Day 177: Fried Onions

Today the Afghan doctors I am mentoring taught me a new way to deal with skin infections and abscesses. Their solution--fry onions and then place them, while they are still hot, on the infected area of the skin. This hypothetically will help draw up all the infection and bring it to the skin’s surface. I know this a good approach to making a hamburger taste better but using onions on skin infections...that was a new one for me. Their approach isn’t necessarily wrong (who knows it may work), it is just different from how we would approach the problem in Western medicine.

This experience reinforced the fact that just because we don’t do something in the United States, doesn’t necessarily mean it is a bad idea or that it won’t work. I try to keep an open mind and try not to judge their approaches to practicing medicine. However, I do try to make suggestions. For example, I have noticed that Afghan doctors don’t keep any kind of medical record. A typical patient encounter goes something like this...patient comes in, the doctor asks one or maybe (on a good day) two questions, the physical exam is usually skipped, and then they write a prescription for some kind of medication. They don’t document anything about the encounter and no kind of permanent record is kept. So today, I suggested that I help them start making very simple patient records...basically a folder with some blank paper in that they can put some notes in. I explained in detail all the advantages for both them and their patients of keeping a medical record. They seemed to agree and we decided to start working on the project.

However, as we continued to talk more about it, some of their concerns about keeping medical records surfaced. “How could a hospital keep a record on every patient that comes in”, they asked. “It would be impossible”. I tried to convince them that it isn’t only possible but necessary. “This is Afghanistan, not America”, they continued, “we can’t do everything you do there.” I continued to try and convince them to my way of thinking.

Finally my interpreter ended the discussion by helping put it all in perspective. He said, “Hey, we don’t even know when our birthday is here in Afghanistan. If we don’t even write that down, how do you expect us to keep a medical record on every patient.” He had a good point. I chuckled and agreed with him. In a country where most people don’t even know the day they were born, maybe asking them to keep a comprehensive medical record is asking a little too much. Let’s work on birth certificates first.

I still will probably keep working on the project and try to teach them how to write and keep notes on their patients. However, I think my first priority will be teaching them how to use their onions to make a double cheeseburger. I think that might be more rewarding!