FAMILY DOCTORS: HEART OF HEALTHCARE
‘I gained a lot of experience between 1968 and 1993 at public hospitals such as Georgetown, Guyana; Lucea Hospital, Hanover; Mandeville Public Hospital, & Hargreaves Memorial Hospital, Jamaica’
THEN & NOW:
OVER THE past 50 years, doctors have benefited from technology, but basic knowledge and clinical experience still stand strong. There is no doubt that FAMILY DOCTORS ARE THE HEART OF HEALTHCARE! Using the experience of our teachers, colleagues, and our clinical acumen, we play a leading role in healthcare.
I refer to our classmates, supervisors – consultants, lecturers when I say colleagues. Since graduating in 1968, over 54 years ago, I have learnt a lot!
I gained a lot of experience between 1968 and 1993 at public hospitals such as Georgetown, Guyana; Lucea Hospital, Hanover; Mandeville Public Hospital, & Hargreaves Memorial Hospital, Jamaica. I left Mandeville in 1990 and have maintained a general practice ever since.
During my internship - 1969-1970 (Then) - I saw a patient who was approximately 35 years old, having had her last child a year before. She started wheezing and sneezing. She had tried multiple antihistamines, bronchodilators, and antibiotics without any success. She was in STATUS ASTHMATICUS! We decided to admit her to the Mandeville Hospital to investigate her further. All tests were normal except her Eosinophil count, which was above 10 per cent. This meant that she had an allergy, tropical eosinophilia, , or worms. Since she had already been on a bronchodilator and antihistamine treatment and had negative stool tests for ova and parasites, experience suggested we proceed with a deworming. The morning after a dewormer was given, the patient passed out nearly 1,000 worms! The wheezing stopped. She truly appreciated the relief!
During her pregnancy, she had followed friends by eating red dirt to increase her iron levels.
Three types of worms are transmitted by the red dirt: intestinal roundworms, trichuris trichura and hookworm. Patients can develop anaemia, heart failure, and chronic bronchitis from worms!
An interesting patient I have seen in recent times – since 1994 – (Now) was 56-year-old Lady Vannie. She had a bad fall in 1982 that affected her back, hips, knees, and ankles. She suffered with weakness, pains, stiffness, and depression, which kept her either bedridden or in a wheelchair following a diagnosis of fracture of the spine.
When she saw us, 11 years after her fall, she was depressed and in a wheelchair. She could also move her legs back and forth at least 15 degrees. Clinical deduction told us that her central nerve was still intact! If her spinal nerve was transected, the muscles would have been wasted, and she would have been unable to move her legs. So our forthright comment was: “You will be able to walk again”. This was the first time that she had received a positive, hopeful comment. Her other complaints – overweight, cardiac failure, joint pains, menopausal syndrome, sleep problems and depression – were also addressed .
She heard: “If all the doctors before said you cannot walk again, what makes your doctor so special that he thinks he can perform a miracle?”With sound clinical evidence we were not daunted. Within six weeks, she walked from her bedroom to the bathroom and called us, announcing for all to hear: “Doctor, I can walk again!”
Our personal strategies of ‘heart of health care’include not only what the patient presents with physically, but goes beyond to re-establishing hope, fostering religious convictions, and general good health. Mental, intellectual, social, financial, environmental, and spiritual health must be included! Diagnosis with the application of all the laws of healing – spiritual, mental, and physical – is a must!
We hope that whatever strategies we used in the past or present (Then and Now), it is obvious that taking a good clinical history and performing a thorough examination with appropriate lab tests will always be necessary to obtain good healing and a happy patient.
DR HAME PERSAUD Family Doctor