Throughout our time in the maternity ward and in the Pediatric Department morning meetings, one issue that often arises is the lack of information doctors have for clinical decision making. This lack of information comes in two forms: first, doctors often don’t have a reliable patient history with which to make a diagnosis, and second, the wards lack access to technologies like glucometers or ultrasounds to feel completely confident in treatment choices and monitoring. While patient care always involves a degree of uncertainty, Western doctors are lucky in the sense that they have so much information at their fingertips.

However, these two types of information gaps represent fairly different needs. A lack of well-recorded patient history demonstrates a need for a public health related intervention at the local level, while a lack of diagnostic and monitoring equipment demonstrates a need for accessible, low-cost technologies that can be sustainably manufactured, purchased, and maintained.

For example, while we were working in the maternity ward with Dr. Kommwa on pre-eclampsia observations, he pointed out the need for stronger antenatal care programs in the communities. Each mother in the Labor and Delivery ward comes into Queens with her Health Passport, the equivalent to her medical chart or electronic medical record in the U.S. Patients keep these passports with them from birth to track anything from vaccines to major medical procedures. In theory, this is a great tracking system, but looking at the passports also reveals major gaps in availability of preventative monitoring and treatment, particularly during pregnancy. In this instance, Dr. Kommwa showed us each patient’s antenatal care page, and a mother with more than two antenatal visits was extremely unusual. Compare this number to expectant mothers in the U.S. who see their obstetrician every 3-4 weeks during pregnancy, and you already begin to see the potential for much higher numbers of high-risk pregnancies going unmonitored. In the case of pre-eclamptics, blood-pressure monitoring is critical for reducing risk to both mother and baby. Early identification of the condition can drastically improve outcomes, but without consistent antenatal care, it’s impossible to know who needs treatment and to what extent until they arrive at Queens already in labor.

In addition, a lack of patient history also complicates things like the decision to induce. Oftentimes, the estimation for gestational age of the baby can be off by almost 3-4 weeks. To know gestational age, you must know the date of the mother’s last menstrual period, but again, this information can be pretty tough to recall 8-9 months after the fact. Without having a recording of this date, memory is the next best option. As you can imagine, doctors would make different decisions on how to treat a 35 week mother as compared to a 39 week mother, particularly when deciding whether or not to induce. Something as simple as an accurate gestational age estimate would have a significant impact on how doctors in the Labor and Delivery ward make decisions.

Health Passports are an incredibly useful and well-designed method for tracking individual patient data, but in order to reach their full potential, the passports must actually have a chance to be used. The gaps in passport usage reveal upstream factors at play that public health interventions such as community-level antenatal care could address. Not only would these types of programs provide better care and lead to safer pregnancies for mothers, but they would have the double effect of improving labor and delivery by providing physicians with a more complete understanding of the patient upon arrival at the hospital.

These are just some of the many examples of the ways that lack of patient information affects diagnosis, and I’ll discuss the second type of information gap in treatment choices and monitoring in my next blog.