High throughput medicine and mopping up polio

October 8, 2006 at 2:39 am (Sarah's Posts)

I had the tremendous opportunity to observe a Rotary International sponsored polio corrective surgery camp yesterday. Although the number of cases of active polio has gone down quite a bit due to a worldwide vaccination campaign, there are still folks who are disabled from previous infections, with the classic manifestation being paralysis in the limbs, such that they appear shriveled and lose some/all functionality.

This particular project is a two day camp where six orthopedic surgeons perform about fifty surgeries to correct the disabilities that come with previous polio infection. When we first arrived, there was an hour and a half ‘inauguration.’ Normally, I have zero tolerance for the sort of events where ten people get up and talk to hear themselves speak and flowers are given out and everyone claps. They strike me as self congratulatory and my impatience stems from the fact that it is nearly a cardinal sin in the US to waste someone’s time. Luckily for the sake of my patience, I got a good explanation for it this time around. The camp was being conducted at a Primary Health Center, which is a government run hospital that serves the rural community. In a sense, listening to the pomp and circumstance is a tradeoff—the Rotarians get the hospital for free, which would have been prohibitively expensive had they needed to find a way to work it out on their own. It was a good reminder to me that politicking and networking are an important part of being able to deliver healthcare. Sometimes I get my eye on the prize and can’t stand the details that prevent me from doing work, work, work.

Most of my time was spent with the first doc that the patient’s saw—the triage doc. The triage process itself was fascinating. Firstly, he’d look at the level of deformity to see if there was anything that surgery could do. But, there was also a practical evaluation. He would ask what they did for a living, and if they could still work with their deformity. No elective procedures here—sheer functionality. The evaluation took about a minute total, and he would give them the outcome—surgery or none. There is no real question of things like physical therapy, although they moved mountains to get one girl some rehabilitive care. You could see the look of disappointment in the eyes of the people who were told that surgery wasn’t possible. The power that this doctor had to pronounce the patient’s future frighteningly godlike. At the same time, he had a down-to-earth humanity about him that was truly beautiful. We would never be able to tell a patient, “You need to be happy with what you’ve been given, because you’ve achieved a lot by being able to walk in the first place.”

It brings up a lot of questions for me about how to best administer care under the high-throughput conditions of a camp like this. It is truly amazing that they can administer to so many people in a short time. We focus so much of our medical care on how to talk to patients, how to deliver difficult messages, how to make the patient feel good about whatever you can do for them. You sacrifice some of these things when you can only give one minute of assessment and care to a patient. It also strikes me that there is a greater degree of distance between the patients and doctors here. Many people are extremely health literate at home, thanks to the internet and the accessibility of health information. Here, the information gap between the patient and doctor is often much wider, so his word is absolute.

Still, they are doing amazing work and touching many people’s lives. It makes me extremely grateful that there are folks out there who are willing to take on these projects with their time and energy. Beautiful inspiration. A few pPhotos at my flickr account, which is under SarahLynnKimball.

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