We’ve visited the secondary care center twice now, and I’ve learned a lot talking to the doctors there. The secondary care center is only for patients with referrals, they don’t take direct appointments. However, the doctors there explained to us that there is a huge primary care problem here, which directly affects the referrals that they get. Primary care doctors aren’t well trained, and aren’t typically confident enough to give quality referrals, so the secondary care facility often ether 1) receives patients who really don’t need to be there, or 2) receives patients much later in the progression of their condition due to negligence at the primary care level.  The transfer from primary and secondary care is more than just a problem of referrals though. Doctors here said that they have trouble getting patient records too. Patients will often have repeated lab testing because the records from earlier tests don’t come with them. So there are large inefficiencies which can be dangerous for patients and waste a lot of resources, but it’s a hard problem to solve.

There’s also a cultural complication. Every patients wants to go to the secondary center, thinking that there are better doctors there, so they’ll sometimes walk into primary care and straight out ask for a reference. For primary care doctors who don’t know how to treat them, there’s no good option but to acquiesce.

The doctors explained to us that the goal of their primary care strategy is to have 1 or 2 physicians and 7-8 healthcare workers service a community. These physicians would develop strong relationships with people in the community and control the quality of patients referred to AME, hopefully by winning the trust of the people in the community over a long-term relationship.

There are a few ideas that have been proposed to fix it. Primarily, they’re focusing on training doctors to do better recognize problems that need referrals and gain the confidence in their own judgment to treat patients who don’t need referrals and keep them at the primary care level. This Wednesday, for instance, we’ll be going to a “Diabetes Day” event where primary care doctors will be conducting hundreds of patient consultations with secondary care doctors by their side, observing and helping train the doctors as they serve the community. It’s a really ambitious initiative that we’re excited to observe.

As Global Health technology students, we asked about what kinds of technology they need the most, and their biggest desire here is improvements in information technology. It seems that medical records here are as big of a problem as they are in the US. But they also want improved communication technology – a better way to communicate with patients long-term and to communicate with primary care doctors. We’re still digging to see what kind of technology that would actually look like, but it’s really been fascinating to see the problem up close.