I read what I wrote last time and I disagree with it now. It seemed self important and not very accurate. I think what happens in Embangweni has more to do with the ability to diagnose and treat. The best way to exemplify this point is to talk about an example; abdominal pain. All the patients carry their medical records with them. Of the many providers who see them over the period of their complaint, often times years for chronic complaints, one provider might make the diagnosis of PUD or peptic ulcer disease. Well let me tell you. This diagnosis generates a lot of interest from future readers of the health passport, for once made, the diagnosis sticks and any time they come in for abdominal,pain the beginning of the documentation states: 45 yo Female with known PUD. Invariably this poor women will receive countless courses of Amoxicillin, metronidazole and omeprazole, the treatment for H. Pylori infection of the stomach which is known to cause PUD. Its too tempting, here we have a complaint, a disease entity and an actual treatment and we have all the meds for the treatment and we can prescribe it and feel good that we are helping the patient. Its the proverbial hammer looking for a nail. In contrast, no one really grasps the diagnosis of IBS and therefore, none in Malawi has it. The same is true for Gallbladder disease, because its just not here( Which might actually be the truth) but maybe the point is there is no treatment available for it on the local level why look for it, why put it in the differential. Providers that preface all,their declaratory statements with, well,it could be just might not be very popular. Drug companies know this. Take restless leg syndrome. I dont know what percentage of the population has this, maybe .01% actually will,fit the diagnostic criteria. These poor patients had no help at all until,, in their magnificence, the drug companies created the diagnosis and a treatment for it. Not only that, they educate the patient population and associate it with insomnia, a much bigger market, and now all of a sudden the sales for this drug goes through the ceiling.
Posted on: Tue, 18 Nov 2014 14:29:12 +0000
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