An educational field trip

Friday, June 15

Yesterday, I had the opportunity to accompany two of the Baylor Pediatric AIDS Corps (PAC) doctors to an educational seminar that they were putting on in the beautiful village of Ntchisi (see picture below), about 80 km north of where I'm staying in Lilongwe. The doctors, Maria and Saeed, were basically there to teach 60 of the local clinical officers (a training distinction somewhere in between doctor and nurse), nurses, and other medical personell how to treat pediatric HIV. Ever since Baylor moved into Lilongwe, its doctors were in demand from hospitals around the country; so they established an outreach program in order to systematically bring pediatric HIV care up to standards even far outside of Lilongwe.

Ntchisi's one conference center where the day-long session was supposed to occur was double booked for the day, with the other party arriving first- so we had to jerry rig this old municipal office for our needs and shift the large audience up the road. We had in-depth HIV treatment booklets to hand out to all of the attendees, which made it easier for them to follow along what was supposed to be a PowerPoint presentation while the power was out. Despite the technical difficulties, we had a rapt audience the whole time.

From Saeed and Maria's presentations, I learned a ton about pediatric HIV management as did many of the attendees, evidenced by the range and depth of questions they asked. I also gained some insight into approaches to medical education at large. There was a "quiz" before the session to see where the largest knowledge gaps were; I also took and filled out a copy. Looking at our responses, it was revealing that the clinical officers/nurses and I each got about half the questions right, but our strong halves barely overlapped! I answered most questions regarding the theory of disease correctly (eg. the intrinsic difference between a PCR and ELISA/rapid HIV tests) but floundered with the clinical signs and procedures (eg. the tricky drug regimen invoked for a new patient with both TB and AIDS). They aced the clinical stuff and stumbled on theory.

Before coming here, I had the misconception that one needed a full-out theory backed education prior to implementing knowledge in a clinical setting. However, in a country like Malawi which has the resources for supporting just one medical school (zero as of a few years ago), produces only ~20 doctors per year, and all the while faces huge health crises, a theory based education is something of a luxury. Both theory and clinical knowledge are ultimately important to medicine, as knowing the science behind your diagnoses, procedures, and prescriptions is what ultimately allows you to adapt to unforseen situations and advance knowledge. But it is the clinical knowledge which is immediately applicable and absolutely necessary for their jobs; in other words, its the the questions that they got right which save lives, while the ones I got right pass exams. The clinical officers and nurses are for the most part autonomous in their own health clinics and small regional hospitals, and the onus is on them to learn pretty much everything they need by doing... I've gained tremendous respect for them!

Though I wanted to include "facts of the day" explaining both the theory and clinical knowledge examples posted above, I've run out of internet time. I'll tackle these next post :)