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Interview with Susan, ENT surgeon in Nairobi

Dr Susan, is 32 years old, and an ENT surgeon. She got an her MBCHB in Medicine from University of Nairobi and then did a masters in ENT. She works across various private clinics and hospitals (and one public hospital), but we visited her at a small private ENT clinic. She sees approximately 20 patients per day. Being a specialist, she gets a lot of referrals from GP’s - 50% of people walking in have been taking antibiotics. From those, she said 80% did not need them.

On how she stays on top of best practice

She uses an app called ‘Up to Date’ that gives you the latest journals and info. She starts discussion forums on there and reads about unusual cases

"Knowledge is not congenital, you forget things and need reminding"
“When you get out of school you have the concept that you need to keep your mind fresh and learn in an ongoing fashion. It’s not even about new information always, but refreshing”

On patients self medicating

"The Kenyan culture of self medication is horrible. Patients will go to pharmacies and get OTC medication save a coin or two, instead of going to the doctors (who cost money). People will literally try a medication to rule out illnesses."
“Patients will say: I took anti malarial, and i didn’t change, so I don’t have malaria.”
“People want a quick fix, they think it’s better walking to the pharmacy. They look at their pocket and go for the cheaper drugs. Once they realise the infection is not clearing, they will go see a doctor.”

On some doctors who rush to prescribe antibiotics:

"Doctors should be giving them symptomatic relief until they understand how the disease unfolds.”

On mis prescripiton:

"In busy clinics, GPs have to clear the queue in a certain time. This leads to a lot of misdiagnosis and mis-prescription"

“Without too much clinical evidence, docs give BS AB’s just in case they can clear the infection.’

Prototype Feedback

Smart Prescriptions

On the system making suggestions around guidelines:

"Which guidelines are you using? A lot of the guidelines are international and from the western world. You need to be able to contextualise the guidelines for Kenya”

On the system giving clear instructions and educating the patient:

"Thats a great idea, it involves the patient in the process and gives them responsibility for their health"

On compliance and reminders:

“Reminders are great, would make sure people are compliant which is important. Sometimes you can take the donkey to the river but you can’t force it to drink water.”

On all the sms messages:

“Can you imagine getting all those texts from your doctor every day though?”

She would like to control (on the system) how many reminders her patients will receive, depending on who they are and what is their condition.

“I don't think patients should receive reminders about taking their paracetamol.”

On the potential impact of the service:

“Patients would be really happy someone is following through, it would be really beneficial for them and would lead to less AMR and more compliance.”
Viusal Aids

Top messages she wished her patients understood about antibiotics:

  • Not every disease requires antibiotics (a lot of patients come in insisting to take them)
  • Overuse of antibiotics  and misuse lead to resistance.

Feedback on some the visuals:

“Oh that means overkill. I would use it to show there are more appropriate antibiotics to use in this case, don’t start with the more powerful ones”