Setting: Lome, Togo
Position: Private practitioner at the branch of the St. Francis Hospital in Lagos, Nigeria
In the consultation room on Ikoyi Island, I feel the bottom of my leather desk chair sagging more each day and leaning to the left for mysterious reasons. Maybe my predecessor in the job was a lefty? At any rate, I am developing a discomfort in my lower back, which in time turns to pain radiating to my left thigh as I procrastinate in confronting the city "go-slows" (the Nigerian term for traffic jams) to buy a new piece of furniture. I unhinge a door with the help of a housekeeper and place it under my mattress. And start taking an NSAID.
I hope that my condition will improve before I go on a long weekend break to Lome. Unfortunately, my acute sciatica does not get better. The car trip to Togo makes it worse because of the numerous potholes I cannot avoid. After dancing in a nightclub and then sleeping on a foam mattress and on the floor, I cannot get up. The pain has become excruciating enough to make me cry. Adding injury to injury, my stomach is burning like a wildfire from the medication.
I drag myself to the breakfast table where someone mentions a Chinese medical delegation working at the General Hospital. I limp into the consultation room where a young acupuncturist from Shanghai plants three tiny needles in my body: Two in my back and one behind the knee on the painful side. She then proceeds to hook them to an electrical stimulator and applies the current for about 15 minutes as I lay there chatting with her about medical studies in China. I walk out of the hospital pain-free with and with a normal gait.
I fear that my lack of pain will be transient, perhaps just a placebo effect. But the pain completely disappeared and never came back. This experience directly challenged the memories of my internship at the George Washington University Hospital where doubt was cast on the efficacy of acupuncture because of the lack of large, double-blind studies versus standard painkillers.
Lesson for the doctor: First, evidence-based medicine sometimes cannot apply at the individual level, and second, necessity is the mother of invention, particularly when you are in pain!
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.