Understanding major diseases from a patient’s story

by Anjali Sastry on November 8, 2008

We looked at some of the big-picture data on major diseases in our second class session, but to begin to really develop an understanding of some of the major medical issues that G-Lab GHD students need to know about, we examined what a patient’s experience might be like. Thanks to our expert guests, we learned of two hypothetical but representative patients.

Dessa, widow with children, first appeared in a clinic in Ethiopia for treatment when she was already 7 months pregnant, and she tested positive for HIV. We learned about her challenges in getting treatment, from her difficulty in making it to the clinic to get medications and the lack of treatment when she gave birth, to the complexities of testing her newborn (antibody tests cannot reveal the baby’s HIV status until 18 months of age) and the need to formula-feed the baby. Students asked many questions and learned some basic facts about HIV AIDS, conditions in rural Ethiopia, and the prevention of mother-to-child transmission.

Our other patient presented at a surgery in Angola with abdominal perforation due to advanced typhoid. Our lively class discussion had us understanding what brought him there and then. We asked, where could things have been done better? Should the rural health post have been stocked with typhoid medications? Should the nurse at that clinic have been paid on time so that she didn’t need to ask her patient for payment for the care which was supposed to be free? Should the village have had better water and sanitation systems? Should the hospital ICU have had a ventilator? Should transportation have been more accessible and reasonably-priced so that the patient could have come in to the hospital earlier?

For more insights into our experts’ experience working in Rwanda and Angloa respectively, take a look at Dr. Weintraub’s blog posts on the GHD blog and at Dr. Riveillo’s personal blog.

I also urge you to take a look at this multimedia site on the work of Partners in Health in Haiti: International Health Interactive website featuring PIH programs in Haiti As you follow Dr. Ivers in her work, you’ll get a vivid sense of what it is like to deliver health care in resource-constrained settings. The site is part of an ongoing effort to document Harvard’s global involvement and features Zanmi Lasante, PIH’s partners in Haiti. It reports on Harvard faculty members’ work to improve rural health care and conduct research that guides governmental responses to AIDS. Videos and articles follow the work of PIH co-founders Paul Farmer, Jim Yong Kim, and PIH doctors Louise Ivers and David Walton, and paint a picture of the work, and the patients, in Haiti. On the page linked to above, please click through to see each segment: Boucan Carre, Cange, Lacolline, and Lascahobas (these multimedia links are not linkable from here; click through on above link) and also check out: One patient at a time; Hospital brings hope to Haiti;  Haiti clinic makes real gains; and Louise Ivers: A higher purpose.

{ 1 comment… read it below or add one }

Lisa Griffiths November 16, 2008 at 10:22 pm

Examining health care delivery in Africa through individual stories was a great way to bring a human experience to the statistics and essays that make up our preliminary research. It also makes me think of our challenge trying to understand an overall picture of public health when nothing can be considered in isolation.

One of the interesting compounding factors we’ll consider as we examine our partner organization’s context, is the prevalence of conflict in the country and region and the extent to which health care networks are impacted. Political conflict can cause damage to health care infrastructure, sap country and personal resources and limit the extent to which external aid might be provided for health care. In addition, we must carefully consider the impacts of mass migrations away from conflict-torn areas, and the unique challenge of not only providing for refugees, but also managing the risks of disease and infection that can be common in high density refugee situations.

Our team was reminded of this recently as we began to research the state of disease and infection in Uganda. In fact, more than 1,000 refugees have fled the Congo and crossed into Uganda in just the last three days, and more than 12,000 have entered since August 2008.

Aid workers have reported issues of concern including securing a clean source of water for the refugee population. They are also facing the impact of cross-culture/border integration of health care practices – UNICEF has begun to educate refugees about vaccines and encourage them to vaccinate children who have come across the borders with them. Hygeine in refugee camps is already challenging, and is of particular importance in efforts to prevent the spread of cholera and other disease and infection. In this particular example, the country will appeal for additional aid to manage the increasing number of refugees. [New Vision Uganda 11/13/2008 http://www.newvision.co.ug/%5D

This particular and timely example raises the specter of the complexity of the problems of health throughout the world. Borders are not impermeable to disease and political crisis can change the landscape of health needs in our respective project areas at any moment.

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