Monday, October 18, 2010

On low-resource medicine in Indonesia & elsewhere: Much to admire.

Greetings from rural Borneo, Indonesia. Indonesians call their portion of this magnificent island Kalimantan, and it is both richly endowed and gravely endangered. Until recently the island was covered in rainforest; since the 1980s, it has been so heavily logged that only a fraction of the original forest remains. Illegal logging, fires, and the clearing of forests for palm-oil plantations are among the reasons why the ecosystem here is being devastated. Through flooding, drought, and changes in disease patterns, hat has led to adverse health consequences for many people here.

I'm in Kalimantan with an organization that provides health care for people living amongst this destruction. Since I'm not writing for them in an official capacity, I will withhold identifying details about them, as I wouldn't wish to bring even the possibility of unwanted publicity through anyone taking offense at what I write.

Some Indonesian readers may be offended, for example, at the term "low-resource medicine." I hasten to reassure them that no slur is intended. On the contrary, I am here because I admire this kind of medical practice. At its best, low-resource medicine has the capacity to surpass medicine as it is practiced in developing countries, in terms of wise stewardship of resources and of providing patient care that is both medically effective and cost-effective. I greatly admire the practitioners of low-resource medicine and of all that they do for their patients, and I firmly believe that medical practitioners in developed nations like the United States have much to learn from their colleagues who work in low-resource settings.

It has often been remarked upon, for example, that physicians who do lack access to a near-infinite array of tests and studies develop sharper physical examination skills and may well grasp a patient's clinical situation than their American colleagues would. And few would dispute that medical care in the United States is becoming unsustainably expensive even as it still doesn't reach as many people as it should. It makes no sense that we spend vast resources pursuing treatments that might give people a few weeks' more life, but that many people with hypertension remain undertreated. It is as if we Americans continue to pour into some glasses while other glasses remain empty--and we're running out of water. That policy isn't reasonable and it isn't fair. Practitioners in lower-resource settings, on the other hand, have experience in making sure that the largest number of people get good, sensible, and sustainable medical care, and I want to learn more about how they do it.

Our organization runs a village medical clinic in a converted house. Indonesian physicians fresh out of medical school spend a year with us doing something akin to a family practice internship; they see patients, then present cases to volunteer physicians from the United States. Then we work through what to do and the Indonesian doctors put a plan into practice alongside the clinic's trained nurses. There is much that the clinic can't do, such as surgery in an aseptic environment; the nearest hospitals are hours away by car, plane, and/or boat, and transfer is frequently not an option. Still, there are a great many tools in our toolbox, including a good array of medications, an ultrasound machine, microscopy, and IV capabilities. It is striking how much we can do from our little house.

I'll post about some of the cases we've seen.

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