Fieldset
Fighting Hepatitis in Cambodia: A fish on a bicycle
With her medical interpreter off to a new role, Theresa has been finding new ways to contribute to the MSF hepatitis C project in Phnom Penh, Cambodia...
Over the last two weeks I’ve discovered that an expatriate doctor without a medical interpreter is like a fish on a bicycle: utterly useless. While the recruitment for a new interpreter has been going on, I haven’t been able to see patients in the hepatitis C clinic. There’s only so far my three sentences of Khmer can get me, and the mechanics of the liver is well beyond my reach.
 
In an effort to add value to the program during this lull, I’ve been giving short talks to the clinic staff about subjects related to the treatment of hepatitis C. At first I thought this would be of interest only to the doctors, but the invitation went out to the nurses and lab techs as well, and before you knew it, there was a whole mob waiting to hear me talk:
 
 
Theresa's class is packed out in the Doctors Without Borders hepatitis C clinic in Phnom Penh
I didn't make enough handouts!   Photo: Theresa Chan / MSF
 
What is remarkable about this is the fact that I haven’t been choosing sexy medical topics. In fact, I warned everybody that one of my talks was going to be extra-boring, because it was about calculating estimated glomerular filtration rate (eGFR) in patients with chronic kidney disease:
 
 
The formulas Theresa used in her talk for staff at the Doctors Without Borders Hepatitis clinic
These formulas are real conversation-killers. Photo: Theresa Chan / MSF
 
This is not fun stuff to talk about (all you nephrologists out there may disagree with me), but it is important because if a patient has a low eGFR, we have to exclude her from treatment with direct-acting anti-viral drugs (DAAs). The general motivation among the medical team is to treat as many people as we can, so being obligated to exclude someone is a bitter disappointment. 
 
Fortunately, I found an app which calculates eGFR based upon all of the formulas listed above. There was an audible sigh of relief when I showed this slide:
 
 
This screenshot shows the app that does the calculations for you!
No panicking!  Photo: Theresa Chan / MSF
 
As of this week, we have a new medical interpreter, so I’ll soon be seeing patients in clinic again, but I think I’ll keep doing these mini-lectures. There’s been a few requests for information about hypertension and diabetes, and every day it seems like we get another complicated medical case that deserves looking up and further discussion. 
 
It just goes to show you: even a fish on a bicycle can be useful.