Shinar on Cameroon Radio Show
Podcast: Play in new window | Download (Duration: 19:20 — 8.9MB)
Subscribe: RSS
![FCO 303 - Bangladesh Travel Advice [WEB]](https://edecmo.org/wp-content/uploads/2014/05/130926_Cameroon_jpeg1.jpg)
This is an exciting and unique experience! – In April 2014 Zack went to visit his brother Joshua, who is working on information technology systems in Cameroon, Africa. While there Zack had the opportunity to teach, interact with their medical community, be a guest speaker on a local radio show, and interview one of their resuscitation specialists. We’ve tried to include a little of each of these experiences in this episode of the EDECMO podcast. Yes, this is a little off-topic from our usual content; but we hope you’ll enjoy it. Maybe medicine in the Third World is archaic and barbaric. Or maybe our First World medicine is just completely over the top?
Medicine and Resuscitation in the Third World
In this episode Zack spoke with Christian Ngem, who is a Nurse Anesthetist/Anesthesiologist/intensivist in Cameroon, Africa.
Christian Ngemt, Nurse Anesthetist (Cameroon, Africa)
Nurse Training – BVH 2002-2004
Baptist Hospital, Banso – Scrub nurse 2004-2007
Nurse Anesthetist School – 2007 – present
“End of Life” care is much different in other cultures.
“African Engineered” = African Ingenuity
Having to utilize limited resources to take care of really sick patients, they have been creatively using drugs we all know and love. For example, the concept of sub-dissociative-dose Ketamine has been going on for a long time!
Drugs:
Ketamine = “The Magic Drug”
Thiopental
Morphine
Halothane
succinylcholine
Physical Exam = I forgot what that was until I heard Christian’s talk here.
ECPR is a “WASTE OF TIME!” –
While they truly believe in resuscitation, they also believe in letting go when the time is right. Cultural perspectives play a huge role here and there is a definite emphasis on allowing death with dignity. Are we wasting time, resources, money, and effort with our Western extravaganza? Maybe we are. Let’s open the discussion!
Zack and Joe,
This episode gives us all a lot to think about. Here’s what I will say about the practice in Cameroon vs. the US.
If we were all trained to use physical exam and no labs to make our diagnoses then that is how we would practice here. Even with all the differences in training and technology, I am sure most of us would love to forgo the over-testing that we all know that happens and rely more on our clinical skills and physical exam.
However, that way of practicing is just not practical in the US. The example given in the episode was using suxs without having access to labs to know the potassium. In the US it just wouldn’t be acceptable to give suxs if you had any inkling that the potassium was high without risking your livelihood, sanity, and lots of money. (Not the best clinical example but you know what I mean).
In Cameroon they (probably) don’t even have this animal called “medical malpractice”. In the US, if your loved one dies a few days, months, or years early because of a dose of suxs that could be lots of money. In Cameroon, that would just be the way things are. In Cameroon, their culture is conditioned that people die and people will die young no matter what you do. In the US, that’s not how we are wired.
Which way is right? I think both. I think it would be irresponsible to deny people useful years of life when we have the technology to do so. The upshot of this technology and cost is that some (with some in italics) of it will trickle down to areas that don’t have it initially. It’s also ok to not even attempt a “full code” if that’s not what is expected in your culture.
While you could argue all day about resource utilization, technology, and costs I think your main point was to ask about how something as resource intensive as ECMO fits into the world view considering countries with lesser resources. I think you guys have already answered this question in your previous episodes on indications and patient selection for ECMO. You only use ECMO for people with previously good functional status who have a reversible cause for their cardiac arrest. If we made this a technology that “no one dies without” that would be the tragedy and a true mockery of healthcare systems with lesser resources.
However, that is clearly not what you guys are advocating and that is the track I hope we stay on with this technology. In the US, if we can get a previously healthy patient another year, five years, or decades more with their family then that is worth it for me and meets the threshold of being a good use of resources. If we do it for 24 hours or longer while we can prognosticate and/or gather family together then that is good as well- especially if we make sure that we put enough people on ECMO to capture those that can truly benefit. The obvious benefit with this technology is the timing of the intervention- you are doing it in stages where you can make decisions at a time when the patient can’t get any worse- they are dead!
I hope this all makes sense- just my thoughts on the topic.
Keep up all the great work- I look forward to more eposes
Steve Carroll
embasic.org
Steve, you nailed it. Your comments are spot-on.
I can tell you that we struggle with this decision-making process (are we doing the right thing?) in every patient we resuscitate…and an aweful lot of of hand-wringing goes on in all patients who go on circuit. ECPR is the tip of the spear right now in advanced resuscitation and I wanted to drive home the point that we should all ask ourselves the question: “Are we doing the right thing?”
Of course I believe that we are doing it right. I believe that, in the right patient, you gotta give it everything you’ve got. But the fact is, the definition of “everything you’ve got” is necessarily different if you are in Cameroon, a community hospital in a rural town, or an ECMO facility. As famously quoted by FDR (or Stan Lee, writer of Spiderman…Winston Churchill…or Francois-Marie Arouet aka Voltaire, depending on who you believe), “With great power comes great responsibility.”
I admit that I usually err on the side of COmmission…but we have many patients who made it to Stage 3, fully cannulated and ready to go, and the decision was made to halt further efforts.
I was hoping to stimulate this exact response by posting this episode. Thank you for tuning and contributing.