Doctors must learn how to communicate

Nations have different codes or cultural norms on how to behave to each other. These are so embedded as to be invisible from the inside: none of us notice how we have been taught to behave until we are confronted by people behaving differently, and we suffer shock, and even outrage, at this breach of ‘rules’.

In Kenya, the culture, predominantly, is not a ‘blunt’ one. Kenyans do not, generally, confront people with difficult truths. There are other societies where it is completely normal to be almost brutal in declaring such issues - it is simply routine to look another in the eye and tell them starkly the issue at hand.

Both ways can be alarming to those brought up differently. And both carry costs.

But limiting the suffering and deaths that follow sometimes requires deliberate compensation for areas where our ‘ways’ are hurting us: a case in point, in Kenya, being in medicine.

When doctors use that particular Kenyan way of alerting patients to risks ahead, it can be possible for patients to really miss the risk, and even die. It’s a gentle thing, no fuss, not to alarm. Yet, sometimes, a patient needs to know there actually is cause for alarm. In fact, it really matters, in our environment that is so far from direct explanation and outspoken ‘difficult’ truth, that our doctors do more, are even trained, to explain. For delivering gentle pointers can affect decision making, and the results can be catastrophic.

In this, the case that will stay with me was about one pregnant young girl, now close to a decade ago. She didn’t make it.

She died, and her baby too, from a condition known as eclampsia. Pregnancy puts a heavy load on a woman’s body. In the early weeks, women start creating far more blood in their system. As the pregnancy progresses, they become far more prone than at other times to high blood pressure.

The symptoms are mild, and typically emerge late in pregnancy, simply some dizziness, swollen ankles as extra water is retained, and breathlessness. These are not sweeping ‘you’re going to die now’ symptoms. They are minor things.

But they kill both baby and mother, in paroxysms. That makes these symptoms in late-stage pregnancy very serious indeed. And a lot of women die from them: eclampsia is the second highest killer of pregnant women in the world. It affects up to 10 per cent of pregnancies globally, and many more than that in developing countries.

If spotted and addressed, pre-eclampsia can be caught before it kills. If early enough, simple drugs can resolve it. If late-stage, an early delivery can save both mother and child.

Yet that young girl, who died on a clinic table, had seen a doctor previously. He spotted some early signs of trouble. He told her that if she got any dizziness, headaches, or swelling in her face or ankles, she must go to a clinic.

He didn’t say why. He didn’t spell out the consequences if she didn’t. And she didn’t hear. Her symptoms got worse. She never went to have them looked at. She died.

In essence, she died due to failure of communication. In an environment where conditions such as eclampsia are not well known, and yet kill thousands of women, it requires a little extra bluntness to ensure headaches do not get ignored.

As it is, we have an overstretched medical industry and doctors who are challenged every single day. However, if we trained them to explain more, that alone would save some lives. It isn’t just about telling people quietly to seek attention if they get headaches. It can only take a second to say that it’s a principal symptom of one of the most dangerous conditions in pregnancy – and more women will seek attention when the symptom strikes, and fewer will die.

So we don’t need to become a blunt society. But we do need to see that sometimes the way we go gently on hard stuff needs a little extra compensation: and train our doctors to be emphatic and explanatory about the potential consequences – even if it isn’t what we normally do.