We’ve learned that there’s a way of reaching out in equality and community that can be validating and empowering to everyone involved. The trick is to not just do it once and then never come back. When you provide this sort of care, there’s a code of ethics around making sure you don’t create unintended negative consequences when you go into a community. —Ann Messer, MD
Explore This IssueAugust 2020
The individuals we’re training in these villages are generally laypeople appointed by the government, not doctors. Sometimes they’re nurses. The level of training is broadly different. Oftentimes, people in low- and middle-income countries who are designated as doctors have some level of training from the minister of health, the Red Cross, or a church organization, but they rarely attend the kind of medical schools we have in the U.S. One Good Turn works to determine where the person is at in their medical education and then bring them information and scale it to whatever level of education they have.
Along the way, we’ve learned that there’s a way of reaching out in equality and community that can be validating and empowering to everyone involved. The trick is to not just do it once and then never come back. When you provide this sort of care, there’s a code of ethics around making sure you don’t create unintended negative consequences when you go into a community. The majority of that has to do with maintaining relationships and not promising what you can’t deliver.
We work pretty regularly with a school in Kenya whose medical officer has had a lot of interactions with the medical system, so he understands a bit about hospitals. When we got there, he showed me children with tinea on their scalps. They call this “shilling.” We talked about how to treat it; he was so excited that there was a medicine that he could put on their scalps and also give them by pill. We also taught him about record keeping and helped him create a rudimentary handwritten medical record system. We’ve also taught him how to treat scabies and diarrhea; next up will be asthma. He’s building a resource of medical information for this community and creating record keeping that will make his job as a healthcare worker much more effective.
We were in another part of Kenya not too long ago and made friends with a young doctor who followed us on Facebook. We had made a post about how loss of smell and taste may indicate a COVID-19 infection. This post helped him identify three people with these symptoms in his village, and he put them in quarantine right away. He also sent us a picture of himself and all of his medical providers wearing masks and practicing social distancing. I’m so excited we were able to make that little bit of impact.
Ending the Opioid Epidemic in Ohio
Stephen Nogan, MD
Facial Plastic & Reconstructive Surgery, Columbus, Ohio
The Ohio State University
My work primarily involves clinical research and grassroots outreach to my patients, their families, and other physicians. As a surgeon, I prescribe opioids on a regular basis, which gives me a daily opportunity to educate all groups of people involved in patient care.
I was partly inspired to do advocacy work when a patient shared with me that they had lost a child to an opioid addiction. There’s so much that can be learned from talking with patients and asking questions. I also spent time reading and studying both academic articles and non-medical accounts of this crisis.
My experiences as a surgical resident involved prescribing large amounts of opioids, which was commonplace at the time for even minor surgeries. When I began practicing as a facial plastic and reconstructive surgeon in 2017, I felt a strong obligation to accurately determine how much opioid medication my surgical patients needed, and I committed to not prescribing more than that.
There have been significant efforts and progress made in preventing prescription opioid abuse nationwide, and especially in Ohio where I live and practice. The more significant issues that need to be addressed now have to do with treating those already addicted, supporting them, and supporting the rehab institutions that are directing these efforts. This is such a critical part of my job on a daily basis that it didn’t feel like I had to carve out specific additional time to focus on it.
The best way to raise awareness about this issue is to share what I have learned with my patients and colleagues and to publish in reputable journals and accept speaking engagements at academic institutions as well as nonmedical settings. I have co-authored recent studies, including “Postoperative Opioid Prescribing and Consumption Patterns after Tonsillectomy” (Otolaryngol Head Neck Surg. 2019;161:960-966) and “Postoperative Prescriptions and Corresponding Opioid Consumption After Septoplasty or Rhinoplasty” (Ear Nose Throat J [published online ahead of print Oct. 15, 2019]. doi: 10.1177/0145561319866824).
Like many other surgical practices around the country, we’ve had significant success thus far in reducing the impact of the opioid crisis, primarily by reducing the volume of opioids we prescribe. Not unlike in other industries, sometimes in medicine we have to learn from our mistakes. The overuse and misuse of prescription opioids is an example of that. I think we have much to be proud of with regard to how the medical community has tackled this challenging issue head on.
Every otolaryngologist needs to know that very often their patients aren’t taking anywhere near the total amount of medication they’re prescribed. At the first postoperative visit, make a habit of asking your patients how many opioid pills they took after surgery. I’m often surprised by the answer. Earlier today, for example, I saw a patient one week out from an open septorhinoplasty who took zero of the 10 oxycodone tablets I prescribed him. I think many physicians have already adopted this kind of recommendation, and patients are also more educated and tend to advocate for themselves when it comes to opioids.