Teaching. I spend a tremendous amount of time teaching at the bedside and in the classroom. In January, I am tasked to help teach a section on Evidence Based Medicine (EBM). In the grand scheme of things, EBM is a newer area in the medical profession where guidelines are written, and practices exacted based upon the current evidence in the literature. This evidence is drawn from (at times) well designed trials or studies that compare old versus new, current standard of care versus novel.
Having said that, there is not always evidence to support everything we do, especially in more resource limited settings. A prime example is this article I just wrote where I used the ONE case report in the literature to treat a pediatric patient because all the literature-recommended modalities were not locally available. Although my write-up is now only the second case report in the literature, hopefully it will provide another data point for similar settings trying to use EBM instead of just anecdotes and/or trial and error.
Practicing EBM can sometimes be challenging in resource limited settings (as highlighted above) where we often don’t have easy access to needed information, much less relevant information for our context; we often can’t get our hands on the “best” modalities outlined in the studies; and we’re often strapped for resources, requiring great diligence with their allocation (i.e., we don’t have resources to waste when we’re not fully sure they’re going to work). Which brings me to an exhausting word in my vocabulary…
Research. It’s the foundation for Evidence Based Medicine. We need it to be relevant to our context to both treat patients and to teach our learners. The lion’s share of the studies we use for EBM are not carried out in a low-income environment, nor are the patient populations similar to ours here in Kenya. For example, studying the effects of intervention X in Europe where the population is primarily Caucasian is likely not applicable to the African population. We (practitioners in Africa) are left to pour over the data in order to determine whether or not it is useful for our patients, and then, of course, whether that particular medication or intervention or procedure or skillsets are available in the region. Moreover, so many of the major studies are only published in journals that are not accessible without incredible fees, which limits access and thwarts learning.
So, what am I doing about all of this, you ask? In simple terms, not enough.
Research is not a core competency of mine, especially compared to many people I’ve worked with in the past – people who are far smarter, and far more qualified who can do far better research in their sleep than I can ever dream of doing awake. As I type and believe every word of that statement, my reality sinks in, though - I’m here; I see the need for this research daily; and I have the opportunity to make some level of progress, despite all my shortcomings. Calling “not it” suddenly doesn’t feel so great. And, how many other places in my life am I likewise so inclined to call “not it” just because I can think of others who could or should engage in that act of love?
The holiday season often opens our eyes to many others’ needs – whether across the street or across the world. Let us challenge ourselves to not compare our own time, talent and treasure to others’, but instead remember we’re all uniquely positioned in this world. In this season of giving, let’s resist the urge to call “not it” and love as we have been loved.
Thanks to all of you who so generously share your love with those we serve here in Kenya.