In settings where no lab tests, X-rays or other diagnostic help is available, the diagnostic process relies on taking an accurate history of the disease and performing thorough, pertinent physical exams. This makes communicating efficiently with the patient and his or her representatives of paramount importance.
I remember one of my first patients at the Moncorvo Filho Hospital in Rio de Janeiro. She was a middle-aged lady, slightly overweight, who lived in a city slum after migrating from the northern part of the country with her family. Her main complaint was: “Estou sentindo dor nas cadeiras,” which literally meant, “I am feeling some pain in the chairs”. I had absolutely no clue what she was referring to, so I had to ask the people who were with her and learned that she was suffering from low back pain.
On the island of Lifou in the Pacific Ocean, some of my some Melanesian patients used the moon cycles as time reference when I asked about the onset of their symptoms, saying that they began feeling ill so many days before or after the last full moon. I quickly bought a calendar with the moon phases on my first trip to the main island.
In Cameroon, some patients would focus on what they believed to be the cause of their symptoms rather than describing the nature of their symptoms, as I had requested. For example, they would tell me how walking by a cemetery had angered some spirits that retaliated by invading their bodies and inflicting various kinds of ailments. Guiding the discussion back on track without offending them required great delicacy and tact.
In Papua New Guinea, a patient who was happy with the result of an antibiotic therapy once told me, “We used to go to the traditional healer, but now we trust you.” Curious, I asked him how I gained his confidence. I expected an answer based on the efficacy of modern medicine, and so I was startled when he replied, “Because your power is stronger.” I tried to explain that my perceived power was the result of the active ingredients in the tablets. His reply was: “We do not understand how this is possible. What we know is that you put your power inside the pills that cure us.” It was a perfect example of the reconciliation of modern science and traditional culture!
Lesson for the doctor: To be efficient in an environment with limited resources and a high level of demand, it is imperative to relate quickly to patients. Knowing the local culture and its idioms goes a long way toward achieving this.
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.
