June 28, 2012
Back home seeing patients at Cleveland Clinic, I’m reflecting on my Peru trip and comparing differences in treating patients in the developing and developed world. Chronic disease management stands out as a major difference.
Chronic diseases have become much more prevalent in the developing world compared to decades ago when infectious diseases dominated health problems. Many of the Peruvian locals had not seen a doctor in ages and developed chronic medical problems. As an internal medicine physician I’m required to manage such chronic conditions, however, managing chronic disease is a challenge when you’re not assured to have adequate follow up. Several patients come in with diabetes, hypertension, hyperthyroidism, etc, but the treating these conditions appropriately requires continuity. Medications often need to be titrated, and side effects need to be monitored. For example, a patient comes in with a BP slightly high of 154/90 but asymptomatic. I know this likely needs to be treated but my concern is starting someone on a blood pressure medicine without follow up. What if they are equisitely sensitive to the anti-hypertensive causing hypotension and symptoms of light headedness? One lady I saw had epigastric burning suspicious of peptic ulcer disease, but after further questioning it seemed to be associated with exercise and became concerned that this may be an atypical presentation of angina cardiac chest pain. At the very least I would like to start this lady on an aspirin, however, what if the aspirin triggers a life threatening GI bleed from peptic ulcer disease? I’d be causing more harm than good. The bottom line is that people need a primary care doctor, and primary care requires follow up – which outsiders simply cant provide during a short trip. I foresee many opportunities to solve this problem, particularly through technology and as well as by capacity building of the local community through various community driven entrepreneurial structures.
Despite the challenges in chronic disease management, I can say with certainty that the PHOP group helped hundreds of people. Treating acute complaints and infectious diseases, referring emergencies, teaching physical therapy for back exercises, restoring eyesight with glasses, giving out toothbrushes, shoes, sunglasses, and the list goes on. We appreciated them welcoming us with open arms, and the Peruvian people genuinely appreciated our efforts (except the one child that kicked Travis, our Friends NE rep, in the “private” parts!). Whether it is their expression as you treat them, witnessing a poor village in the Andean Valley going out of their way to cook lamb for us and naming their new health center after us, or a patient making chocolate bean dip for us, they clearly appreciated our help. And it is this appreciation from the Peruvian locals that made the mission especially rewarding.
Vipan Nikore MD, MBA
PGY-2, Cleveland Clinic Internal Medicine Residency Program
Back home seeing patients at Cleveland Clinic, I’m reflecting on my Peru trip and comparing differences in treating patients in the developing and developed world. Chronic disease management stands out as a major difference.
Chronic diseases have become much more prevalent in the developing world compared to decades ago when infectious diseases dominated health problems. Many of the Peruvian locals had not seen a doctor in ages and developed chronic medical problems. As an internal medicine physician I’m required to manage such chronic conditions, however, managing chronic disease is a challenge when you’re not assured to have adequate follow up. Several patients come in with diabetes, hypertension, hyperthyroidism, etc, but the treating these conditions appropriately requires continuity. Medications often need to be titrated, and side effects need to be monitored. For example, a patient comes in with a BP slightly high of 154/90 but asymptomatic. I know this likely needs to be treated but my concern is starting someone on a blood pressure medicine without follow up. What if they are equisitely sensitive to the anti-hypertensive causing hypotension and symptoms of light headedness? One lady I saw had epigastric burning suspicious of peptic ulcer disease, but after further questioning it seemed to be associated with exercise and became concerned that this may be an atypical presentation of angina cardiac chest pain. At the very least I would like to start this lady on an aspirin, however, what if the aspirin triggers a life threatening GI bleed from peptic ulcer disease? I’d be causing more harm than good. The bottom line is that people need a primary care doctor, and primary care requires follow up – which outsiders simply cant provide during a short trip. I foresee many opportunities to solve this problem, particularly through technology and as well as by capacity building of the local community through various community driven entrepreneurial structures.
Despite the challenges in chronic disease management, I can say with certainty that the PHOP group helped hundreds of people. Treating acute complaints and infectious diseases, referring emergencies, teaching physical therapy for back exercises, restoring eyesight with glasses, giving out toothbrushes, shoes, sunglasses, and the list goes on. We appreciated them welcoming us with open arms, and the Peruvian people genuinely appreciated our efforts (except the one child that kicked Travis, our Friends NE rep, in the “private” parts!). Whether it is their expression as you treat them, witnessing a poor village in the Andean Valley going out of their way to cook lamb for us and naming their new health center after us, or a patient making chocolate bean dip for us, they clearly appreciated our help. And it is this appreciation from the Peruvian locals that made the mission especially rewarding.
Vipan Nikore MD, MBA
PGY-2, Cleveland Clinic Internal Medicine Residency Program
