Thinking...

So. Things at the hospital have been going well.

Today I gave a presentation to the Peds Department on electronic medical knowledge resources. Ostensibly, this was the purpose of my trip -- to come and do a brief project with the aim of improving access to and familiarity with available resources.

Physicians who work in major US hospitals, in addition to having (relatively) unlimited resources with which to practice clinical medicine, also have free access to a huge variety of online medical information, including journals, reviews, systematic databases, decision-support tools and so forth. Just ask any resident you know how often they use UpToDate. These resources, however, are not cheap, and are therefore not widely used in the developing world. There has been movement in recent years, however, to bully the major medical publishers into providing free access for free to those practicing in the developing world. HINARI is a program from the WHO which makes this access possible.

So, with the help and guidance of one of the Medical Librarians at the Yale Medical Library, I undertook it upon myself to find, catalog, and consolidate resources like HINARI in a way which made them easily accessible to the house staff here at Korle Bu Hospital. I did this by making a simple HTML page with one-click access to the major points of interest. The purpose of my presentation this morning was to review the available resources, distribute and explain the HTML access page, and give some tips on how best to navigate these resources.

The presentation was well-received, and was undoubtedly the first time that many of the staff present come into contact with some of these resources. Still, it takes far more than mere presentation of new information to affect clinical practice. Habit is a powerful thing. The integration of electronic medical resources into regular clinical practice requires personal interest and motivation, not to mention a certain baseline technical knowledge and infrastructure. Just ask the aging generation of physicians in the US, many of whom continues to struggle with some of these requirements.

Regardless, one must start somewhere. So consider it started here.

While having a coherent project plan (as above) was necessary to arrange an international elective, my personal interests were equally in clinical work and learning my way around the wards, which is how I have spent the remainder of my time. As with much of life, it has been educational, in that once again, I have learned how much I still have to learn.

There is this idea that a Western Doctor can show up in the developing world (even to a hospital well staffed with locally trained physicians) and be expected to provide better care than the local staff. Perhaps this is an obvious fallacy to some, but I doubt that it is to everyone. So let me put it this way:

Do you think it's easier to practice medicine in a resource rich or a resource poor environment?
Is it easier to practice medicine in a familiar environment or an unfamiliar one?
Is it easier to treat patients with illnesses that you see often or illnesses that you rarely see?

Exactly. Or how about this one:

If I am still very much a student of medicine at my home institution, will I be less of a student here?

So the initial idea is a bit off.

What, then, do I and my cohort of do-good Westerners have to offer? Not necessarily that much, initially. Still, there is a reason that the rigors of a US medical education are prized. The reason is not simply what you learn -- which in a foreign situation may be of little relevance -- but how you learn. Or more appropriately: how you learn to think. How to approach a problem and manage it's solution. This is a lesson that always serves you well. But form without content won't get you far in the hospital. You still need to fill in the blanks - the specifics of diseases, languages, treatments, and the politics of life and work in THIS place.

So, as always, there is still a lot to learn!
But who doesn't like learning?