Table 1 Discussion board results

Identify the traditional medicine practices and belief patterns prevalent in your area.

Primary role of traditional medicine

9

“The traditional medicine, or ‘country medicine’ was a force to be reckoned with in Cameroon.”

Prominent societal role of traditional practitioner

6

“Herbalists in Malawi are licensed to practice by the Malawian government. He/she fills a great position in society.”

Symbolism

8

“We have been seeing woven bands and strings tied around kids’ waist or wrist. When we asked about the mothers about the significance, they had difficulty putting it into words but said it offered ‘protection’.”

Physical intervention

5

“Many kids show up with multiple 1-2 cm vertical scars on their abdomens and we’ve heard various explanations for them.”

Herbs/medicine

5

“We rotated through a traditional Chinese medicine pharmacy, which encompassed a highly diverse portfolio of herbs, roots, animal products, and minerals. The most surprising included mammalian fossils, centipedes, burned human hair, water buffalo horn shavings, and armadillo scales.”

Allopathic medicine as rescue therapy

9

“More often than not, and maybe out of convenience and location, patients would often visit their local healers first. Their visit to the hospital often came only after traditional medicine failed.”

Complications of traditional medicine practices

7

“During my four-week rotation, there were at least 4 children who presented with signs of ileus and underwent exploratory laparotomies only to find that they had been given a green leaf herb that was an extremely potent anticholinergic agent.”

Identify the funding of the local healthcare system and compare this to the systems you have experienced in the United States.

Patient contribution/fee-for-service

7

“The patient was required to pay the estimated cost partially or in full prior to their admission and if they didn’t pay, they wouldn’t receive the required operation.”

Government sponsored

8

“The majority of services provided here are funded by the health services arm of the federal government.”

External aid

5

“Much of Mozambican Ministry of Health is financed by foreign aid and mandated philanthropy from foreign enterprise operating within Mozambique.”

Physician compensation

4

“Most physicians are compelled to fulfill their obligation to [the government] by staffing the public hospital on weekday mornings and then working at private hospitals and clinics in the afternoons to supplement their incomes.”

Inequities of care

10

“Government spending on health is split between the public and private sectors with 50 % going to the public and 50 % going to the private sectors. However, the private sector only serves 15 % of the population while the public sector serves 85 %.”

Ask a local attending what one tool/resource they wish they had and how they compensate without it.

Training

6

“Physicians practicing in [rural] areas often have only high school vocational training, rather than five or seven years of medical school common in larger cities.”

Personnel

4

“…what was in shortest supply was strongly trained nurses.”

Technology/equipment

6

“There were no ventilators, defibrillators, a-lines, monitors, etc.”

Lack of basic supplies

5

“Consistent electricity was a serious problem that always needed to be considered.”

Improvisation

6

“For instance, [there is a lack of spacers for inhalers], so plastic bottles that were used to hold saline were cut up so that they could fit in the inhaler.”

Importance of the physical exam

4

“The amazing outcome that arose as a result of the absence of these modalities was how much the physical exam meant when a decision needed to be made…”

Different expectations of healthcare outcomes

5

“Every patient carried a virtual DNR label because there were simply no measures to keep a resuscitated patient alive if it was in fact successful.”

Make a list of the three most common illnesses you’ve seen during your rotation and how they presented.

Infectious disease

9

“Tuberculosis and related complications – pneumonia, meningitis.”

HIV

7

“There are some children as young as one-or two years old who, at such a young age, are already on second line antiretroviral therapy because their caretakers had been non-adherent with the regimen and resistance developed.”

Gastrointestinal disease

7

“Diarrhea was perhaps the most common reason for visits to the clinic.”

Signs and symptoms

14

“The most common presentation for adults has been productive cough and weight loss but there is great variability in presentation due to the high prevalence of HIV and AIDS in the community.”