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I’ve started to catch a few short glimpses of medical care here, walking around KCMC, the main local hospital, with Maria and others. It’s the best for hundreds of miles but still of course in many ways a very sad place. Still, it’s already clear many problems here fall into the category of complicated and others are excrutiatingly simple, and it’s hard to know which is more frustrating.
To take just one example: ECT, more commonly known as electro-shock therapy, for treating severe depression. My understanding of the history is basically that it has gone through several phases of use in the US. There was a period of overuse, followed by a backlash of concerns it was barbaric for patients and it was scaled back. Now it’s used more selectively, but still commonly. It is a difficult and upsetting procedure and there can be hard side effects, but for many patients who don’t respond to any other treatment, including some so severely depressed they are essentially catatonic, it is often remarkably successful. In ECT clinics at US hospitals, it may be administered to dozens of patients a day. We still don’t understand how it works, but the evidence is clear that for many people it is truly a life-saver (apologies to the experts for the inevitable shortcomings of this account).
In Moshi — in fact for this entire region of the country — there is one psychiatrist. One. Ane he is actually a neurologist. And he teaches medical students (and has to grade dozens of papers every night). He also covers three hospitals. So needless to say there are not adequate resources for the population.
It seems clear ECT might be of great use in such a place. After the start-up costs, it is relatively cheap to administer and highly efficient, and there are huge numbers of people who could benefit from it. And until recently it was apparently used fairly commonly. But one day instructions came from the capital in Dar that ECT was now considered barbaric by western doctors and its use should be stopped (they may indeed have gotten that message from some western doctors, especially non-psychiatrists).
And so, apparently for several years now, this often useful treatment has not been used on hundreds or perhaps thousands of potential patients, largely because of a miscommunication. Perhaps in other fields there would be some mechanism to correct the problem, but psychiatry is so off the radar it’s not clear anybody would even know how to begin that process.
