Book of the Month: Better

This book doesn't necessarily have anything to do with Africa...but it does have a lot to do with medicine.  I was first introduced to Atul Gawande's work when I found a copy of one of his New Yorker articles on health care in the bathroom.  I spent a very long time in the bathroom that day, reading his article on what's wrong with health care, why it costs so much, and what we can do about it.  Come to find out, Gawande knows what he's taking about:  he's a Harvard trained surgeon who also happens to be an incredible writer.  I found one of his books, Better: A Surgeon's Notes on Performance, on the Faders' shelf at Tenwek and devoured it in two days.

It is difficult for me to say for certain, since I am decidedly a medical person, but I think Gawande has a knack for explaining complex medical issues in layman's terms.  He seems to write about things in a way that makes a lot of sense and is incredibly interesting.  How else could I have stayed so interested in a chapter on hand washing?  The book is a great look at how we do what we already do...better.  As physicians, we almost always have the best of intentions.  We know what has to happen.  But how does it actually get accomplished?  If, for example, we know that washing hands stops the spread of disease, and it's easy and cheap, 100% of people must wash their hands, right?  No, not even close, says Gawande.  Why?  How do we improve?

He illustrates his point and talks about various aspects of the problem by focusing on a different issue each chapter:  polio vaccines in India, APGAR scores, trauma surgery and developments in the military, cystic fibrosis, malpractice suits.  It's nonfiction, but Gawande's way of making his point through story left me flipping pages rapidly.

I was hooked after a page or two, but I felt like we were really connecting as I read his final story.  Gawande is Indian by birth, and he went back to India during his training to spend a few months working in on of their hospitals.  He recounts an incident where he was trying to place a chest tube in a man dying from a massive pleural effusion (fluid around his lung causing it to collapse).  The hospital had a CT scan and the ability to do angiograms, but no chest tube.  No scalpel.  No pulse ox.  The man died.  As I read this account, it reminded me of all that we are trying to do in the developing world.  There are days where someone has donated some new equipment, or we open a new hospital wing, or implement a new program.  These are all GOOD THINGS.  But when patients are still dying because no one checked their vital signs, or we have run out of IV fluids, BASIC things, then it begs the question...do we need to work on doing what we already do, better, before we move on to something new?  Gawande asks the question.  Something worth pondering.