White doctor = good clinic...

People often tell me that the clinic is good because we have white doctors. Even a Sierra Leonean doctor made that comment. Well, I guess in a sense they are correct, but it definitely has nothing to do with the color of my skin. In my opinion it’s all about: trained staff, adequate resources (even if basic), focus on both cure and prevention, commitment, compassion, and calling. I try to explain to families that it is not the color of my skin that ensures health, it is quality of care- that flows from education, resources, etc. In my opinion quality care is made up of the following components:

HISTORIES: we take the time to ask what is wrong with the child. Unfortunately people often go to pharmacies or get treated by nurses in their homes and decent histories are often not taken.

EXAMINATION: we take the time to examine the child. In the informal setting (pharmacy, nurse’s home) this is not done, even in some of the official healthcare facilities this is not always carried out according to patients, due to lack of Time? Resources? Training? Attitude? Patients are often prescribed medication without being properly examined and so often not treated for the correct disease, getting sicker.

BLOOD TESTS: we have lab facilities and check a child’s blood before prescribing medication. Many health facilities in the area do not have a lab and so often people are treated based on their history, not knowing if they do or do not have malaria for example. So some are treated even though they don’t have it, other’s aren’t treated that do have it and then die. I do have to add that even our lab is very basic. But at least it helps us diagnose one of the main killers- malaria.

DIAGNOSIS: based on the above three items we make a diagnosis, sometimes multiple ones, depending on the case. I suppose others healthcare providers make a diagnosis- but it is often done like this: cough=pneumonia (even runny nose will get you ‘Septrin’ tablets here- an antibiotic), fever=malaria (although it can be 101 other things as well), or the famous disease typhoidmalaria= which is what many adults are treated for. Apparently most people think if an adult is sick it is either typhoid or malaria or both.

TREATMENT: we give the right medication for the right sickness; using national and WHO guidelines, prescribing doses based on the child’s weight, etc. The amount of nurses and pharmacies that are still giving out chloroquine is appalling. The drug is no longer effective for malaria in Sierra Leone and in my opinion should be banned!!! There are children dying because even though they are diagnosed with malaria, it is not being treated correctly. It can’t be too hard to follow the national guidelines. But I guess if chloroquine is all you have or all you know from the past, that’s what you do. I have also had children come in that have been given adult doses of sleeping tablets! Dangerous and scary. People do not realize that medication can do harm!

PREVENTION/EDUCATION: this is a key. This year we made two videos (with my nurses as actresses) on diarrhea/rehydration and malaria. They are great tools to use to teach parents how to prevent their children from getting sick! Another major issue is nutrition!

I am fortunate to work in a clinic that has trained staff and adequate resources so that we can carry out all of these components. These vital aspects of clinic care can ACTUALLY take place. Of course, we don’t always cure every child, some cases are complex, sometimes we will misdiagnose, sometimes the children come too late. But we do our best to provide a good standard of care. And that’s what people are seeing. Unfortunately in many clinics around the country resources are scarce, level of training is insufficient and many of these components of healthcare are missing. Some of this is due to the poor infrastructure due to years of civil war. But what saddens me most is that I think some of it is due to people’s attitude- not wanting to take the time to include all of these components, or wanting to make money off of people. I do hope that with time things will change. I firmly believe that any clinic with trained staff, adequate resources, and dedicated people should run well, whether the staff is black or white.