the needle. Ghosh was dead against injections of vitamin B for the RLH syndrome, but Matron had convinced him it was better for Missing to do it than have the dissatisfied patient get an unsterilized hypodermic from a quack in the Merkato. The orange B-complex injection was cheap, and its effect was instantaneous, with patients grinning and skipping down the hill. T

Dr. Lydia Ciarallo in the Department of Pediatrics, Brown University School of Medicine, treated thirty-one asthma patients ages six to eighteen who were deteriorating on conventional treatments. One group was given magnesium sulfate and another group was given saline solution, both intravenously. At fifty minutes the magnesium group had a significantly greater percentage of improvement in lung function, and more magnesium patients than placebo patients were discharged from the emergency department and did not need hospitalization.4 Another study showed a correlation between intracellular magnesium levels and airway spasm. The investigators found that patients who had low cellular magnesium levels had increased bronchial spasm. This finding confirmed not only that magnesium was useful in the treatment of asthma by dilating the bronchial tubes but that lack of magnesium was probably a cause of this condition.5 A team of researchers identified magnesium deficiency as surprisingly common, finding it in 65 percent of an intensive-care population of asthmatics and in 11 percent of an outpatient asthma population. They supported the use of magnesium to help prevent asthma attacks. Magnesium has several antiasthmatic actions. As a calcium antagonist, it relaxes airways and smooth muscles and dilates the lungs. It also reduces airway inflammation, inhibits chemicals that cause spasm, and increases anti-inflammatory substances such as nitric oxide.6 The same study established that a lower dietary magnesium intake was associated with impaired lung function, bronchial hyperreactivity, and an increased risk of wheezing. The study included 2,633 randomly selected adults ages eighteen to seventy. Dietary magnesium intake was calculated by a food frequency questionnaire, and lung function and allergic tendency were evaluated. The investigators concluded that low magnesium intake may be involved in the development of both asthma and chronic obstructive airway disease.

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