Early in my medical career I was doing well and feeling comfortable in how I practiced medicine when I saw an AD in a journal. Doctors needed to work with The United Nation Border Relief Operation to help at the site 8 refugee camp on the Thai/ Cambodia border. So I signed up and almost immediately someone called and asked if I was available soon which I was and within a few weeks I was in Bangkok, Thailand. I spent a week there seeing the sites of Bangkok, going to meetings and then headed out to the site 8 refugees camp and hospital. It was a six-hour trip but the last hour of the trip we were going thru a military checkpoint every four miles. So I asked why all the military checkpoints? They replied “because we are going into a war zone”. That must have been in the fine print I didn’t read! We eventually got there and let me say it was a little bit of a shock. 33,000 Khmer Rouge refugees in a quarter of a mile square area. These are the people that killed millions of fellow Cambodians, remember Pol Pot and now they were being hunted and killed by the North Vietnamese army. What goes around comes around. Barbed wire was all around. We were told not to leave the camp as minefields were everywhere!
When I arrived at the hospital I met the hospital director who was a physician from the Philippines. She gave me a tour of the hospital which wasn’t much. There were 6 bamboo structures each one about 50 feet long and 15 feet wide and the floor was dirt. The bed support was bamboo sticks and a bamboo mat and wire to hold it all together. The sides and roof were bamboo and palm fronds all held together by wire. Cheap, easy and practical. My job was to see male and female medical unit, pediatrician, leprosy and the tuberculosis department. She handled OB and GYN. She let me know that the camp is attacked usually once a week by the Vietnamese and since I was the newest doctor that I would be left in the camp to take care of the wounded while the rest of the team left the area to a nearby military outpost but would get me after the weekly skirmish was over. You know they don’t build fox holes for guys 6’6”. It was about 1-foot-deep which is not much protection as those rocket propelled grenades go over your head!
The first patient I saw was a 12-month old girl in her mother’s arms. Someone said she had polio and some other condition. Her eyes were glazed over and she was so out of it. She was breathing fast with a fast heart rate mouth open and flies in her mouth and on her eyelids. I told the director we need to send her to a referral hospital. She looked at me and said “This is a United Nations Refugee camp there is no referral hospital. You are the referral hospital John”. Whoa talk about a wakeup call! It was my job to keep people alive and healthy with the very limited resources I had. Which were once a week a truck brought a portable X-Ray machine from 9 to noon, I could get some lab test like a dip urine analysis, and hemoglobin and hematocrit test to check for anemia and if it was absolutely life and death I could get a WBC test to check for infection. As for consultation or CAT Scan nothing. I did have access to some antibiotics, water pills, and a few types of blood pressure medication, and Tylenol, aspirin, and digoxin for heart disease. Occasionally, I could get an inhaler for asthma treatment and some Pepto-Bismol for stomach issues. That is when it dawned on me I am back to the basics of medicine and forget high tech medicine. I was forced to go back to just the basics of medicine. That knowledge I learned in my first 2 years of medical school. How, the body works, anatomy, and biochemistry. I spent a lot of time at night going over those textbooks I had brought with me. Sure we had cases where in the U.S. I could have saved a person’s life if I had high tech medicine but I feel that even without that there were a lot of lives saved just by figuring out the basics and treating them. Which unfortunately now is a lost art. Today in America it is all about following the algorithm. If a person has a cough you do there 5 things, if they are no better send them to a specialist and he looks at 3 other things in his algorithm. If they still aren’t better the patient is either depressed or this is a disease for which there is no cure or treatment. There is no disease that doesn’t have a cure our job as doctor should be to try to find the cure.
I am saying all of this to say I saw a patient recently who told me his eye doctor diagnosed him with an eye disease that will eventually cause him to lose his sight in the right eye. It is a rare disease. What happens is that the sheath that surrounds the optic nerve, artery, and vein close tighter and tighter around those 3 structures. If he looks at me he sees my face but from the neck down my body is all foggy. He can’t tell if I have a body as his visual field is so distorted. His eye doctor told him there is no treatment. They tried steroids but to no avail. I looked up the disease. Saw some of the underlying mechanisms which were causing the loss of vision. So I had a general idea of what is going on structurally to the nerve artery, and vein and came up with 3 options I said may work if we break the disease down into its basic components. I gave him my ideas and we decided to go with my first suggestion. I took and old drug around for years but thought of another way to use that drug. Went back to basic anatomy and accessed a vascular system that is written about in the medical literature but very few doctors seem to know how to access that system. I did some research on it and we proceeded to treat the patient. To cut to the chase from the time I gave him the treatment till his eyesight was normal was less than one hour.
I would have never figured this out if I had not learned in those months treating refugees using mainly the basic medical science to figure out how to treat many of those refugees and years later that is what I continue to do every day in my practice of medicine. It is so easy to say well there is nothing medicine can offer you and your condition. Don’t be so sure! Your doctor works for you. Ask him to check again maybe there are some basic medical principles the corporate medical profession is missing. With pray and much work a lot can happen.
Happy New Year everybody!