credit: Floating Doctors
Sermo physicians have been big fans of Ben LaBrot, M.D., the founder and passionate leader of Floating Doctors for a while now. He came into our community organically, discovered our curbside consult app iConsult and has used it to help him with unusual diagnoses when he’s on mission in tropical jungles of Panama. Today he’s contributing a post on his perspective of infectious disease and specific takeaways physicians can use in their own practices. — Ed.
Dr. Ben LaBrot on Mission
In my career as a medical mission doctor, I have worked with patient populations in different low-income tropical settings and found that the health landscape of rural poverty assumes a certain familiarity regardless of clothing, language or skin color. In addition to acute disease pathology, tropical infectious disease practitioners must overcome a variety of challenges not faced in most temperate practices.
1. Lack of Attention: Low-income populations are not a lucrative market for new and costly medications, and low-income governments lack purchasing power. Low-income rural populations can rarely exert coordinated political pressure on governments that CAN afford to purchase needed meds. PHYSICIAN STRATEGY: Be more than a doctor, be an advocate for your patient!
2. Lack of Infrastructure: The shortage of health care delivery infrastructure is a huge barrier to the treatment of tropical infectious disease and to the surveillance of diseases or interventions. Even if you build a hospital, how will your patients get there if there are no roads? By contrast, many infectious diseases travel quickly and widely on the wings of flying vectors or in flowing rivers. PHYSICIAN STRATEGY: Always consider infrastructure realities when designing treatment plans and be creative in overcoming barriers.
3. Infectious Diseases Rarely Revisit Failed Strategies: Diseases continuously adopt novel defenses, whereas humanity frequently re-adopts failed strategies for combating disease. Consider malaria, in which whole populations have repeatedly been treated, irrespective of diseases states, resulting in short-term reductions that inevitably resurge. It was tried with quinine in Panama in the 1930s, with Atebrin for soldiers during WWII, in the 1980s when Nicaragua dosed their entire population with a 3-day course of chloroquine and primaquine…and again in 2004, in Cambodia. Each time, malaria came back, more resistant than before. Humanity did not learn from these previous experiences…but malaria certainly did. [1] PHYSICIAN STRATEGY: Be willing to acknowledge when a seemingly great idea is impractical, and move on.
5. High Patient Mistrust & Low Health Knowledge: Treating infectious disease in the tropics often means overcoming patient distrust of medical care, low confidence in services, and misinformation stemming from lack of access to health knowledge. In some communities of Sierra Leone, for example, one of the words for ‘Medicine’ is the same as the word for ‘Magic.’ PHYSICIAN STRATEGY: Every consult is an opportunity to repair lost patient trust and for education—knowledge is a powerful preventative.
Bottom line—poverty magnifies every risk and every barrier to effective treatment in the tropical setting. Whether treating an individual patient or planning a national infectious disease control strategy, sustained success is as dependent on addressing the sequelae of poverty as much as the acute diseases, and on engaging patients and communities to help take control of their health. After all, imagine how much infectious disease can be avoided by hand washing, or by simple interventions carried out by schoolteachers or village leaders. In low-resource environments, make your tropical infectious disease patients your partners in treating their illnesses, or better yet in tackling the conditions that make them vulnerable in the first place.
1. Shah, Sonia. The Fever. Picador, NY 2010 pg. 120
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