Such an important topic that doesn't get nearly enough attention.
I would add that in highly resource restricted environments, not only does staying the urge to jump in for acute fixes support sovereignty and autonomy but it also prevents all the limited resources going to acute fixes. After digging out lots of splinters a splinter clinic might seem like a good idea but then where does the budget for maternal nutrition come from?
Thanks for your post. For 18 years I have worked on health capacity building in Solomon Islands. During that time I have learned the best approach is through a partnership: teaching (and learning) as you and the local team go. Mom needed to see how to remove a splinter as painlessly as possible. The rigid Peace Corps philosophy of teaching only misses the value of learning by observing. Using the work together model our program has established endoscopy services in Solomon Islands. “We are in this together” works better than “I will tell you what to do.”
Hello Ethan, I'm so happy that you and I share the same worldview. I think that once you're on the ground and look around, you would be crazy to reject an integrated, partnership based approach.
It’s the age old parable: teach a guy to fish etc etc.
But there is also the age old adage in med school: see one; do one; teach one. You can “learn”/read about it till you’re blue in face, but you still need the practical learning part.
This vividly brought back my own Peace Corps experience in Burkina Faso in 2003-4. I was also a health volunteer and suffered the same sense of moral confusion. I wrote my own essay about a very similar experience--walking out of my mud, tin-roofed hut to find my favorite little girl, Sandrine, sitting in the dirt crying and holding her knee, which had a deep wound with visible maggots in it. I had my Peace Corps-supplied medical kit inside, full of gauze and antiseptic ointments, but they had drilled into me the warning against sharing any of it with the villagers, for the reasons listed in this essay. I found Sandrine's mother and urged her to take her to the local clinic, but I knew it was unlikely that she would. It was the first of many experiences in my time as a volunteer that left me feeling helpless and frustrated.
My goodness, Mo Perry, you have a brain. Use it. Rules should be guidelines, not something to be followed blindly at all times. Understand that sometimes "the rules" get in the way of doing the right thing. A good starting place would be to read Vinay's piece from yesterday that addressed this very issue.
There's such a difference being on the ground than in a classroom. The good news is that things are getting better. Average life expectancy has risen by one year every year for the past 20 years (thanks, as I understand it, in large part to PEPFAR). The bad news is that many things still aren't where they need to be. When I visited a secondary school a few months ago, my first thought was, "Wow! This is so nice! I only can see one window frame that has broken glass! The glass isn't even on the floor." It's not all bad everywhere, but there's so much work that can be done.
Aren't we Westernets so much more intelligent, wise, knowing? If so, we must know - and act on knowing- the difference between truly helping and prolonging the pain. Bravo to you for knowing and acting!
Thank you for the compliment. I have not heard of this at all. We mostly use Coartem nowadays to treat malaria. If you have a study in mind, please send it to me!
Loved this bc I was a health pcv in Burkina Faso after college! Nothing grounds you more in reality than living in a rural African village.
I remember being given that book Where There is no Doctor. Do they still give that to you? I’m going to follow your Substack
Such an important topic that doesn't get nearly enough attention.
I would add that in highly resource restricted environments, not only does staying the urge to jump in for acute fixes support sovereignty and autonomy but it also prevents all the limited resources going to acute fixes. After digging out lots of splinters a splinter clinic might seem like a good idea but then where does the budget for maternal nutrition come from?
In other words you employed common sense.
Indeed, the rarest commodity in healthcare.
Thanks for your post. For 18 years I have worked on health capacity building in Solomon Islands. During that time I have learned the best approach is through a partnership: teaching (and learning) as you and the local team go. Mom needed to see how to remove a splinter as painlessly as possible. The rigid Peace Corps philosophy of teaching only misses the value of learning by observing. Using the work together model our program has established endoscopy services in Solomon Islands. “We are in this together” works better than “I will tell you what to do.”
Hello Ethan, I'm so happy that you and I share the same worldview. I think that once you're on the ground and look around, you would be crazy to reject an integrated, partnership based approach.
It’s the age old parable: teach a guy to fish etc etc.
But there is also the age old adage in med school: see one; do one; teach one. You can “learn”/read about it till you’re blue in face, but you still need the practical learning part.
I love that! I see that everyday with the teaching work I do. There's a lot of passing knowledge on to others through demonstration.
This vividly brought back my own Peace Corps experience in Burkina Faso in 2003-4. I was also a health volunteer and suffered the same sense of moral confusion. I wrote my own essay about a very similar experience--walking out of my mud, tin-roofed hut to find my favorite little girl, Sandrine, sitting in the dirt crying and holding her knee, which had a deep wound with visible maggots in it. I had my Peace Corps-supplied medical kit inside, full of gauze and antiseptic ointments, but they had drilled into me the warning against sharing any of it with the villagers, for the reasons listed in this essay. I found Sandrine's mother and urged her to take her to the local clinic, but I knew it was unlikely that she would. It was the first of many experiences in my time as a volunteer that left me feeling helpless and frustrated.
Lol I was in Burkina Faso also. But a couple years before you
My goodness, Mo Perry, you have a brain. Use it. Rules should be guidelines, not something to be followed blindly at all times. Understand that sometimes "the rules" get in the way of doing the right thing. A good starting place would be to read Vinay's piece from yesterday that addressed this very issue.
You can cross hemispheres and decades and some things don't change. Those are the exact feelings I have with so much of the work I have to do.
This brought me to tears. Will reflect on why... thank you for sharing.
Maybe there is something metaphorical in this story... so many Chombas, so much theory, not enough well-focused action.
There's such a difference being on the ground than in a classroom. The good news is that things are getting better. Average life expectancy has risen by one year every year for the past 20 years (thanks, as I understand it, in large part to PEPFAR). The bad news is that many things still aren't where they need to be. When I visited a secondary school a few months ago, my first thought was, "Wow! This is so nice! I only can see one window frame that has broken glass! The glass isn't even on the floor." It's not all bad everywhere, but there's so much work that can be done.
Aren't we Westernets so much more intelligent, wise, knowing? If so, we must know - and act on knowing- the difference between truly helping and prolonging the pain. Bravo to you for knowing and acting!
thank you for your help, and for your experience.
by the way, have you looked into using chlorine dioxide solution for malaria? I ve read so much from Andreas Kalker using it for many years.
Thank you for the compliment. I have not heard of this at all. We mostly use Coartem nowadays to treat malaria. If you have a study in mind, please send it to me!
https://theuniversalantidote.com/
please go there. its truly amazing.
watch the documentary, and download the pdf, it has tons of research links in it.
my pleasure to give you options. I safely use it in my family, and i have four little kids