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An Ounce of Prevention ...

Kendracampbell272x721_3Kendra Campbell -- We had a lecture last week on hypertension for our "Doctor, Patient and Society" class. Our professor made an interesting comment, which I’ve been pondering over for the past couple of days. He mentioned that untreated hypertension is an important cause of kidney failure. If left untreated, hypertension can lead to a patient having to go on dialysis and can eventually lead to death. For more affluent patients in the U.S. and other developed countries, this is not something that they’ll ever have to face. With the proper medical attention, a patient with hypertension can live until a ripe old age and will never have to worry about facing the frightening prospect of undergoing dialysis. But there are many people who are not so lucky as to have the benefit of adequate medical care.

My professor used an interesting analogy to describe the current situation of hypertensive patients worldwide. He said that if you blindfolded him, and placed him in the dialysis unit of any hospital in the world, he would immediately be able to ascertain how developed the country was, merely by looking around at how many of the dialysis patients were there because of untreated hypertension. The reality of healthcare in America is that the dialysis unit of a hospital in Kenya, compared to a hospital in an impoverished neighborhood in Chicago, may look exactly the same. Most of the patients on dialysis are not there because all attempts at preventing kidney damage had failed, but because they had not received any preventive medicine which would have treated the hypertension before it led to organ damage.

The solution to our international healthcare problems is certainly not obvious. Everyone has their own version of the answer. The reality is that improving the health of humans on this planet is a task which will never be completely finished. But it seems obvious to me that one of the easiest things we can do is focus on preventive medicine. If we can do something now to address the health of the world’s population, perhaps we can alleviate the need later on to find ways to heal the sick.

November 15, 2006 in Kendra Campbell | Permalink

Comments

How many of those people on dialysis in an impoverished area of Chicago are there because they didn't attend to their health and how many are there because they couldn't?

Is it that the resources aren't there or that they're not being utilized?

How do we increase compliance?

How do we cope with non-compliant patients?

A few of us can go work at a posh clinic where compliance is mandatory or they fire the patient and pull the next one from the waiting list. But, how do we convince the throngs of people who hate their very lives?

I'd love some answers.

Posted by: Tom | Nov 23, 2006 4:01:12 PM

We have to keep in mind how many patients in the US (let alone Kenya) never have access to dialysis at all. Beyond that, I think it's arrogant to say that people are on dialysis because they wouldn't do something about their hypertension (vs. couldn't do anything). Compliance/adherence is one of the great unsolved mysteries of the public health world - how do you convince people enough to change their behaviour when the danger isn't imminent? Just look at any doctor who smokes for a visual illustration of this conundrum. You can lead a horse to water but you can't force it down their throat!
Hypertension is a multi-faceted problem, only part of which is related to salt intake, diet and exercise, as you and your prof seem to be pointing out. Some of the biggest social determinants for this condition are SES and educational status - makes you wonder what simply making basic preventative healthcare free and ensuring health education to grade 12 would do for the hypertension rates in the US?

Posted by: jocelyn | Nov 26, 2006 12:27:33 AM

I happened onto your very interesting blog while searching for medical textbooks in Spanish. The books are intended for use by a young Nicaraguan woman recently accepted to study medicine in Cuba. The community she comes from in Nicaragua is Mulukuku, a village beyond paved roads, no running water for most residents, and intermittent electricity when affordable. She is just beginning her studies, and sent an email, probably her first, to her parents requesting help in getting the following:
Histologia de Harper
Fisiologia de Guyton
Anatomica de Moore
Introduction to Ciencias Medicas
Bilquimica
Metabolism
Agentes Biologico
Embriologia
Atlas Anatomico Los 3 Tomaos
Psiologia
Salud y Sociedad
Bioestadistica
Neuro Anatomia
Histoembrologia de Ganon

Do you or your friends have any suggestions?

A note of interest is that Mulukuku has only one internet connection, in the mayor's office. It has been in operation for less than a month.

Thanks for any help you can give. bette

Posted by: | Mar 6, 2007 8:13:19 AM

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