March 25, 2015
In my field, endocrinology, we order labs…lots of them. We use this information to help guide us to pick the correct treatment. It should be one of the most straightforward fields of medicine out there. Except that it’s not. So far, everywhere I have practiced it has been like entering a whole new world where the rules change (and sometimes there are no rules at all). I thought that going from practice in little ‘ole Tecumseh, Michigan to Dearborn was a shock, but nothing prepared me for what I would see here.
I have never felt so helpless practicing medicine as I did today. Don’t get me wrong, there were cases where not only was it clear what to do, we also had the means to provide what was needed. But, there were a countless number of cases for which there were just no good answers. Every time I saw a child with short stature who was almost as desperate to be given a magic pill to fix their problem as their parents were, my heart sank. What could I ask them? How’s your nutrition? And if I followed the pattern of labs that I would check in the states, how would they get one of the most expensive medicines, even in the states? I saw over 50 patients today. After I saw the 7th child with short stature before 1:00 PM, I told my nurse I needed a break. She graciously brought me a hot cup of tea. After a 5 minute break, we got started again.
With diabetes, I can’t believe I used to say ‘tsk tsk’ when people didn’t bring in their blood sugar log. I let go a bit in Dearborn. But now, people didn’t even have glucometers. I soon learned that I would have to write a requisition for a blood sugar and that might be all I would have to go by. When one lady happened to show me a glucometer, I was telling her to change her insulin dose when her 16 year-old daughter piped in and said that they share a meter and the values that read ‘hi’ were hers, (of course there is always diabetes ROS to fall back on – dry mouth, polyuria/polydipsia).
I really think my father’s prayers were answered in this experience. Since I started medical school, he’s been telling me ‘Don’t practice the defensive medicine you learned in med school. Don’t order every test under the sun; use your clinical exam skills to guide your workup and treatment. Especially when you don’t have a lot of resources.’
While treatable diseases usually become a little blip on the screen for most people, for the people I met here, these treatable entities will shape their lives to the core. Many people immediately lost their lives when the troubles started. Now I see, that many more are slowly losing their lives. What we are doing is truly a small drop in the ocean of what is really needed.
I would not have made it through my day without my nurse who was an energetic, efficient young lady who left Dhar’a and now lived and worked in the refugee camp. She was so focused and organized that I did not have a moment to waste in between patients. (If you’re reading this, make a special dua for her). One of her friends, also a nurse, came into my office after we were done seeing patients to see what I was all about. Shortly into our conversation she shyly asked me about a hormonal level that could be preventing her from getting pregnant. It turns out she got married 6 months ago in the refugee camp, and was trying to have a baby. Despite everything that is happening, life goes on…