Doctor, how good are you in geography?
A little tummy trouble? An epidemic in the community? You want to be a doctor, diagnose what ails people, and help them heal? Well, you better have a good sense of geography and its connections.
Tummy troubles
In 1990, while studying for my PhD, I visited India for the summer for my fieldwork. By then, I had lived in USA for a little over eight years. One of the joys of every visit to India was all the delicious food I would enjoy. This trip was no different.
Summer stay done, I returned to my university to continue my studies. For about a week or so after my return, I was having tummy trouble. Medicines I bought at the shop on my own did not help. So, I decided to go to the health centre on our campus. There, you did not have a regular doctor. Whoever was free when you went there would attend to you.
The nurse took my basic data … age, height, weight, blood pressure readings, and temperature readings. Then, I was shown into a room where the doctor would come and examine me.
The doctor, a very elegant-looking man, probably in his early 40s, walked in and greeted me with a smile. Instead of poking or prodding me and examining me physically, he started chatting with me. Very friendly.
“So, how do you pronounce your name?” I told him and he tried it getting it reasonably right.
“Where are you from?” India. “Ah, I see. I have never been there. Some day, I hope to. I have a lot of Indian doctor friends here.”
“What seems to be bothering you? Tummy trouble? What are your symptoms?” He listened very attentively.
“Do you like American food?” (I started thinking that the good doctor is spending time gossiping … instead of poking and prodding and writing out a prescription of some kind.) But I was not in any particular hurry and thought it would be rude to cut him off. So, I played along. “Yes, I love American food.”
“How about Indian food? Do you get to have Indian food often?” “Yeah, usually on weekends when I feel like cooking it. Otherwise, I have whatever American food I fancy.”
He came to his point: “That’s your problem. American food is not healthy. Your body is used to all that good Indian food. Those spices have a lot of important nutrients, a lot of fiber … all good for your digestion and health. Instead of having that, why are you eating American food? We are used to it because we have grown up with it. Your body is not used to it. Just go back to making Indian food and eating it. Don’t take any medicines; they are unnecessary. You’ll be fine in a few days.”
A few more pleasantries later, I left. I followed his advice. In three or four days, I was just fine!
Long after I left the university, one day, I suddenly realized how geographically sensitive and wise that doctor was. I still remember the entire episode very vividly.
Outbreaks and spreads
Whenever a disease spreads, geographical understanding is vital to treating it and stopping its spread. The recent outbreak of ebola is an example of this. The first question to ask someone showing signs of ebola is to ask if they have been to Africa. If yes, which countries? If the answer is no, then start asking where they have traveled and try to figure out where they may have come in contact with someone who had ebola.
This process, we hope, leads us to the first person in the chain of infections — that person is usually called Patient Zero. Unless we understand the geographical connections of Patient Zero, it will be very difficult to figure out how to address the deadly disease at the individual level (the current patient) and at the population level (because it spreads very quickly).
In the mid-1990s, in a village near Mandya, a farmer suddenly developed strange symptoms, fell very ill, and died. He had been a healthy man but suddenly this happened. In treating him, doctors diagnosed it was AIDS, the condition caused by HIV (Human Immunodeficiency Virus). This virus is transmitted in very specific ways. So, there was a geographical investigation … where did he travel, did he go to any barber shop (tainted blades were one way by which HIV was supposed to spread), and so on.
Eventually, they found out that he frequently traveled to Bangalore for work. He seemed to have become infected by having risky sexual behaviour during his visits.
People knew just enough about how HIV spreads and boycotted the whole village. People from other villages would not marry people from this village. The boycott basically drew an invisible barrier around this village. Over the years, and a lot of awareness-building later, that barrier was removed.
Geographer-doctor
Whenever an epidemic (a disease that spreads in geographic space among large populations) breaks out, good geographical knowledge can make a huge difference. And if you are a doctor dealing with it, you will be able to help more number of people because you are geographically aware and use this awareness in your work.
And by “geographical knowledge” I do not mean knowing just the kinds of things you memorize for your exams. I mean the ability to make connections based on sound knowledge, sound understanding, and powerful skills.
Geography makes you a better doctor!
Things you can do: (all links open in a new tab/window)
1. Study Dr John Snow’s application of geography to stop a cholera outbreak in London.
2. Study how ebola was tracked in the USA to help prevent its spread here and here.
3. Read about medical geography.
4. Observe conditions in your neighborhood that could promote spread of different diseases.
5. Ask your doctor about the types of diseases that are common in different places in India. How geographically well-informed are they?
A version of this article appears in the Deccan Herald Student Edition on 05 November 2015.
(Featured image: Courtesy, Wikipedia)
