Understanding major diseases from a patient’s story

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.

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