Storm Clouds

It has been wonderfully exciting these last few weeks to see people cured or treated, returning to their lives and family, in a setting of resource-limited medicine. 

There are sobering times to balance this happiness, though.  When a patient at home is failing to respond to treatment for their illness, it is often only after a prolonged effort involving multiple specialists, extensive tests, and multiple attempted treatments.  There is a point in illnesses which are not responding to treatment where both patients and healthcare providers begin to understand that the attempted treatments are not working and that good additional treatment options are not available.

Those "storm clouds on the horizon" appear sooner in the setting of resource-limited medicine.  There are often few or no second-line treatments available if the first treatments of an illness are not effective.  It is one thing to see such a patient for whom no effective treatments are available anywhere in the world.  The real sadness comes when you are sitting looking at a patient and thinking that if you only had "this or that", that the patient could well recover from the illness which is taking their life.