Self-medication and access to care in Global Health

By Nathan Douthit

I am a local village doctor. I came to the eye hospital escorted by two people in view of my severe eye condition and blindness. Fortunately, I was immediately relieved of my symptoms and my vision was restored after treatment. I am now completely aware of the ill effects of using home remedies. I will spread awareness about these ill effects to all people in my village. I will also bring other blind people from my village for eye treatment.           

            Above is the case "Self-medication complicating pseudo membranous conjunctivitis" by Singh et al described in the words of the patient. The patient had an episode of conjunctivitis 20 days prior to presentation, "for which he had instilled ghee (clarified butter) as well as goat's milk in his eyes as a remedial measure. Also, he had instilled some antibiotic–steroid combination drops." His condition had worsened to the point of near blindness before he sought out care at a medical center, where he was diagnosed with pseudo-membranous conjunctivitis and treated appropriately.

One aspect of this problem is Non-Degree Allopathic Practitioners (NDAPs). These practitioners practice allopathy, however very few have any formal allopathic training and by definition, none have allopathic degrees. Some are trained in traditional medicine (for example, the AYUSH practitioners—Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy) while some lack formal training entirely. For many rural residents in India and other countries, these are the first point of contact for acute illnesses.^[1] This is likely secondary to the inadequate access to appropriate care, particularly in rural areas, with several other confounding factors including illiteracy, insufficient women's rights, food insecurity and other variables.

This is especially a problem with ophthalmologic problems.^[2] While traditional medicine and traditional practitioners certainly play a role in global health, these delays in presentation can prove costly to the patient and their local community.^[3] It can lead to decreased public health and long-term morbidity and mortality from treatable illness.

Education and proper care play a key role in scenarios like this. Since this patient had a high status in the local community, he is using his experience to help educate others:           

            Being a local village doctor, he has better access and hold over the local populace, and now, following positive outcomes of eye treatment based on the principles of mainstream medicine, he wants to extend the same advantage to others who require help—particularly the blind and the visually impaired in his locality—by bringing them to our secondary eye care centre for treatment and vision rehabilitation. He is now voluntarily spreading awareness among people and of his own accord discouraging the use of home-made remedies for different ailments, especially of the eyes.

BMJ Case Reports invites authors to publish cases regarding self-medication, delays in care, and inadequate access to care. Global health case reports can emphasize:

-The effects of educational interventions for patients and providers

-Training methods for non-degree allopathic practitioners, and how to incorporate them into the local healthcare system

-Disease spread or exacerbation as a result of self medication

-Successes in treating cases complicated by early inadequate intervention.

Manuscripts may be submitted by students, physicians, nurses or other medical professionals to BMJ Case Reports. For more information, review the blog on how to write a global health case report.

Read more about cultural competence and humility at BMJCR

–Consequences of low birth weight, maternal illiteracy and poor access to medical care in rural India: infantile iatrogenic Cushing syndrome

–Factors affecting illness in the developing world: chronic disease, mental health and traditional medicine cures

–Why tuberculosis control programmes fail? Role of microlevel and macrolevel factors: an analysis from India.

Read more about cultural competence and humility from other sources

-May C, Roth K, Panda P. Non-degree allopathic practitioners as first contact points for acute illness episodes: insights from a qualitative study in rural northern India. BMC health services research. 2014 Apr 23;14(1):182.

-Carvalho RS, Kara-José N, Temporini ER, Kara-Junior N, Noma-Campos R. Self-medication: initial treatments used by patients seen in an ophthalmologic emergency room. Clinics. 2009;64(8):735-41.

-Cambanis A, Yassin MA, Ramsay A, Bertel Squire S, Arbide I, Cuevas LE. Rural poverty and delayed presentation to tuberculosis services in Ethiopia. Tropical Medicine & International Health. 2005 Apr 1;10(4):330-5.

 

^[1] May C, Roth K, Panda P. Non-degree allopathic practitioners as first contact points for acute illness episodes: insights from a qualitative study in rural northern India. BMC health services research. 2014 Apr 23;14(1):182

^[2] Carvalho RS, Kara-José N, Temporini ER, Kara-Junior N, Noma-Campos R. Self-medication: initial treatments used by patients seen in an ophthalmologic emergency room. Clinics. 2009;64(8):735-41.

^[3] Cambanis A, Yassin MA, Ramsay A, Bertel Squire S, Arbide I, Cuevas LE. Rural poverty and delayed presentation to tuberculosis services in Ethiopia. Tropical Medicine & International Health. 2005 Apr 1;10(4):330-5.

Competing Interests

None Declared

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