I don´t speak Chinese, but imagining how my patients feel when I start talking about NCDs and what the goals and target in treatment are. I imagine they feel I'm speaking Mandarin. Although I work really hard with my drawings and avoiding technical words, I know that embracing prescriptions, lifestyle changes and numerical data is always overwhelming.
I always wonder why physicians lost their educational role. I wonder if they voluntarily let it go or if they never felt it was something they had to do to begin with. I wonder why in medical school I was not taught to teach and become the active motor of education for my patient's wellbeing. I had a million courses on ethics, not even one on education for my patients. Why is education to patients always a neglected role among doctors? Why do we think it is someone else's job?
In poor resource settings where illiteracy rates are high, most health professionals don´t even try to engage in educating patients. "It's a lost battle" I have heard more than once. Even though the odds seems to be against it, from my own experience I have seen people that can´t read or write, that have achieve (with a lot of hard work in multidisciplinary teams) the autonomy to be agents of change in their own health. The biggest challenge has always been NCDs were the long term treatments force patients to obey prescription medication sometimes for life. I remember one of my successful stories: 58 year old woman, DM2, HTA, DLP. She couldn´t read or write. During one of our follow up visits, the first one with me because her previous attending left, she confessed that she took pills a little irregularly. I could see that myself, because the goals in treatment for her cardiovascular were far from being achieved. The treatment in her last 4 years seemed perfectly reasonable, but in her files you kept seeing how everyone made arrangements but nothing really made it better. After we talked for a long time (me trying to discover what was going on), she finally confessed she couldn´t read. What she did, was guess more less what the pill looked like, and tried to stick to taking according to what a neighbor told her when she showed the prescription. None of that information was on the chart. No one knew she couldn´t read. I decided to include that as a diagnosis, so from know on, everyone could start taking the precautions. In the next follow up visit, we designed a plastic box (that I bought from a crafts and stationary store) with stickers to point out the times of the day. Sun (morning), Apple (lunch), Moon (night) so we could cover medication taken every 8 hours, every 12 hours or every day. As she couldn´t recognize or read what pill was what and the pharmacy bought different generics every month, we decided to make appointments with me or any member of the healthcare team once a month according to her follow ups. In those meetings everyone read my prescription and I added to the prescription to help her out to sort the pills and fill up the box. Every month, some from our family practice team helped with that and we developed a system. We offered reading and writing lessons to every member of the community we served on a monthly basis (for free), but frequently the stigma was so big that patients were not compliant with the program. After many failures, the only thing that kept everything going was my little plastic box with stickers. Months went by and the system was perfected, and I added metabolic goals depending on the medical history, and patients started learning what their exact goals were. All of this, with plain drawing and a few numbers. I gave them homework for our visits, and many of them even learned about Hemoglobin A1c.
Simple intervention, time consuming but simple. Doesn´t solve the problem, and it feels like it is covering the sun with a finger, but at least, our grown patients who are not willing to go back to learning, can deal and be in charge of their own treatments.
I would love to hear about ideas for education about NCDs centered to patients in poor resource settings and how was physicians we do have a role. Ideas go along way, and I would love to share new interventions with my team in Chile.