Category Archives: Global Health

Diagnostic tools needed

Valérie D’Acremont, medical doctor,  working in my hospital, just published ” Beyond Malaria — Causes of Fever in Outpatient Tanzanian Children” (see article) . This article reminded me of the challenges we were experiencing when taking care of patients in outpatient departments OPD in rural areas of Angola and Liberia. ( I was working in these countries with Médecins Sans Frontières, MSF in 2006)

The outpatient departments’ waiting room is full every morning with children attending with fever. I remember arriving at the hospital at 7 AM for the night shift report and finding the OPD waiting room already full with mothers and their sick babies and kids.

In order to reach the health center most families have to walk or travel long distances. Patients have to come early enough to go trough a long process: get registered, get screened, wait their turn, see the health worker, get investigation tests at the lab, wait for the results, see the health worker again for discussing the results , go to the pharmacy to get their drugs…. and then return back home before it’s too dark.  Taking one kid to visit the doctor requires a full day for families in most african rural contexts.

When passing the door of the consultation room, health workers have to face their own challenges too, when taking care of the patients. The diagnostic tools available to them being very few, they have to count mostly on their clinical judgment when making their diagnosis.

Knowing how much effort ( money, energy and time-wise) families put into going to see the doctor, there is a certain pressure on the health worker to provide “the good treatment” to their patients.

In these circumstances, it is common for clinicians to over-prescribe antibiotic or anti-malaria drugs which, in addition to not improving the patient’s condition, can also cause side effects and contribute to the development of drug-resistances in the communities.

In their study, V. D’Acremont’s and her team researched the causes of fever among 1005 children attending OPD in two health facilities in Tanzania (one rural and one urban setting) and found that among 7 out of 10 children, the cause of fever was a viral infection, not needing any antibiotic nor anti-malaria treatment.

Knowing that, clinicians might feel more confident when sending back home families without an antibiotic prescription, and in providing the families with reassurance and health education about management of viral infection.

However,  making a good diagnosis with limited diagnostic tools remains a big issue “the diversity of the causes of fever, most of which cannot be diagnosed on clinical grounds alone, calls for the development of point-of-care tests” ( D’Acremont et al., 2014)

See here how WHO is working on developing new diagnostic tools.







Cultural Humility

Voici un nouveau concept que je découvre et qui rejoint tout à fait la vision des soins aux migrants telle que je l’ai apprise dans le cours “Approche des migrants” d’Appartenances, que j’ai pu développer dans ma pratique à l’Equipe Mobile Vulnérabilités et que j’ai présentée aux étudiants du module “Migration” de HESAV, en décembre passé.

L’humilité est l’attitude clé dans une relation soignant-patient migrant de qualité

La cultural humility a été utilisé comme “framework” pour le développemnt du curriculum d’enseignement des compétences transcuturelles en soins infirmiers aux Etats-Unis, comme décrit par Clark et al. dans Cultural Competencies for Graduate Nursing Education, J Prof Nurs. 2011 May-Jun;27(3):133-9. 2011 May-Jun;27(3):133-9   abstract ici

Sayantani Das Gupta , dans le Lancet, en 2008  s’inspire  pour sa “Narrative Humility” article ici , du terme de  Melanie Tervalon et Jann Murray-Garciace, ce qui m’amène à l’origine du concept de cultural humility, qui est né en 1998 en contraposition avec “cultural competency” ou“cultural sensitivity”, dans le but  d’aider les cliniciens à répondre aux besoins d’une population diverse. article ici