Monday, March 12, 2012

Local Knowledge

"Africa to Anchorage"

Love never fails. But where there are prophecies, they will cease; where there are tongues, they will be stilled; where there is knowledge, it will pass away.  
1 Corinthians 13:8( NIV)

This last three and a half years have taught me the essential nature of local knowledge in providing health care.   This is not a rejection of evidenced based medicine or new scientific discoveries.   The reality is that as clinicians we have the task of translation of evidence and new knowledge in response to changing demands.  Underneath that reality is a passion to make a difference!
When asked “Are you retired?” I respond that “I still practice part time anywhere between Africa and Anchorage.”   This changes the conversation from my age to “Wow, that must be interesting!”.  Well it is “interesting” but more importantly, I have come to appreciate the local realities of the delivery of care.
What I have seen are very dedicated healing agents who are willing to share their knowledge and responses to challenges.   I see people looking for more efficient and safe transport of patients.   I see nurses and physicians separated from family and their homes working diligently to learn and improve care.  I see frustrations with systems of care that interfere with the care they want to provide.  
What has also been wonderful for me is the great diversity of the patients and having a chance to sometimes, if only briefly, to be invited into their lives with its celebrations and losses.  In addition, I have been able to see education at its most basic as well as it’s most advanced.  But what excites me most is the passion and dedication at the bedside.  It is true that there is “burnout” and “frustration”, but there is another reality of local strengths and knowledge making a positive difference in the care of patients in many global locations!
in Kenya
p.s.  Here are some references that you may find interesting.
Henry SG.  A piece of my mind. The tyranny of reality. JAMA.  305(4):338-9, 2011 Jan 26.
Smith DG. Viewpoint: envisioning the successful integration of EBM and humanism in the clinical encounter: fantasy or fallacy?.  Academic Medicine.  83(3):268-73, 2008 Mar.
Shaughnessy AF.  Slawson DC.  Becker L. Clinical jazz: harmonizing clinical experience and evidence-based medicine. [Review] [16 refs]  Journal of Family Practice.  47(6):425-8, 1998 Dec.

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