Medics here 'take a history' from patients who present with stories or sometimes symptoms. They then 'examine' the patient thoroughly. So far, so normal, for me as a UK-medical student in training. As usual we don't know where our patients come from or the often tortuous journey they've been through till the point at which we 'clerk them in'. That too=pretty normal. But it's the next step that's different.
In Leeds we send off a raft of (or - hopefully - a few highly targeted) investigations, receive the results and use these three things (History, Examination, Investigations) to formulate a management plan. Here in Freetown (1) patients often can't afford to pay for their investigations, (2) the investigations take till the next day to be processed and (3) even if they point to some manageable medical condition there's no guarantee re: availability or affordability of the necessary medicines.
Obvious points, perhaps. But the cost of this is not only seen in lives lost and families bereaved, but in a seemingly endless negative spiral where highly trained, highly competent staff have to struggle to fulfill their professional duties, to serve their patients and to gain the satisfaction of a job well done.
Here we've been taught the great value of the first two parts - History and Examination - as well as the massive benefit of a decent clinical judgement. Each person can only act to the best of their abilities in a given situation but it must be difficult for people here having constantly to swim against the tide.
