Not everyone approved when we took Yohanita, a severely malnourished woman, from her village to the hospital. Dr. Lisa Dillabaugh, a Pediatrics resident, posted an opposing view:
“…It is so natural for a doctor to feel the immediate need to intervene when seeing someone so ill, but this need to intervene is the reflection of your Western medical education…. It is so important to also consider what your actions will affect in the long run.
While this woman may very well recover in the hospital, she may also die there away from her family and community. Did she actually want to go an hour away from her home with a neighbor? If the community was reluctant for her to go, what happens if she dies there? Will they think hospitals are a place you go to die and be reluctant to allow others to follow.…
But probably most importantly, that community still has no medical care and no transport and no empowerment to change it. All they have are caring, but transient muzungus who dropped in and helped one and left the others. I truly believe this is always the wrong approach and that as physicians committed to improving global health we have to empower people to improve their health, not save them.”
I disagree with Dr. Dillabaugh, but she raises two important points. First, is it appropriate to impose our values on Yohanita and treat her? Second, even if we helped her, there are still larger problems in the community, and many others are left ill and in need.
Regarding the first point, I agree that to simply whisk Yohanita away in a car while her parents and neighbors opposed the treatment would be akin to kidnapping. However, that’s not what happened.
Her parents were initially reluctant, and her fellow villagers had doubts, for good reason: they didn’t know if her condition was really that serious, and they hadn’t had the means to pay for her care. Once we explained the gravity of the situation, and helped them overcome the barriers to her care, they were glad to have her be treated. Most importantly, Yohanita herself consented to the treatment. The warm reception we received when we went back to Malehe to update her parents on Yohanita’s condition gave me confidence that we did right by her family.
Regarding the second point, as a public health-oriented doctor whose goal is to shape international policy, I cannot agree more that there are larger issues to address. Yohanita is far from the only person in the Congo, and not even the only person in her village, whose life is in severe danger from disease. Of course it would be preferable to address the larger issues: to stop the war, provide food for everyone, and institute universal education and healthcare. Of course it is better to “empower people to improve their health, not save them.”
But what happens if you come across someone who is dying in front of your eyes? Do you say to that person, “Sorry, we need to have global reform, so because we don’t have it yet, we should just let you die”? I can’t imagine any doctor, or any human being, saying this to Yohanita.
Was it fair to help her and not the rest of the people in the community? We can only do what’s within our abilities. We didn’t go the village to “save” someone, but I don’t think there was any other choice but to help her once saw the severity of her illness.
Thanks for contributing your comments. We have had limited Internet connection, and I am just now getting to see your thoughts. I am glad to know that you are reading. Keep the comments coming!
