Thursday, 28 October 2010

Africa, Mindset, Development and Doctors

You may have noticed that I said “AFRICA” and not “AFRICANS”. This is deliberate because it is Africa that needs to be developed and it is African Doctors working in Africa that need change in mindset. Africans are as exposed as anyone in the world. With globalisation, knowledge is no longer a scarce resource. However, many doctors living in an African environment operate as if knowledge is very scarce.

There are so many things one takes for granted living in a western country like the United Kingdom. For example, when I go to see my doctor (here in UK referred as GP), one thing that strikes me is that he/she has a computer right there and a pile of books. Once or twice he/she goes on-line to check for something or refers to the books. I have therefore made it a habit that before I go and see my GP, I “Google” and try to understand what I may be suffering from. This helps me ask relevant questions. Turn the page and go to Malawi or Zambia (where I lived for 4 years). Apart from papers and some books on the desk, doctors have no computers and probably have no access to internet in their offices.

In my first early history lessons, I learnt about the different types of history which included “written and remembered” history. It seems our medical personnel in Africa prefer to use remembered history and find “written history” either a nuisance or unnecessary. As someone once said, “If you want to hide anything from an African, put it in a book”. It seems this is true for our medical personnel. My wife once had a gynaecological problem and a doctor in Zambia after one visitation and a scan boldly said, “I have to remove your uterus”. The reason was simple. My wife had confirmed that we did not intend to have any more children. Therefore removing her uterus was, to the doctor, the best solution. If this surgeon had read new medical findings he would have known that removing uterus is only recommended when the condition is life threatening. The reason might be that a woman’s body minus the uterus could bring other complications or imbalances. When the doctor was asked when he could perform the operation, he quickly said, "If you want, tomorrow"! Was motivation money? I am glad we went and read and consulted. We flew to South Africa, and my wife still has her uterus!

I had surgery in 1995 in the USA to remove a duodenal ulcer. Years later, in 2007, as I advised a friend with ulcers in Malawi, he was not even aware (nor his Doctor) that nowadays anti-biotics are part of ulcer treatment. In 1982 two Australian scientists, Robin Warren and Barry Marshall showed the bacterium Helicobacter pylori (now known as H. Pylori in medical field) plays a key role in the development of both stomach and intestinal ulcers. They were eventually awarded a Nobel Prize for medicine in 2005.

A friend recently shared a story of how three different doctors in an African country kept giving her antibiotics for over a year and told her that it was a gynaecological problem. The diagnosis after more than 3 scans kept changing. The last time she was told that the doctor would open her up to see what the problem was! She decided to go to South Africa and within a day, it was discovered that she had Irritable Bowel Syndrome (IBS). Google it if you want to know IBS. Imagine the trauma of being opened and being told that it was IBS and closed again.

This may look simple, but imagine the loss of life as a result of poor diagnosis, money spent on irrelevant drugs, time spent going and visiting doctors, resources used to go for medical treatment in South Africa etc etc. This all adds up and continue making our health systems expensive and strained. Yet we have qualified and competent personnel. It only takes a change of mindset to reverse this trend. Doctors have to start reading. Doctors have to be innovative. Medical practice is only for those that understand that the world is changing on a daily basis and they have to keep in touch with the changing world.

Perhaps Doctor should only be given a licence to practice if they have access to internet and subscribe to modern journals, and perhaps they should go for exams every two years. This however means in countries like Malawi, Internet infrastructure should be made available and affordable. Doctors can send patients’ scans abroad by email to get a second opinion before giving a diagnosis. This try and error method is a disaster.