A large part of my purpose of involvement at the hospitals here in Kyrgyzstan was to help with the development of an Emergency Department. I think the lingo here was harmful in explaining our purposes at the get-go of this project. When we would explain: we are here to development an emergency medicine program, they would usually say: “but we already have one.” So, instead of hearing that this was a completely different type of medical practice, they would hear, “we are importing Western medical practice.” And I usually tried to repeatedly explain that this is a world–wide form of practicing medicine, using examples like WHO, but somewhere in the explanation, it still only meant “importing something from the west” instead of good medical practice. How to get past this? I still don’t know. So, they do have an Emergency department of sorts: it is where people are brought in at the start, they come into a room where doctors look at them, call in their colleagues who are up the food chain to admit them, and often people just come in pre-planned to be seen by a doctor they were pre-arranged with. It is more like hospital admissions, not an ER. There is minimal diagnostic equipment, and again one of the defining differences is the lack of knowledge to treat a wide variety of patients. If the patient doesn’t fit the correct qualifications, then they are sent to the next hospital over, and the next….
ring around the rosey,
pocket full of poseys,
ashes, ashes and we all fall down.
So we had to start somewhere with our teaching. When there are few things in common, you start with the basics: CPR. This also was very complex to be able to convince Doctors and Nurses of its value: they had already learned how to do CPR in the soviet days, and had done it one way forever, so why change your practices? And to make it even worse, our practice based methodology of the west (in other words, we study statistics of everything we do and try to always find ways of improving by analyzing the numbers, even our mistakes and “bad” numbers) is changing constantly to reflect current best practice. Well, if what you have done has worked for the past 50 years, why in the world would you change your methodology to reflect new ones that they seem to never be able to agree on or perfect, since those westerners are always tweeking their ways? They are obviously flawed!
Ahhh…. In medical teaching contextualization is everything!