I think since most of technologies are for nurses and doctors, some aspects of our implementation and assessment processes are actually taken for granted. A simple day spend with Alex on his daily mobile palliative trips taught me a lot about the basic challenges that can undermine any global health intervention.
The case that has particularly engraved itself to my memory was the first patient we saw: a HIV positive woman with Karposi Sarcoma who had recently experienced swelling on her right side. This recent development had not only caused her increased pain but had prevented her from performing basic household duties. St.Gabriel’s doesn’t have the resources or the capabilities to treat the problems of patients on palliative care; moreover, often times, treatment actually worsens the situation. The best Alex could do for the woman was upgrade her level of painkiller from brufen to morphine. Here comes the problem: the morphine was only administered in a diluted liquid form. The patient was given a plastic measuring cup to give the morphine herself. However, she didn’t know how to read the cup and neither does the community health worker with us. Her ideal dose would have been 2.5ml, but it was obvious she didn’t know that 2.5 is between the 2 and 3 mark or that it is halfway between 5. Instead, Alex doubled the dose to 5 so that it would be easy to find and we also marked the depth with a black marker so she could not miss it. The next problem was the time of the dose. She is supposed to take the each every four hours. Again, mathematics proved challenging as the patient needed to do the addition that if the medicine is taken at 6, then the next dose needs to be at 10. Actually, the reality was that even if she could do the math, she didn’t have the clock or even the electricity for one to be able to tell time. The best we could do was to draw pictures of the sun’s positions at roughly the different times: sunrise for around 6am, vertical sun for the period around 10am to noon, then sunset for 4-5pm. Of course, not all of Alex’s patients lacked a basic level of education, but when asked, Alex would roughly estimate that 50% of patients in his care did not have a primary education. This is especially a problem for the elder population as primary education had only become free. I have never considered education from a treatment aspect before; the experience has certainly given me a larger picture of what implementation means, not only from a technological standpoint but also from a social infrastructural one.