This week has truly been a great picture of family medicine and its broad spectrum, from prenatal ultrasound to procedures to geriatric care, we did it all! I have always enjoyed the variety of family medicine and flexibility challenge that is required. This is especially magnified in this setting, where you have to be prepared for everything since you never know who is going to walk in next through the door from the long "queue" waiting outside. There's so much I'd like to share about the full week, but in keeping the Malawian tradition that elders go first, I'll start with a bit about our geriatric experience:
On Tuesday, Elizabeth and I journeyed into the rural southern region to the Mchere district. The family medicine department at the College of Medicine was recently asked to partner with a new "Elderly Care" health center there that just opened in June 2014 and serves patients >60 years old. This project is funded by the government of Finland with a vision to provide quality healthcare and services to Malawian elders. (quite random, but true-http://formin.finland.fi/public/default.aspx?contentid=286981&contentlan=2&culture=en-US) COM Faculty (aka Elizabeth and Martha) have agreed to do some teaching, and in exchange, the Malawian doctors-in-training will rotate through the facility as part of their geriatrics curriculum.
Elizabeth had done some lecture trainings several weeks ago, but this was the first day of coming alongside direct clinical care at the facility. We saw patients with common aging concerns from vision loss to arthritis, along with some more unique pathologies, including a new diagnosis of polymyalgia rheumatica and a likely disseminated parasitic worm infection. We "precepted" patients alongside one of the clinical officers named John and he was eagerly taking notes on the learning points Elizabeth discussed and remarked, "This teaching is what we've been craving!" Geriatrics has not been a part of medical training here up until now, and the staff are thirsty for knowledge about geriatric issues and approach to care to help fulfill the center's mission. This certainly made me thankful for the quality geri training we have at Swedish! Although the setting is so different, many pillars of elder care hold true at this clinic: longer visits to address multiple issues, focus on maintaining function in their families and communities, and supporting mental and emotional challenges of aging.
It was also fun to hear John report that this center has become somewhat of a social hub for seniors in the area. They like to gather and compare stories to see who is the oldest, since exact birthdays are usually unknown. John told us that the oldest patient at the center is 115 years old and had ridden his bicycle from his village to the clinic just the day before! Apparently, he was able to trump everyone else's stories by recalling events from both World War I and WWII!
Although there is such a burden of early mortality in Malawi, I think it totally makes sense to develop comprehensive geriatric services here, as it parallels the vision being set forward to establish primary care in this country with family medicine as its base. The average life expectancy is currently about 60 years, so that makes every patient at this clinic surpassing the odds of survival, with a particular hardiness and wisdom that should be celebrated and can likely teach us all a great deal. Hopefully, as development efforts continue to extend longevity here, this center will be the foundation of infrastructure to sustain older generations to come. Perhaps one day, more vibrant Malawian octogenarians will use the opening of this center as bragging material during their age competitions!
Figured out the photos, enjoy!
-- Janelle :)