Kenya is hot, the average temperature is about 85 degrees though the population seems to be used to warmer than that. On a 72 degree day we had mom’s bringing their kids in with many layers; winter hat and winter coat, sweater and 1st layer of pants followed by a long sleeve shirt and occasionally a second pair of pants, followed by thermal underwear and undergarments. It felt like an SNL sketch just trying to get close enough for lung sounds. What shouldn’t have surprised me was that the medicine fundamentals were the same. Get the history, do the exam and treat the illness with the most appropriate medication available. Physiology isn’t different around the world. There were some language differences, such as “hotness of body” or what I interpreted as subjective fevers.
How medicine is practiced however is different based on the resources available. Often investigations are unavailable, prohibitively expensive, unreliable or would simply take too long that the patient would have already experienced complications from whatever illness. Nearly 90% of patients seen in our hospital were given antibiotics similar to how we treat newborns in our ED while waiting for results just in case there is a bacterial infection brewing.
The other difference is that the history is often obscure or challenging. Yes, there is a language barrier but even in the same language it is a challenge. Its unreasonable to ask a mother of 5 who has to worry about feeding, providing for, cleaning and raising her children with no running water, intermittent electricity in a 2 room house made of tin sheets whether its day 4 or 5 of illness. With barriers to history, testing, follow up and limited physical exams from ferocious toddlers; often the safest thing to do is just treat the most likely life threatening illness.
We spent our last week at a community hospital where we helped a Medical officer who was trained in OBGYN run a pediatrics clinic. At home, I wouldn’t have prescribed anything for 90% of the patients though nearly every mom went home with some kind of prescription such as appetite stimulants for what seemed like picky eaters or antibiotics for kids who were afebrile but mom reports “hottness of body” after removing the seven layers of winter gear. Unfortunately that OBGYN officer was the only one available and did the best she could with the 50 patients she had to get through that morning. Treating the possible life threatening illness is the safest thing she could offer these struggling patients.
Of course the ultimate goal is to have enough staff and resources to conduct appropriate diagnostic testing and treat only those who need treatment but the experienced folks we met with seem to have done a good job with what they have.