@article{,
title= {Medical Handbook for Limited Resource Settings},
journal= {},
author= {Daniel Griffin, MD, PhD},
year= {},
url= {https://parasiteswithoutborders.com/medical-handbook-for-limited-resource-settings/},
abstract= {When one practices medicine in their home country there are standards of care and guidelines often established by societies and organizations. Many look to the World Health Organization when practicing abroad and in limited resource countries. Many WHO guidelines can be found online such as the WHO Model Prescribing Information: Drugs used in Bacterial Infections (http://apps.who.int/medicinedocs/en/d/Js5406e/9.2.html). It is important and can create for a better dynamic when interacting with local providers to be aware of any country specific guidelines that may be created and published for a particular country. These may be created by societies or organizations in a particular country or even by the country’s Health Ministry (e.g., Uganda Clinical Guidelines https://www.health.go.ug/ content/uganda-clinical-guidelines-2016 ).

Two major features of practicing in limited resource settings are usually a limited number of available diagnostic tests and a limited medication formulary. Included in this handbook are examples of basic tests that might be available as well as a few examples of basic formularies. In many countries there are ‘required’ medications and these may be stocked despite no obvious local need. Selecting medications and management algorithms often involve complex decisions based on finite and often limited pharmacy budgets and the local availability and cost of medications. Deciding to stock, prescribe and dispense the latest name brand antihypertensive for an elderly individual with a slightly elevated blood pressure may result in not having malaria medications for a critically ill child.

The following executive summaries are a starting point for the understanding, diagnosis and treatment of common presentations one is likely to encounter in low resource setting as well as specific diseases. The final decisions regarding how these presentations and diseases are approached and managed should however be based on the judgement of a medical profession familiar with the local epidemiology, customs, and standards of care in a particular region. 

Several aspects of this guide will serve only as the foundation of further judgement on the part of the clinician. As far as dosing recommendations, if the dosing is 3x/day a clinician will need to communicate with the patient or caregiver regarding if this is 3 times per day with meals, every 8 hours or is  maximum per day. Not only does this aspect of care require judgement but it also is greatly improved by understanding the cultural context. In certain cultures, 3 meals are customary while in others a morning and evening meal are the norm with a late morning break for tea. Another area where cultural sensitivity is critical are issues surrounding family planning. If one administers an intramuscular contraceptive in a women’s shoulder below the area covered by the shirt sleeve and then affixes a band aid over the site the patient’s privacy may be compromised with negative consequences. Recommending Co-trimoxazole (trimethoprim-sulfa) to a patient with a urinary tract infection in Sub-Saharan Africa might seem to make perfect sense while a patient might be confused and upset as the widespread use of this as a prophylactic medication in the HIV-infected population has led to this medication being viewed as an ‘HIV medication’.

Visit https://www.parasiteswithoutborders.com/medical-handbook-for-limited-resource-settings/},
keywords= {, parasite, parasitism, Medical},
terms= {},
license= {},
superseded= {}
}