Necessity THE MOTHER OF INVENTION

by John Young, M.D.

Early in my medical career, I was doing well and feeling comfortable in how I practiced medicine when I saw an ad in a journal: Doctors needed to work with the United Nations Border Relief Operation to help at the site 8 refugee camp on the Thai/Cambodia border. I signed up and almost immediately someone called and asked if I was available soon—which I was—and within a few weeks, I was in Bangkok, Thailand. I spent a week there seeing the sites of Bangkok, going to meetings and then headed out to the site 8 refugee camp and hospital. It was a six-hour trip and the last hour of the trip we were going through a military checkpoint every four miles. I asked why all the military checkpoints and was told “because we are going into a war zone.” That must have been in the fine print I didn’t read! We eventually got there and let me say it was a little bit of a shock—33,000 Khmer Rouge refugees in a quarter-of-a-mile square area. These are the people that had killed millions of fellow Cambodians (remember Pol Pot) and now they were being hunted and killed by the North Vietnamese army. What goes around comes around. Barbed wire was all around. We were told not to leave the camp as minefields were everywhere.

When I arrived at the hospital, I met the hospital director, a physician from the Philippines. She gave me a tour of the hospital which wasn’t much. There were six bamboo structures, each about 50-feet-long and 15-feet-wide and the floor was dirt. The bed support was bamboo sticks and a bamboo mat and wire to hold it all together. The sides and roof were bamboo and palm fronds all held together by wire. Cheap, easy and practical. My job was to oversee the male and female medical unit, pediatric, leprosy and tuberculosis departments. The hospital director handled OB and GYN. She let me know that the camp was attacked usually once- a-week by the Vietnamese, and since I was the newest doctor, I would be left in the camp to take care of the wounded while the rest of the team would attend a nearby military outpost and get me after the weekly skirmish was over. You must know, they don’t build foxholes for guys 6’6”; mine was about one-foot deep—not much protection as those rocket-propelled grenades zing over your head!

The first patient I saw was a 12-month old girl in her mother’s arms. Someone said she had polio and another condition. Her eyes were glazed over and she was so out of it. She was breathing fast with a fast heart rate, mouth open, flies in her mouth and on her eyelids. I told the director we needed to send the infant to a referral hospital. She looked at me and said, “This is a United Nations Refugee camp; there is no referral hospital. You are the referral hospital, John”. Whoa! Talk about a wakeup call!

It was my job to keep people alive and healthy with the very limited resources I had which was a once-a-week truck toting a portable X-ray machine. From 9 a.m. to noon, I could get some lab tests, like a dip urine analysis and hemoglobin and hematocrit to check for anemia, and if it was absolutely life and death, I could get a WBC test to check for infection. As for consultation or CAT scan, nothing. I did have access to some antibiotics, water pills, a few types of blood pressure medication, and Tylenol, aspirin and digoxin for heart disease. Occasionally, I could get an inhaler for asthma treatment and some Pepto-Bismol for stomach issues. That is when it dawned on me I was back to the basics of medicine and to forget high tech medicine. I was forced to go back to just the basics—that knowledge I learned in my first two years of medical school—how the body works, anatomy and biochemistry. I spent a lot of time at night going over those textbooks I had brought with me. Sure, we had cases where in the U.S. I could have saved a person’s life if I had high tech medicine, but I feel that even without that, there were a lot of lives saved just by figuring out the basics and treating them—which unfortunately now is a lost art.

Today in America, it is all about following the algorithm. If a person has a cough, you do these five things; if they are no better, send them to a specialist and they look at three other things in his algorithm. If still not better, the patient is either depressed or this is a disease for which there is no cure or treatment. There is no disease that doesn’t have a cure; our job as doctor should be to find the cure.

To this end, I recently saw a patient who was diagnosed by his eye doctor as having an eye disease that will eventually cause him to lose sight in his right eye. It is a rare disease. What happens is that the sheath that surrounds the optic nerve, artery and vein closes tighter and tighter around those three structures. If he looks at me, he sees my face but from the neck down my body is all foggy. He can’t tell if I have a body as his visual field is so distorted. His eye doctor told him there is no treatment. They tried steroids but to no avail. I looked up the disease and saw some of the underlying mechanisms causing the loss of vision, so I have a general idea of what is going on structurally to the nerve, artery and vein, and came up with three options that may work if we break the disease down into its basic components. I gave him my ideas and we decided to go with the first suggestion. I took an old drug, around for years, and thought of another way to use that drug, going back to basic anatomy and accessing a vascular system that is written about in the medical literature but very few doctors seem to know how to access. I did some research on it and we proceeded to treat the patient. To cut to the chase, from the time I gave him the treatment until his eyesight was normal was less than one hour.

I would have never figured this out if I had not had that experience treating refugees, relying pretty much on basic, sound medical science, and now, years later, this is what I continue to do every day in my practice of medicine. It is so easy to say there is nothing medicine can offer you and your condition. Don’t be so sure! Your doctor works for you. Ask him to check again; maybe there are some basic medical principles the corporate medical profession is missing. With prayer and much work, a lot can happen.

Young Foundational Health Center is located at 7241 Bryan Dairy Rd., Largo. To schedule an appointment, call 727-545-4600. Most major medical insurances accepted. For more information, visit YoungFoundationalHealth.com. See ad page 15.