As I mentioned in my previous post, there are two major types of information gaps that doctors here face during clinical decision making. I already wrote about the lack of reliable patient histories, but lack of diagnostic and monitoring technologies also places a significant burden on doctors and nurses at Queens.

To use another example from the maternity ward, Tanya and I were observing in the High Dependency Unit (HDU), which is essentially the equivalent to the maternity ward’s intensive care unit. There was a woman on the ward who had been in the hospital for 15 days post-delivery, and she was so ill that she was unable to consume food without a feeding tube. She had been having this issue for the duration of her stay, so even though her vitals had stabilized, she was still lethargic and unable to continue improving and gaining strength.

There happened to be a British doctor visiting the ward that day who brought a small creatinine and lactate measuring device with him, so clinicians were able to actually quantify how severely malnourished she had become. With this new knowledge, they realized the urgency of developing and following a new treatment plan that included removing her feeding tube and transitioning her back to solid, more nutrient rich foods within 12-24 hours. However, this entire decision was spurred by using this expensive monitoring device brought in for a two week stay with the British physician. With the device, it was easy to see what the next logical treatment step was for this woman, and they could also monitor her creatinine and lactate levels every 4-6 hours to evaluate whether or not the treatment was working. Without the device, the process would look a lot more like a guess and check method, and the severity of the condition could have been discovered much later in the process.

In a way, situations like this one require Malawian physicians to have an incredibly adept ability to analyze what little information they have at their fingertips to make the best decision for their patient, but it also places significantly more mental and emotional burdens on them. For example, while the Malawian doctors were excited and grateful that they had the chance to use this monitoring device to better understand how to care for their patient, there is of course an element of frustration in knowing that when the visiting physician leaves, the device leaves as well. It’s difficult to continually have these experiences with high-tech, expensive devices that are incredibly helpful but also incredibly out of reach for Malawi’s current healthcare system.

This is just one area where the need for low-cost, well-designed diagnostic and monitoring technology becomes so clearly apparent. While Malawian doctors do the best they can with limited resources, seeing these instances is a constant reminder that there is still a long way to go in medical technology development, and it is important to keep low-resource settings at the forefront of our minds as so many great advances are made in medicine.