I forget sometimes that February does not have 30/31 days,
and consequently I didn’t even realize that today was the last day of the month. This month we covered the psychiatric block (similar to last
block but with a focus on drugs used for treatment as well as drugs of abuse)
and I now appreciate the complexity of psychiatric illnesses and their
treatment regimens.
This block made me also think about mental illness and the mental health system back home in Senegal. Growing up, my experience with mental ill people was limited to either the people I saw on the streets, half-naked, walking aimlessly and occasionally causing traffic or to the stories that I would hear of people being "possessed" by spirits. I never heard of ADHD until I came here for college.
One
particular aspect about mental illness (and it can be argued for other
diseases) is that it is intrinsically related to culture. This is not to say that schizophrenia for example has one set of symptoms in America and a different one in
Senegal, but it means that people's experiences with the illness (how they live it and how they address it) will be profoundly influenced by culture and social norms around them. For example, mental health care in Senegal is rendered complex by the
permeating traditional beliefs and treatments of it. It is not unusual to see people seeking traditional healers (actually, people tend to seek traditional healers before going to the hospital).
It is amazing to see the progress that has been made in understanding mental disorders and finding medications that can help patients and their families better cope with them.
However, in class, professors always mention the issue of compliance, and a strong support from the family and community, a strong understanding of the illness are critical for compliance. But with mental illness in particular (and really with any other chronic disease) I realize even more so the importance of cultural competence.
I came across the concept of "Cultural competence" when I was in college and studying (in my medical Anthropology class), a book by Anne Fadiman "The spirit catches you and you fall down".
The book talks about a child named Lia Lee, born to Hmong immigrant parents in California. Lia is diagnosed with Epilepsy at 3 months old. The story revolves around the conflict between the American doctors
and Lia’s family perspectives of her illness. The book talks about how the Lees view Lia's seizures as a sign of life of honor in the Hmong community (while also being very concerned with their child's health) while the physicians deem the family as non-compliant, and both having different approaches to how they care for Lia. The tragic consequences that follow are due to difficulties of the two parties to communicate effectively (language and cultural barriers, and a lack of culturally skilled health care takers).
As a future doctor, it is very important to make sure that I also acquire the tools and skills necessary for an effective delivery of culturally relevant and competent care. Medicine can be and should be humbling. Yes as physicians, we can say that we have in depth knowledge about diseases and their treatments, but it would be a mistake, arrogance (and just malpractice) to assume that we hold all the answers and so don't give enough agency to our patients...I could go on and on, but I will not.
P.S I plan to continue volunteering with Green Light New Orleans and helping install more gardens (was waiting for the temperatures to go up a bit). I also want to start volunteering at a hospice care facility (one my classmate, Evy, told me about it and I am very interested) in order to discover and understand another aspect of healthcare that is equally important.
