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DOA: Dead on assessment

Year: 1989
Setting: Medical office in We, New Caledonia
Position: First and only private general practitioner on the island

As I am consulting with patients on a sunny morning, cars regularly pull up in my driveway. The outdoor area has become an extension of the clinic waiting room with entire families of patients on mats weaved from palm trees and placed under huge mango trees.

A Melanesian mother steps out of her vehicle carrying a toddler. She registers with the secretary and goes back in the yard to sit with her friends. After a few minutes, I hear screams coming from outside my window and can see people gesticulating in panic. I rush out. The small child is seizing. In a few seconds and before I am able to reach him, he goes into cardiac arrest. I frantically administer CPR with the assistance of a local nurse who happens to be in the crowd. We bring him inside and try a defibrillation procedure but unfortunately cannot resuscitate him. I am crushed and feel completely empty.

Slowly, the mother starts explaining that her son has not experienced a bowel movement in more than three weeks. She has taken him to a state doctor twice. The second time, she was referred to the general hospital on the main island where only a laxative was prescribed.

After moments, which seemed like hours, I look at the utter devastation on the faces of the mother and her friends, who must now take the small corpse back to their village. All night long my mind is racing with various issues. Why didn’t the child get proper care in his previous consultations? Could I have prevented this situation if I had seen him first?

The next day, I go to the funeral and pay respect to the family and mourn, squatting by the body reposing in the family hut. According to mores, it will remain there for a few days. Many months later, elders of the village inform me that this particular spontaneous gesture of mine had unknowingly earned me a privileged position in the local social structure, which came in handy down the road when dealing with some public health challenges.

The lesson for the doctor: In some environments, the social and interpersonal behavior of a general practitioner is often as important as his/her professional competence.

Yann Meunier, MD, is the health promotion manager for the Stanford Prevention Research Center. He formerly practiced medicine in developed and developing countries throughout Europe, Africa and Asia. Each week, he will share some of his experiences with patients in remote corners of the world.

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