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An example of Preventative Medicine

The Ultimate Example of Preventative Medicine.

Video link

Peaked my interest to see a nice personal story clip that really puts a face on, exactly what CompassQuill rightly named it PREVENTATIVE MEDICINE.

Preventative medicine allows you to improve both your quality & quantity of life (ideally).

But the real take home message is:

The old-fashioned yearly (or at least periodic) physical is STILL SO IMPORTANT!

Remember the line he says in the video – I don’t go get check-ups regularly, I don’t even have a doctor.   There was the problem right there.  He’s using his body well & it’s working for him so far as he can tel but he’s not keeping up with the maintenance. Any young adult who didn’t know how to take care of their first car will tell you – if you don’t check & change the oil and keep up the maintenance, it’ll work for a while but next thing you know it’s gonna croak on you, usually in the middle of no-where with no cell signal and no one to help too.

A history & physical alone can do much in the way of prevention.  In prevention, your doc is like you’re own personal guide. But he or she can’t do anything for you unless you show-up & participate.

One thing to warn from this video though:

Medicine loves it’s fancy new machines (imaging, testing & labs) as much as everyone else loves their fancy new gadgets, phones, etc. But we can’t & don’t rely on them as first line and neither should you.

Medicine is a scientific field remember. So we rely on Evidence, which we get from trials – but not just any trials (with little effort I can find you lots of bad trials) – reliable, repeatable & thoroughly vetted trialS (and I capitalize that cause it’s never just 1 either).

This evidence tells us why we don’t CT everyone who walks in the door. Its not all because of $ either for the cynics out ther. Other than the radiation load, Its because in just about everyone’s films, etc you’ll find incidental things that were never going to hurt the pt (and those films can also not show things that will hurt you too – ask a surgeon or a radiologist about abdominal dx & imaging sometime). Unfortunately who’s to say that those incidental findings are never going to hurt you? Well you do actually. Your body through your experience (hx), physical findings & selective testing,  points your doc towards problems or potential problems. But unless you have those pointers the evidence tells us that doctors chasing down findings from uneccessary tests/images end up hurting the patient more than if they had not done the test.

Joining Forces Initiative.

Medical schools announce the:

Joining Forces Initiative

Quick summary: Med schools are making a commitment to enhance medical education to ensure that challenges faced by military service members, veterans & families are not completely foreign to physicians in training.

I wonder how the schools plan to do this.  My school prides itself on it’s cultural sensitivity and such but oddly enough, I never heard anything related to military populations unless it was recruiting or a trauma lecture given by a military student.

My advisors, for the most part, had to be honest & tell me that they really couldn’t help me too much as they had little to no clue about military scholarships, residencies or life though many of them are former military docs.  Its certainly gotten better over the last several years that I’ve been in school as far as availability of information with the different branches & acceptance by classmates but there’s room for improvement still & many hard at work on it.  (a thank you extended to those working on that front)

With more and more medical students pursuing military scholarships and training I anticipate that education, advising and knowledge about military life and the needs of the many populations affected by military life will get better. Hopefully those who pursue military medical training will follow many of our mentors into mentoring or educating not only the students following us into service but those who travel with us in medicine as well.

Happy Trails.

 

Video Testimonials.

See me talk about Elective Africa while in Arusha, Tanzania.  These were taped in a garden though it may not look like it with the cement and all.

Elective Africa Testimonials

(These were off the cuff and without much direction of planning so be kind, plus water pressure is awful and I was funning out of clothes and balancing on a poorly positioned chair so … all in all we rose above to make a halfway decent video … )

Swahili

Kiswahili (Swahili)

  • Key language of communication in East Africa
  • Bantu group from Niger-Congo family
  • Proven to be present in 1st millenium AD
  • Widely spoken but only the 1st language of 4-5 million people with ~45 million using as second language.
  • National language of Kenya & Tanzania, Common in Uganda, Rwanda, Burundi, Zanzibar, Comoros, eastern Congo, southern Ethiopia, southern Somalia, northern Mozambique, northern Zambia & NW Madagascar
  • Heavily influenced by:
  • Arabic (‘coastal’ –> ‘Swahili’)
  • Europeans spread the language inland
  • Persia
  • Portuguese
  • English (baisikeli – basically,  penseli – pencil, kompyuta – computer)
  • Standard Dialect = urban Zanzabar City
  • Used in Kenya & Tanzania during Precolonial times for missionaries & colonial governments to interact with locals, then used in adminstration, which led to it’s official status in the post-colonial period.
  • First written by the colonialists so it is based on a Roman alphabet and spelled exactly as it sounds.

 

Alphabet / Sound English words with equivalent sound Alphabet
a father a
ay may  
e   ay
ee bee  
i   ee
o   oh
oh role  
oo moon  
b big bee
c   see
ch chilli  
d din dee
dh this  
f fun ayf
g go jee
h hat ay-chee
j jam jay
k kick kay
l loud ayl
m man aym
n no ayn
ng sing  
ny canyon  
p pig pee
r run (more like a d) ar
s so ays
sh ship  
t tin tee
th thing  
u   oo
v van vee
w win dab al yoo
y yes wa ee
z zoo zayd ee

 

Articles a ___  = ua __ some ___ =  ___ watu   or   watu ___

 

Am/is/are  =  ni    Am not/is not/are not  =  si

 

I = Mimi  We = Sisi

 

Nouns:  person or animal – singular = m-,  plural = wa-

object – singular & plural n- / j- / no prefix

 

Nouns –> Adjectives:

  • person or animal – singular & pleural = wa ___
  • object – singular = ya,  plural = za.

 

Doctor = Daktari

Student = Nafunzi

 

I am a student doctor  Mimi ni wa nafunzi daktari.
We are student doctors Sisi ni wa nafunzi daktari.

 

Samahani = Excuse Me        (most useful word!)

This has been your (& my) primer in Swahili. I still don’t understand most things said to me but, Thanks for watching.

Arusha “Hospital”

Today we started working at the Kaloleni “government hospital”, it’s really a multi-specialty primary-focused outpatient clinic, in Arusha, Tanzania.

We started our orientation in the Family Planning clinic.  Here women learn about birth control and receive preventative gynecological counseling and services. The tables for this years’ services depict a predominant use of condoms and IUDs, then Depo-Provera & OCPs. All of these forms of birth control and counseling are provided for the patients free.

Next was the laboratory. Later today we saw a patient’s urine who was suffering from Schistosomiasis.  I watched the Schistosome on the slide as it attempted to ‘hatch’ from the capsule, according to the technician the organism moves within the capsule as they attempt to hatch. I was very impressed as I’ve never seen a schistosome before and Brian tells me he’s only seen them on fecal smear slides.  Later on Brian saw a Giemsa stained blood smear of a patient suffering from malaria with the smear ‘chock-full’ of parasites.

There was a small triage area, a minor theatre (minor procedural room) & clinics for: Diabetes & Hypertension, dermatology , eye, ante-natal, TB, HIV & a vaccine clinic. Anyone who can not be stabilized at the clinic in <24 hrs is transferred to either the district, regional or local private hospitals.

Patients over 60 & under 5 years of age receive all care, meds and vaccines free of charge as well as anyone’s treatment for pregnancy, Diabetes (oral Rx & DM1 insulin), Hypertension, HIV, TB & generally most chronic diseases, as well as the afore-mentioned family planning. All other treatment must be paid for at the governmental clinics but this covers most of the needs.

The major public health project of the hospital is “Know Your Status”. Funded through the US, this initiative aims to test everyone who recieves care at the hospital for HIV using a rapid reactivity screening test. Screening is free to all patients and done maximally once a year. Patients are allowed to refuse the test and continue to receive care however there seems to be many who are willing to be tested.  This initiative started in August of 2011 and so far to date they have found 25 patients with HIV who were not previously diagnosed.  After screening the patients are counseled about their status privately and anonymously with well trained nurses and an overseeing physician in small offices at the back of the compound. Overall this seems to be a very positive program.  Those patients who have been found positive have had their CD4 count taken and are seen back 2 days after counseling to discuss treatment plans and results.

Unfortunately the places that we can really spend time at in the hospital are limited by language. Tanzanians speak Swahili almost exclusively with only some English speakers amongst them and at far more varied proficiency than in Kenya.  (Kenya secondary schools, middle & high school, require English language & the medical school is in English with some Swahili.) So we’ll be working on our Swahili.

Today I had greetings drilled into me because EVERYONE is SO POLITE and nice. My usual Jambo is not cutting it here.

A: Karibu (Welcome)

M: Asante sana (Thankyou very much) – remember this from the Lion King, rafiki’s little song: “asanti sana, squash ban-ana, wee di wee di, wee di oh ana” – Shh don’t tell anyone but I have to think of that song every time I panic thinking “which one do I say back again?!” and now even when I’m not, lol.

A: Habari (Hello/How are you?)

M: Nzuri, Asante. (I’m Fine Thankyou.)

Today I spent my clinical time in the Eye Clinic.  The Optometrists were very interesting to watch and speak with.  We saw many patients with miopia, some with overlapping allergic conjunctivitis, cataracts & “lazy eye”. One of our patients was a ~17 year old African male, acutely post-blunt trauma to the eye resulting in prolapsed iris & both prolapse & subluxation of the lens (in otherwords the colored portion of his eye appeared to be bulging out of the white globe of the eye and the black center of the colored portion was misshapen and showing the lens to be displaced from it’s typical position). Don’t worry though – he was not in a lot of pain unless you uncovered the eye and shown light into the pupil, which causes it to constrict and … well HURT! He was immediately referred to a local eye hospital where an opthamologist could perform pretty urgent surgery to replace the lens and reduce the overall pressure within the eye.

Because my sneakers are still damp from pushing the van through the creek in Masai Mara the other day I wore my Vibram Five-Finger shoes to work today (I think it’s better than wearing flip flops which was the alternative). But what a stir I caused. EVERYONE was looking at my feet and commenting on my shoes (a similar stir was seen in Kenya but many more people seemed to notice here).  Perhaps I should buy stock in Vibram or they should think about establishing stores in Africa as I’m sure they would be VERY popular very quickly, if only they weren’t so expensive. I wish I could get away with wearing them to the hospital or with my uniform in the US – I’d be so so comfy. 🙂

Kwa heri (Bye)

  • Mchele/Mishel (uncooked rice – or the way that most people spell my name here, I guess I am just that white ;-D )

A Day in Life @ CPGH

Our work at CPGH continues.  There is a large group of students here from Drexler University CoMedicine and they easily fill up the van Elective Africa uses to ferry students back and forth from the hospital to the housing facilities. So Brian & I go into the hospital an hour earlier than them, ~ 7 – 7:30 am & work until ~ 1 – 2pm when we leave, usually later than them to return to the house.

When we arrive in the morning it is before the hospital has truly opened. Despite this Brian & I went about our day, checking on patients, reading through charts and results, etc until the clinical officer arrived. The clinical officer or intern (in their 5th & last year of post-secondary training prior to independent practice) is assigned to a ward & is responsible for patient care, orders, etc on that ward for the entire year.

The clinical officer would then round on his/her patients in the ward and generally would be followed by a cluster of ~10 medical-officers-in-training.   A medical officer is a person who has received 3 years of schooling post-secondary school and is then allowed to practice medicine, including prescribing medications, etc, without supervision in the community in Kenya.  They are not doctors or nurses and based on what we saw of these “senior” medical officers knowledge base & clinical expertise, I certainly worry despite the obvious need of community practitioners.  We would encounter some “doctors” in the community in future events & emergencies, who were in fact medical officers with years of clinical practice. I’m sorry to say that our fears were confirmed.

Often in the midst of this pre-rounding, the consultant would arrive & Consultant Rounds would take place. Consultants are similar to Attendings in the US, a boarded medical doctor with many years of experience and seniority. Invariably the number of medical officers would instantaneously & insidiously double or triple at this point. This would make rounds look like a crowded spectacle with ~25-35 people tightly clustered around a rusty metal cot in a large rectangular room of more than 30 tightly crowded  & occupied rusty cots. The crowd would be joined by the patients family members & often the neighboring patients & their family members as well. The heat would soar & the body odor would be overwhelming, especially since the habit of speaking quietly would require all of the students to tightly crowd together & jostle in order to hear. Thankfully we became more familiar with the patients & could therefore separate from this crowd, standing further back while still participating.

Consultant rounds would proceed with each patient presented to the consultant in English (this with the low speaking volume being the only privacy really afforded patients) wrapping up with the diagnosis, plan and current status of the plan.  At this time these rounds would proceed either with either ascension of the plan, advisment or teaching.  We most often worked with Dr. V, a cardiologist by training and a good & practical teacher. He would ask questions of the crowd regarding basic science and escalating to clinical science and finally treatment & management.  Early on a system established itself as to whom & in what order these questions would be answered. First the medical officers were given the opportunity, then the clinical officer and finally he would tilt his head back & in the direction of where we would be standing signaling for us to answer.  At first both Brian & I felt very self-conscious in this practice, as if we were being forced to showing up the others (be ‘gunners’) or were being objectified like “See the White Americans know all the answers”.  This was particularly disturbing for us with respect to the clinical officers whom we worked most closely with and thought of as our superiors & supervisors. However, in all but one case, they quickly put us at ease. They seemed to admire our knowledge & experience, especially in areas of non-communicable disease. They eagerly sought us out during work-rounds & began many interesting discussions with us about various aspects of medicine, global health and medical culture.

The clinical officer with whom we mainly worked seemed to project a sense of pride even, that we were all working together and gravitated to her ward. She is a truly good clinician and a great person. Brian & I both enjoyed working and talking with her very much and admired her resourcefulness & the resilience of her compassion for her patients despite the many daily obstacles she faced and the generally bleak & thankless nature of the environment in which she labored.

First Day at Hospital

Today we went to Coastal Provincial General Hospital, the second largest hospital in Kenya.

I’ve never been around or in a ‘third world’ hospital before and neither had Brian so it was very interesting.  3 floors with multiple buildings connected with covered outdoor corridors, etc. Total of ~ 700-ish beds. The minor trauma/procedural ER area was enclosed and without a breathe of air – therefore so very incredibly HOT!  The Wards are like a very long open room with windows on both sides and about 25 stationary (not mechanical) beds plus several in an outside (river-facing) patio.

A cultural quirk we encountered today was “the whispering”.  Generally people do not speak very loudly and during rounds, especially with about 15 other medical students it’s absolutely impossible to hear any of it.

The pathology in just one general ward was amazing. We saw:

  • TB,
  • HIV,
  • Sepsis,
  • “CCF”= Congestive Cardiac Failure – in US C-Heart-F,
  • Elephantiasis,
  • Lymphadenopathy the size & shape of lemons,
  • Anasarca (REALLY bad swelling and third-spacing of fluid outside of the veins),
  • Ascites that was so bad that the umbilicus inverted and stuck out like a balloon about 5 inches from the swollen belly,
  • Cerebral Palsy,
  • Upper GI Bleed
  • Encephalitis.

Patients & patient’s families supplied food and water, there was almost no-one on IV fluids and the blood drawn for labs were handed to the family member to bring to the lab themselves.

More updates to come.

teaser: Monkey’s like skittles.