As doctors, we have the rare privilege of listening to patients’ pertinent histories. History taking is a skill that one grows with in the profession. Together with proper examination, these two skills still account for a successful medical encounter. A lot of trepidation and second-guessing characterized my first moments at history taking as a medical student. Most respectable people respect age and in many African societies, young people have boundaries of what they can speak or do in the presence of elders. Call it conservative or timid but I think it is fair and proper to show respect for senior citizens on mere account of their age. Well, everyone deserves respect.
The point however is the departure medical practice makes of this tradition. As students, all young doctors invariably attend to elderly clients. In this set up, the doctor –patient relationship kicks in and the little matter of age is not expected to hinder the encounter. It took me a while to drop my sensitivities and ask older patients all questions I needed to ask and examine all organs I needed to examine. My first prostate and breast exams are still etched in my mind. In this learning process, it was apparent some older clients have reservations at giving certain information to younger doctors. However, these relations are human nature and expected. Every society has its norms and traditions that modulate any interaction between individuals in different circumstances.
Just like patients, the medical practice has its history – some hilarious, others quirky. Trailblazing advances like the development of vaccines, the discovery of penicillin (an antibiotic) and advances in transplantation medicine are just few of the great strides in the field. Perhaps a revolutionary advance was the development of the germ theory; the concept that infectious diseases arise from microbial material. This theory was long in coming, spanning hundreds of years before Robert Koch conclusively demonstrated it in the late 19th century. He went on to earn the 1905 Nobel Prize for his work. Prior to these works by Koch, Pasteur and others, the widespread belief that illness came from foul air in the environment was well grounded and accepted. Hospitals were not always as safe as they are today. Maternal and neonatal deaths were extremely common and the incidence among hospitalized and non-hospitalized patients was not significantly different. It was not uncommon to lose up to 30% of women delivering in hospital to infection! Many children died before their 5th birthdays. To put this in context, one Kenyan hospital today loses about 0.6% of the women they deliver.
In 1847, one young doctor made a simple revolution that was 50 years too early. Dr Ignaz Semmelweis discovered that by doctors simply washing their hands before examining patients, the mortality rates in the obstetric and neonatal wards fell by over 60% within the month. He concluded there must have been some material in doctors’ hands that transferred to patients during the examination in order to cause the fatal infections. At the time, doctors and students shuttled freely between anatomy/autopsy dissection rooms and the wards. His theory turned the prevailing ‘foul air’ belief on its head. As a younger doctor, Semmelweis’ findings were generally dismissed by senior faculty at his university hospital in Austria without much of an interrogation. The stellar results in drastically reduced mortality rates were conveniently overlooked. The mere notion that doctors, respected gentlemen, harbored germs in their hands was in itself inconceivable.
In spite of his remarkable results, brilliant Semmelweis eventually lost his job in Austria and had to return to his country, Hungary. Even back home, he could only practice in a small village hospital. As with the university clinic, he introduced his hand washing policy and the statistics spoke for themselves. Dr Semmelweis saved the lives of thousands of women and children but his work remained a one-man match against an army of entrenched tradition and norms. The frustration of having a solution no one would care to adopt in the face of great loss of life led the good doctor to mental breakdown. At the age of 47, he died of an infection from injuries sustained in a mental asylum.
Today hand washing is universally recognized to prevent several communicable diseases and is celebrated every October 15th. Among others, diarrheal and respiratory illnesses can effectively be kept at bay by proper hand washing. In operating theatres, surgeons spend a good deal of time scrubbing away at their hands and instruments are sterilized to destroy the germs they may carry. Looking back in time, one wonders how many lives were needlessly lost in breach of such a simple cost-free strategy. The medical establishment’s refusal to question prevailing norms and beliefs in the face of incontrovertible dissenting evidence caused needless and wanton pain and suffering. Dr Semmelweis was eventually honored 100 years posthumous for his work and is considered the real Father of Asepsis. If for nothing else, health workers need not forget to wash/disinfect their hands today in recognition of the brilliant colleague we drove to death by our refusal to wash hands.