Saturday 16 August 2008

Ignorance brings us nearer to death

A couple of years back, a very pregnant young lady came to see me, let's call her Desni. She told me that she was living with HIV, and wanted to know what she should do to stop her baby becoming infected. I gave her details of the latest guidelines that I got from the Internet. She then told me that she had already been to Dr. A at the B Hospital, who had given her different advice. Desni had then talked to a counsellor at the C Hospital, and again got different information.

Desni is an intelligent and relatively well-educated person. But she was (naturally) confused. Like a good counsellor, I told that all I could do was to pass on the latest information so that she could make a decision. And in the end, that's what she did: she decided to do nothing. Her baby has HIV.

I still feel a little (or more!) responsible. Problem is that the advice on preventing mother-to-child transmission of HIV seems to change every few months. This is especially true of recommendations about breast-feeding. Should we advise based on latest ideas, or should we restrict ourselves to national guidelines, which are usually several years out of date?

Most of the AIDS referral hospitals in Indonesia are treating less than ten people with HIV. How can the doctors and counsellors possibly keep up to date with the rapid developments in HIV practice, particularly since many have very limited English language capability, and poor Internet access?

People are dying for lack of information.

Babé

1 comment:

Elizabeth Pisani said...

Re: should we wait for national guidelines?

No, no and again no! As you point out, they are often very out of date. Often that's because of bureaucratic inertia, sometimes I suspect it involves vested interests and worse. It took nearly three years for Indonesia to change STI treatment guidelines after we had exceptionally strong evidence that we were treating people with drugs that don't work, and another year and a half to arrange for drugs that do work to be widely (and affordably) available. That's nothing short of a disgrace.

Physicians that don't know any better can be forgive for following national guidelines. But anyone who does have access to more recent data is surely obliged to push hard for its use. Even when that means urging a patient to ignore the advice of a less well-informed medic.