Marginalized Medicine: surgery in the sticks

“It’s a lot of make it up as you go.” Dr. Jack Chamberlain has been practicing medicine in rural areas around the world since 1993.  A U. S. based physician turned humanitarian aid worker, he has practiced medicine everywhere from the ER of Detroit to the war-torn jungles of Burma.

“Marginalized medicine” is a term very dear to his heart, and he defines it as “anywhere that people have a really hard time accessing modern medicine–like if they have to walk two days to get any kind of medicine, regardless of what it is.  They have no access to a doctor or nurse of any kind, the best they have is often like a local shopkeeper.”

Doctors today have years of institutionalized medical training under their belts, and they are surrounded by a full staff with years of experience, tons of equipment and access to books and internet to back them all up.  Not to say it’s an easy job by any means, but there’s an existing system to support them.

A lot of experienced western doctors come out on trips to support Dr. Chamberlain, but they run into all sorts of problems (that he ran into as well at one point).  Western medicine is “generally geared toward mainstream problems.  In marginalized areas, you have stuff that people just aren’t trained in.  You have infectious diseases that people in central areas have never seen before.”  For example, in the United States immunizations have generally taken care of measles, but out in Burma they will have epidemics more often than you’d think.  The U. S. public health system has effectively combated malaria in the west, but it remains one of the biggest killers out in places where public health hasn’t progressed in decades.

So how do you practice medicine in a place like that?

“With a little creativity, you can actually provide pretty good care, but there’s a limit and you have to be brave enough to face it,” Dr. Chamberlain says, “you just have to know that there are things you cannot take care of.”

He would go on to say that it’s easy if you can identify the issue, even if it’s fatal–if they’ve got an advanced malignancy, “sorry, there’s nothing we can do.”  Dr. Chamberlain says it gets a lot harder when they simply don’t have the resources to know.  “You get to where you think it may be treatable if you could only figure out what it was, but you’re not really sure. Those are the really hard ones.”

Resources are huge.  While having one or two pieces of equipment might sound like they could only help, in medicine it seems like each machine or device needs a whole arsenal of other machines to back it up.  Consider this:

• Pneumonia is the number one infectious killer of children under 5.
• Anti-biotics are cheaply and easily available if you make preparations for them.
• Some anti-biotics take 24-48 hours to kick in.  A lot of the kids Dr. Chamberlain sees are far enough along that they don’t have that much time to wait.  They need oxygen to make it long enough for the medicine to work.
• Bottled gas is too large and cumbersome to carry out into these rural areas, so they get an oxygen concentrator.
• The concentrator needs 500-700 watts of electricity running 24 hours a day for 2 or 3 days.
• You have to provide that power somehow, be it through solar, hydro or a gas generator.

These are the types of problems they face on a daily basis, and it’s a constant struggle to find creative ways to solve these problems and save as many lives as possible.

“A lot of people are dying of non-issues over here,” Dr. Chamberlain also commented, “diarrhea, for example.  Over half of the deaths in Karen State (Burmese jungles) are easily treatable or even preventable for children under 5.  The second you venture into a nearby city–and not even big ones–the survival rates triple.  They just don’t get treatment because of where they are.”

In 2011, the World Health Organization (WHO) estimated that worldwide anemia is present in 43% of children, 38% of pregnant women, and 29% of non-pregnant women.  The largest portion of those anemic people are simply treatable with iron.  “Iron is super simple,” Dr. Chamberlain said, “it’s in our everyday diet.  We take it for granted.”

But the doctor considers his work incredibly rewarding.  While he does love the creative problem solving and unpredictable lifestyle, the people are eternally grateful.  “I remember I was in the jungle and it had been a long day in the clinic and I was tired, and I just sat down by my little bamboo hut.  Old lady came and stood there, cradling a bundle in her arms. I thought, ‘Oh man I just can’t see one more sick kid.’ Disheartened, I reluctantly got up and said, ‘okay, can I help you?’  She very gingerly peeled back the covers, smiled and revealed a pineapple. It was her way of saying thank you. She walked away and I felt great.”

Modern medicine has been heading toward the big business realm for a long time, but many doctors get into it for altruistic reasons.  “The business side can be disheartening,” Dr. Chamberlain said, “marginalized medicine sort of hearkens back to those original reasons for becoming a doc.”

All images taken by the author.