A Monday To Remember

By Dr. Thomas Agyarko-Poku

In this book, which is written for ordinary people (general public) as well as medical professionals, a medical doctor of high repute, with over 20 years of experience in hospitals and academic institutions, zeroes in on sexually transmitted infections? Within his private practice as well as public hospitals, Dr. Agyarko-Poku has interviewed, diagnosed and treated several patients who have had varied sexually transmitted diseases. He has meticulously shared with his readers some joyful as well as near-tears encounters often experience by doctors within the four walls of their consulting room.

This interesting, easy to read book is filled with case after test and should be of interest to all people. Individuals who have not often thought of such medical issues will particularly benefit greatly. The technique and procedures used for the STI are immediately applicable to other issues and will force readers to immediately seek medical help.

As a word to the wise is enough, so is an ounce of prevention better than a pound of cure. This must read book provides a roadmap.

• Language: English
• Publisher: Dr. Thomas Agyarko-Poku
• Release date: Jan 28, 2022
• ISBN: 9798201125622

Book preview

Understanding Sexuality, Sexual Health and Sexually Transmitted Infections

Copyright © 2020, Dr. Thomas Agyarko-Poku

All right reserved. No part of this publication should be reproduced in any form or by any means without prior permission of the  Author or Publisher.

ISBN: 978-9964-975-62-7

Page Layout and Cover design: Judith Kafui Adzah

First Published 2020 by: Adwinsa Publications (Gh) Ltd.

Telephone: [phone] E-mail: [e-mail] Website: www.adwinsa.com

This piece is dedicated to Linda my wife and our children, Osaah, Afia, Serwaa and Yaw Agyarko-Poku.

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ACKNOWLEDGMENT

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Having an idea and turning it into a book is as hard as it sounds. Writing a book is more challenging than I thought and more rewarding than I could have ever imagined. The experience is both internally challenging and rewarding. I especially want to thank the individuals that helped make this happen.

I'm forever indebted to Mr. Oppong of Adwinsa Publications for his keen interest, insight, and ongoing support in bringing my stories to life. Because of his efforts and encouragement, I have a legacy to pen down part of my experience and pass on to augment my knowledge propagation enterprises.

None of this would have been possible without my best friend, mentor and teacher, Prof. Yaw Adu-Sarkodie of KNUST.

This book's publication is one of the numerous fruits borne out of my over three decades of association with him.

To all my working colleagues at the STI/HIV Clinic at Suntreso Government Hospital in Kumasi; Sister Elizabeth Adu Boahen, Cynthia Frimpong, Margarete Oduraa and Mallam Kwabena Issah for their enormous support in rendering service to humanity.

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I cannot pay for the long hours of sleeplessness of Judith Kufui Adzah of Adwinsa spent conceptualizing the cover design and putting my words in shape for my readers.

I shall ever be grateful to all my persons, alive and dead, who sought my assistance for medical care for being part of this incredible story and teaching material.

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FOREWORD

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Lack of vocabularies and terminologies in the local languages presents a challenge to many health or medical educators, especially in their quest to explain to non-medical people who daily seek consultation on medical issues. The author has skillfully brought a solution to this arduous task through his writing.

'A Monday to Remember is not just a storybook but a bundled piece of sound intellectual and educational information on sexually transmitted infections and sexual health presented in straightforward terms. The book seeks to entertain and educate both health care and non-medical persons through this piece of good work.

The author, through very enthusing storylines, has successfully provided insightful education and counselling most needed by the general public and health care providers on some common sexually transmitted infections and selected sexual health issues. First, he recounts the experiences medical doctors routinely go through in the discharge of their duties in the context of the environment they practice. He then exhaustively takes readers through the causes, signs & symptoms, differential diagnosis, various investigations, general management (including treatment and prevention) of each disease condition. Each chapter of the book deals with at least one common sexually transmitted infection. The infections discussed include Gonorrhoea, Syphilis, Chlamydia, Trichomoniasis, Genital warts, Candidiasis, and Genital ulcers. Significant problems with HIV

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infections, including the perceptions and reactions of individuals, are presented with different scenarios and storylines. The author also dealt with sexual health issues such as sexual weakness and premature ejaculation in males, and lack of sexual desire.

In explaining the various disease and conditions, he makes a conscious effort to avoid medical jargon to ensure that non-medical people can read and understand.

My association with the author of this book dates back to his days as an undergraduate, postgraduate study, and a professionally profound experience of him having had an opportunity to work and travel extensively globally with him as a lecturer, clinician, and researcher. I have listened to him on several platforms as he discharges his duties of educating the people.

The excellent sense of humour, a hallmark of the author, and his long teaching experience are very much on display and characterizes the entire writing of this piece of work. He theatrically presents each of the medical problems he encounters reminiscent of live scenes in a dramatic ac theatre. The interjection of his narratives, with soul touching poems, make it fascinating reading.

The author possesses so many of the qualities that go to making a good writer and teacher. His diligence in research, meticulous accuracy coupled with an immense capacity for marshalling facts, the excellent sense of proportion that allots to each medical problem or incident is complete, but no more than its due place in the general picture. In

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addition, he has a robust critical habit of mind and a thorough command of the subject area.

His dedicated years of patience, together with active labour, has been devoted to producing this present work. The book has rendered a thorough medical and non-medical field knowledge in sexually transmitted infections and sexual health, a field of medicine he has long been connected with a service of conspicuous value.

It has not infrequently happened that a medical doctor performs labour of this description during his not over-abundant leisure. However, no ardent reader can rise from the perusal of these pages without being conscious that the author of this book has conveyed to him or her a more profound and more genuine appreciation of the subject matter; Sexually Transmitted Infections, including HIV and Sexual Health.

Yaw  Adu-Sarkodie Professor of Clinical Microbiology College of Health Sciences

Kwame Nkrumah University of Science and Technology Kumasi, Ghana.

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PREFACE

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What goes on during the encounters between medical doctors and their patients remains their own business. While medical doctors strive to understand their patients' complaints to enable a better solution, they seek beyond not just well-being. Still, they are also concerned about how they come to be sick and why they? Thus, it requires medical doctors to provide answers to these questions by addressing their patients' concerns. After over two decades of dedicated medical practice, public health education, research, and teaching and design and implementation of intervention programs, I am motivated. I deem it an obligation to contribute my quota to this knowledge-sharing and acquisition enterprise.

I have done this by transforming both the ugly and good encounters, thoughts, memories, and the experiences I have gathered through all these years with my patients, which I have penned down into entertaining and educative stories.

I am highly satisfied as I glance through my old diaries, which I kept for this purpose: to share the most unforgettable events in my life as a medical practitioner, researcher, administrator, and teacher. As I enter into my closet to scribble these pieces down, I have only one objective, and one only in writing-to educate people. In the storybook, I can educate people and talk about my experiences as a medical doctor in my style.

The book contains series of episodes of my encounters in the consulting room over the years of my practice. The whole book depicts a series of

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occurrences on a particular Monday. It tells the stories from the early period of the HIV epidemic of non-availability of medicines to treat persons living with HIV to the point the remedy became available in Ghana. Each scene centred on a particular sexually transmitted infection or sexual disorder and some valuable details about the condition. It saves the trouble of wading tediously through the pages of voluminous textbooks. It is valuable time for those yearning for information on sexually transmitted diseases and sexual health, either for personal consumption or for the education of others. The drama that accompanies each of the scenes adds up copiously to spice my presentations.

Although these stories are genuine encounters, the names of the personalities are fictitious. The verses of poems readers would encounter in this book spontaneously poured out of my heart as I reflected on my previous encounters with persons in the course of my writing.

The primary target is non-medical persons; nonetheless, the content may be helpful for health care practitioners in sexual health and sexually transmitted infections.

I have penned down these pieces with the cardinal view of supporting knowledge acquisition and propagation enterprise in the field of sexual health, of which I am proud to be a partaker. So shall my voice be loudly heard in the discussion of this subject now, and the days I shall no longer be part of the living.

Thomas Agyarko-Poku

BSc., MBCh.B., DipGUM., MPhil., MSc., Ph.D., FISSM., FRSM.

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Excepts

...Doctor, I would like to explain my issues to you in a language I guess you would understand. We all go to church to worship in anticipation of receiving the Holy Spirit, isn't it? But are we not forbidden to enjoy the service for a while before the ultimate? We often listen to the readings, participate in the chorus, joyful praises, and listen to the sermon before the Holy Spirit descends on us. After this period, we take our time to meditate on the spoken words. But, Doc, mine is not the case. Even before I enter the church building, the Holy Spirit is already upon me. The service is over before it begins! Sometimes the mere sight of the church building invokes the pouring of the Holy Spirit. That is the level of the enormity of my problem. Could a man continue to stay in this land of the living when he counted among the dead? I must go back to my maker to negotiate for a better fulfilling lifestyle.

The wise child, according to the adage, is spoken to in proverbs but not in words. I needed no other argument or further interrogation because I had accurately spotted his diagnosis. The man was suffering from - Ejaculation praecox. Latin words which mean premature ejaculation!

Gentleman. I have listened to you enough. At this stage and from my professional knowledge, I have so far an idea about your troubles. I must also tell you I have understood your sermon perfectly well.

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Chapter One

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and dehydrated. What should I do, Doc?" The voice on the other end of the phone stuttered.

A telephone call from the watchman, the cleaner, or the nurse on night duty, always began my day. So, it did happen that on one of the sultry Monday mornings in September, my phone rang with a melodious tune I could hardly ignore. It signalled the end of the rest I had enjoyed in the night, whatever chance I had of peace inside those block walls. It was a call to duty and a reminder of my service to humanity.

They've brought a very sick person waiting in a taxi. Some men are also looking for you. Doc, how soon would you be here? Someone is sick., the voice continued in a sonorous manner.

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A MONDAY TO REMEMBER

These were some of the messages I usually received in the mornings delivered by desperate and anxious but dedicated staff who made every conscious effort to get me to duty to support them in preserving precious lives.

Please, detain her in the ward. Give her an oral rehydration salt solution. Set up an intravenous infusion. Wait for me. I'm on my way.

These were some of my consoling responses to buy time and confirm that I would be around.

"Are there  many  patients  around  to  see  me,  Sister?' I asked, wanting to know how the day would look like for me.

Although I was always conscious of the task ahead of me on Mondays because of the characteristic record-high number of patients visiting the clinic and the predictability of the type of reported cases, the usual mystery was the characters that would be involved. (On average, between eighty and ninety persons visited the clinic on Mondays). Dramatic and real scenes of individuals, couples or groups of persons were to be always anticipated. I gradually became accustomed to this situation and accepted it to be part of my daily interaction with my patients and non-patients.

The core business of my clinic involved but was not limited to addressing complaints of individuals or groups of persons about sex, sexuality, sexual health, and their attendant problems, including sexually transmitted infections. That was the same job

I, son of a woman, had taken upon myself; to enter into the realms of the sanctity and privacy of individuals, groups of persons, and communities, to explain the nitty-gritties, modalities, and calamities of the very act of procreation and enjoyment.

Complaints of individuals or groups of persons about sex, sexuality, sexual health, and sexually transmitted infections are not trivial and should not be underrated. Often, these are issues that touch on the moral fiber of the individuals, group of persons, and sometimes the whole community. That is because the 'game' of sexual intercourse is communal; it is a shared game. Hence, the characters involved may not only be the individual or the group of persons present before you as a doctor or healthcare provider at any point in time but may extend to the whole community who may not be sitting before you. To this effect, the search for a solution to people's problems in this area of medical practice should constantly be widened. Conscious efforts should be made to look beyond the individual to include other persons in the course of searching for solutions.

From my experience, many people with issues bothering on sexuality are often hesitant to disclose the entire contents of their predicament. Why would a person seeking help be reluctant to disclose their whole story to the persons who can help them? The strategy for practitioners in the field of sexual medicine, in my candid opinion, should be for them to consider every complaint

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of an individual who patronizes their service as the tip of their iceberg, which requires further in-depth probing. Management of such cases, therefore, goes beyond the mere administration of medicines. It requires diplomacy and tact from a person who is well-trained to understand and appreciate the issues.

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My faithful and loyal driver Kwabena Issah, a devout Muslim, was without fail in front of my house on or before half- past seven in the morning from Monday to Friday. My routine was to begin the day with classical music, usually enjoyed on my way to the clinic. Over the years, my driver became accustomed to my classical symphony orchestra music, which he commonly referred to as 'ghost songs.' He knew the right composer for the day and always made sure the correct disc is inserted into the player in the car. Yes, I had a driver. For someone not yet sixty years old, driving should have been a pleasant hobby, but duty demanded that I be driven to and from my workplace. The heart- piercing sound of the horn of the official Super Sonny saloon car signalled the end of my night and the commencement of another unpredictable day. A quick partially masticated breakfast (while standing) or no breakfast at all sent me packing into the vehicle.

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An orchard of various fruits surrounded my rented three- bedroom-house sitting on an acre plot of land. This gave an enviable breeze, a cool afternoon breeze in the afternoons, which, unfortunately, I could hardly find time to enjoy. Indeed, that edifice was more of a dormitory to me than living quarters. Indeed, that edifice was more of a dormitory to me than a house because I habitually left by seven in the morning and only returned after six in the evening. Located in a tranquil part of the city, the stand-alone house was only six kilometres away from my hospital. However, my morning journey often took an average of thirty to forty minutes by car to reach the hospital due to the heavy vehicular traffic at that time of the day.

A lot of ideas cropped into my brain as the driver accelerated towards the hospital each day. From discussions I had had with my colleagues, it seemed normal for medical doctors to disengage their brains from all issues concerning all ill-health once they stepped out of the hospital premises. How did I wish I could forget the patient I had to attend to on three occasions for recurrent sudden collapse attacks or the woman who had to be served several doses of oxygen within a few minutes of her hospitalization? How I wished this assertion could be true. How could I forget the patient I had had to attend to on three occasions for recurrent sudden collapse attacks or the women who had to be served several doses of oxygen within a few minutes of her hospitalization? How could I disengage my brain

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from the possibilities of finding blood for the four months old baby with a very low blood level whose father had disappeared six hours after he was told to find a blood donor?

It would undoubtedly be inhuman on my part to forget about the fifty-seven-year-old headmaster of a local secondary school. He was still gasping for breath and deeply unconscious by the time I left the hospital last night? Indeed, the substances forming the inner-thinking part of my head could not be allowed to have peace when I was to reveal to a twenty-five-year-old lady, the first progeny of a colleague medical practitioner, that she had HIV infection. This beautiful lady was only two moons away from tying the knot with her sweetheart after almost a decade of friendship. How do I start?

My mind was focusing on the happenings at the hospital as I set off, reviewing all the information I had received from the staff on duty.

Has the patient's condition, whom they had reported vomiting, worsened or was he already dead? Were my instructions well carried out? Does she/he need a referral? Is the patient already aware of his/her HIV status? Can she/he afford the cost of her/his treatment and medication? Are parents of this beautiful lady around to find out the cause of the death of their daughter who passed away last night? How many people would come today for their HIV test results? I must break the news to this couple, but how do I do it?"

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These and many more were some of the heart-wrenching questions that engulfed my brain as I approach the hospital each morning. Therefore, it stands to reason that I always started my routine journey to the clinic each day with a mental review of cases, both old and new. At this point, you may understand why, my dear readers, I always began my day with soothing heart music.

The journey to the hospital was also often inundated with numerous telephone calls- expected as well as occasional irritating ones.

Yes, please, this is Dr Agyarko-Poku. How may I help you? always ready to respond.

Doctor, how are you and the family today?

My family, the very optimistic callers, referred to my wife and the children without any room to conjecture whether or not I had a family. I found some irony in their wanting to know if the medical Doctor is healthy, for I knew they thought that doctors are supposed to hold the key to healthy living, and if they were sick, what would happen to the 'seekers' of good health?

We are doing well, and you?

I was quick, and I was always mindful that a response that suggested we were not well would invite more questions from them.

Hmm, Doctor, I am not well at all. Someone directed me to see you. Would you be at the clinic today?

The  questioner  would  ask. Yes. I am on my way to the hospital.

I would simply answer, wanting to end the call quickly. Then the irritating part,

Please, Doctor, when would you close from the hospital today? I am swamped now, and I would like to see you in the house this evening with my problem. I am too sick, and I have suffered for a long time.

You may be perfectly right to suggest that I hang up at this stage, but I had many other options to help me to be polite and humane about my response. This meant that I remain silent and expecting the fellow to say more or shout hello, hello, hoping the person would assume that I could not hear him or her well. It was a situation the person is likely to attribute to technological failure after I had dropped the call. Another option was to hang up and switch off the phone to avoid further calls of such nature. I certainly needed to be sober and have a sound mind at the beginning of the day. These were a prerequisite to making a sound judgment, such as a clinical diagnosis.

Doctor, would you come to work today? was the usual follow-up question, perhaps on the assumption that I had not heard him/her. This was also a common question I received from unidentified voices after picking up calls and asking them to introduce themselves.

"Please, I am at the hospital to see you, and I'm told you are absent. I have been waiting for the past two hours, so I just want

to know if you would come to work today," the voice would continue to explain without identifying him or herself.

The chronometers fixed in-between the two speedometers on the dashboard of the six months old Super Sonny car, the one on my computer and my mobile phone, measure the same time: forty-five minutes past seven in the morning. That puts me within the time since everyday clinical work for the morning shift commences at half-past eight. I was expecting anyone who called me at this time of the day to be very conscious of the fact that the hospital was not my dwelling place; I only went there to work. Ironically, perhaps, this may be an assumption of only me.

Are doctors not supposed to attend to the needs of their patients during day and night, in darkness and sunshine, in happiness and sadness, during better conditions and worse ones, till healthy conditions or death do us apart? a thought popped into my head.

To the patient, the availability of a medical doctor at the hospital to take care of them is the most important and, therefore, would care less about which Doctor's turn it is. Indeed, I have sworn by; Apollo, the physician, and Aesculapius the surgeon, likewise Hygiene and Panacea, and I have called upon all the gods and goddesses to witness; that whatsoever house I may enter, my visit shall be for the convenience and advantage of the patient.

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This indeed is my oath! I recited with my clear mind, without any coercion, at the beginning of my career as a medical doctor. At the time, I indeed called upon the Almighty God to help me achieve the oath's requirement. Giving reverence to my ever-unfailing brain for always ensuring my quick recall to my professional commitment, I often calmed down swiftly in such circumstances when these tempting calls arrive to irritate me. There and then, I would reply soothingly in one of the following:

Please have a little  more  patience  to  wait. I will be with you soon to serve you. I'm on my way. Please, if you are sick, then you must see me now.

Your health is important. Get some time for yourself, no matter how busy you may be

Please, it is not advisable to attend to you in my house. Since you are telling me you are too sick, let me rather see you at the hospital, where I have everything I may need to take care of you.

Unfortunately, this dispensation may often not be extended to persons I expect to be aware of the fact that, but for emergencies, I would not be available at the hospital at such 'unholy' hours before the sunrise. Although my ever-unfailing brain reminds me quickly of the oath, the human in me sometimes manifested. When the level of my tolerance was stretched to the limit, I could throw professionalism unto the dogs and shouted these distasteful words into the mouthpiece of my hand-held communicating companion.

Do you think I sleep at the hospital? Look at your time? It's not yet clinic hours.

I may burst out and rudely hang up.

I have always made a conscious effort to be among the first batch of staff members to report for duty. This ensures that I have enough time to interact with my patients before the commencement of the day's business. As I step out of my car, my first port of call was the patient's waiting room, a small room with a seating capacity of thirty and that was woefully inadequate to house the large number of people who patronized the clinic. Walking through the crowd of those standing or squatting in the room was very uncomfortable.

A glance at the occupants in the waiting room and around the clinic vicinity always preceded my hasty handshake to exchange greetings with most patients. It was also an opportunity to scan through the patients to identify those seriously ill and need my prompt attention by my clinical judgment and instinct. It was always a hectic time departing to my consulting room or my office from the waiting room, as everybody wanted to be heard once I was in sight. Some patients would decide not to partake in the morning educational talks offered by the nurses at the beginning of daily consultation. They instead preferred to take strategic positions at the car park, the space in front of the clinic or along the roadside to ensure that they get the needed attention from me as quickly as possible. Of

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course, to many of these patients, the fact that I

Reviews for A Monday To Remember

[lilian owusu-mensah · Rating: 5 out of 5 stars]

Its an excellent piece for the public as it creates awareness for all to be on guard.Thank you Doc