Africa’s inventions: Medicine

Medicine is an important field of human knowledge that enriches every society in which there are doctors and nurses. Breakthroughs in medicine and science have led to increases in the life expectancy of the entire world. Furthermore, medical ideas relating to public health are not only ideated by qualified doctors, but also by specialists in the fields of mathematics and computer science through the development of infectious disease models, electronic record keeping applications, artificial intelligence diagnostic tools and consultation mobile phone applications.

Examples of record keeping software include EMIS Web, Systmone, Vision, Adastra and Meddbase. These are solutions used by General Practitioners (also called GPs) or family doctors. There are many more.

There are different types of doctors and the path to becoming a doctor starts in medical school. Most medical schools around the world are highly selective, sometimes admitting students from the education system scoring in the top one to five per cent. Once medical students graduate, most doctors earn the right to use “Dr.” before their name, before going through foundation training on the path to becoming surgeons, specialist doctors, family doctors or consultants.

For historical reasons, in the United Kingdom, after the successful completion of an examined post-graduate diploma earning them membership to the Royal College of Surgeons, male surgical trainee doctors revert back to using “Mr” in front of their names and females back to “Miss”. In certain other countries such as the United States of America, surgeons don’t have a different prefix to other doctors.

Doctors are responsible for providing healthcare. Although, it should be observed that in most countries with strong institutions, for each country, the national government, policy makers, and other allied healthcare professionals are also responsible for providing healthcare.

The field of medicine involves sharing peer-reviewed research as well as practice.

Typically, doctors assess the symptoms of patients, consider possible causes using algorithms learnt from medical school or the latest research, and gather insights from examinations and investigations before advising patients of treatment options. They follow up this process by monitoring the effectiveness of the initial treatment. If needed, they will send patients on to specialists or another healthcare professional for further assessments.

Some aspects of medicine don’t have to be carried out by doctors such as nursing, managing the doctors’ diary or triaging. Triage is a systematic approach of evaluating a patient’s likelihood of deteriorating in order to risk stratify their condition and prioritise management. Triage may be carried out by ambulance workers. Most clinicians are expected to be able to perform this risk stratification within 2 minutes.

Types of doctors

Medical students enter the workforce as “junior doctors”. Junior doctors are graduates of medicine who are pursuing their initial clinical training, sometimes referred to as foundation training. The duties of a junior doctor and the oversight of junior doctors by more experienced doctors provides a bridge between medical school and specialist training. There are over 60 types of specialisms doctors can pursue and some of these specialisms take more than eight years to master, while other specialisms may only take three years.

Doctors who have completed their foundation training, sometimes completed in the first two years after medical school, become a specialist trainee or a core trainee for another one to three years before becoming a “registrar”. Sometimes after completing their foundation training or becoming a registrar, qualified doctors may also pursue either advanced medical qualifications or non-medical studies in fields such as leadership, public health or business administration, before narrowing down their long-term medical career interests.

A “senior doctor” is a term reserved for a doctor that has completed their medical training. Senior doctors can have various titles. All senior doctors are required to maintain a minimum level of continuous education.

A “consultant” is a senior doctor with major responsibility for the care of patients in a hospital. Senior doctors must complete a minimum number of years of training in their chosen specialty before obtaining a Certification of Completion of Training (CCT) and being registered as a Consultant. Consultants work in multidisciplinary teams that include nurses and other professions. Consultants have to register with a supervisory body.

In practice, doctors who have not yet obtained a CCT (and therefore earned the professional accolade of “consultant” or “GP”) are still considered trainees, and broadly speaking “junior doctors” for the purposes of payment contracts and rotas.

A “SAS doctor” is a doctor with at least four years’ postgraduate experience that has chosen to focus on an area other than becoming a consultant, a surgeon or a family doctor. The SAS stands for Staff grade, Associate Specialist or Specialty. They can move into a specialty at any level of seniority or experience. They may become a psychiatrist, choose to work in paediatrics or in another specialty.

Family doctors, in some countries also called “General Practitioners” or GPs, are senior doctors that have completed post-foundation training in General Medicine. They operate from health cares, or GP practices.

There are three broad types of the GP role: the primary care GP (who operates in a practice), the urgent care GP (in a hospital) and the GP with a specialist interest (that has undertaken advanced qualifications in specific field such as in for instance dermatology, minor surgery, or cardiology etc).

Many GPs come from or defect from other specialist training such as emergency medicine and maintain qualifications to enable them to operate in multiple specialties. Many GPs have a portfolio career comprising some or all of the above pathways of the GP professional silo. They are unsupervised, unlike trainees, and generally take on trainees on a career path to becoming a GP. Family doctors manage patient care outside of hospitals. Family doctors can diagnose and treat most illnesses unless specialist treatment or hospitalisation is required, in which case they will refer patients to the relevant hospitals or specialists.

Other types of doctors include academic doctors and locum doctors.

Academic doctors perform a combination of teaching, research and specialist clinical care. Academic doctors may have titles such as “clinical fellow”, “clinical lecturer”, “senior clinical lecturer”, “associate professor” or “professor”. Academic doctors usually have two employment contracts – one with a university and another with a hospital or a GP practice.

A locum doctor is a fully qualified doctor that parachutes into either a hospital or a GP practice to cover doctors on sick leave, maternity leave or to relieve higher than normal workloads. All locum doctors have to be registered in the country in which they practice. Locums doctors may have any level of experience or seniority. They may either be junior doctors or senior doctors. Sometimes locum doctors are foreign nationals attracted to the country by government appeals.

The taxonomy of medical career progression used here for categorising different stages of experience and seniority comes from the United Kingdom. In the Unites States, medical students enter the workforce as an “intern”, then become a “junior resident”, then “senior resident”, then compete to become “chief resident”, before eventually becoming an “attending” – the equivalent of a consultant in UK parlance.

Specialisms of doctors

There are 60 or more specialisms doctors can pursue within the medical profession. Around the world, each country has medical colleges or bodies which design curricula for doctors pursuing specialist training and examinations doctors have to pass before being recognised as qualified specialists in each country. Such colleges often bestow a fellowship to members who contribute to their chosen specialisms either through experience or by making outstanding contributions. Becoming a “fellow” is usually a mark of distinction and outstanding skill for members of a specialist medical body or medical college.

What do these specialists do?

Anaesthetists provide anaesthetics to patients before, during and after surgery, and treat chronic pain. Anaesthetists also care for critically ill non-surgical patients on the hospital intensive therapy unit (ITU) or high dependency unit (HDU).

(Anaesthetics are drugs which cause patients to lose sensation.)

Emergency medical doctors work in A&E. They specialise in resuscitation. They assess, treat, admit or discharge patients requiring emergent medical attention, when brought to hospitals. Emergency medical doctors are generalists skilled at executing emergent management of conditions that span the entire spectrum of medicine, surgery, paediatrics, trauma, obstetrics, psychiatry and other disciplines.

(A patient requires emergent medical attention when there is a critical compromise to life or limb, sometimes requiring resuscitation.

A patient requires urgent medical care when there is a non-critical compromise to limb, and serious but non-critical medical conditions. Non-critical by inference means not requirement for resuscitation. Patients who require urgent medical attention, in medical terms, are sent to the Urgent Care Centre.)

Forensic physicians have a varied role, including providing care to police suspects detained in custody, attending death scenes, and providing expert interpretation of the cause of death to the police and courts for deaths under suspicious circumstances.

A gynaecologist is a specialist focussed on the medical care of the female reproductive system (the vagina, uterus and ovaries) and the breasts. Gynaecologists are affiliated with the breasts due to hormonal interplay but it is actually breast surgeons that manage breast conditions and surveillance.

An obstetrician is responsible for medical matters relating to pregnancy, childbirth and post-natal care. An obstetrician is also able to perform certain surgical treatments such as caesarean sections.

A paediatrician focusses on medical conditions affecting babies, children and young people.

A psychiatrist specialises in the diagnosis, treatment and prevention of mental conditions.

A radiologist is an expert in the use of medical imaging equipment for diagnosing and treating disease which can be seen within the body.

Sports doctors manage medical conditions and injuries relating to physical activity.

A surgeon is a doctor trained in the use of invasive medical treatment by operating on the body.

Broadly speaking, there are ten types of surgeons.

  • Cardiothoracic surgeons who focus on the heart, lungs and oesophagus
  • General surgeons – consultant general surgeons focus on any of the following areas: vascular, endocrine, oncology and gastrointestinal
  • Neurosurgeons carry out surgical treatment for conditions affecting the nervous system
  • Oral and maxillofacial surgeons carry out surgery for conditions affecting the mouth, jaws, face and neck
  • Otolaryngologists deal with the ear, nose and throat (ENT)
  • Paediatric surgeons deal with conditions affecting foetuses, infants, children, adolescents and young adults
  • Plastic surgeons carry out reconstructive and reparative surgery, as well as cosmetic surgery
  • Orthopaedic surgeons perform surgery for injuries and diseases of the musculoskeletal system (bones, joints, ligaments, tendons, muscles and nerves)
  • Urologists deal with the kidneys, ureters, bladder, prostate and male genitalia.
  • Vascular surgeons perform surgery for conditions affecting body circulation, including diseases of arteries, veins and lymphatics.

Is any of this new?

Origin of medicine

Although there have been many mind-blowing advances in medicine, emanating from various continents, the origin of medicine can be traced back to Africa, to Egypt particularly.

Egypt was the first to develop the practice of specialists evaluating symptoms, treating illnesses either through surgery or medicines and monitoring progress. Egypt was the first to establish medical schools, such as the Temple of Sais.

Furthermore, much of this evidence comes from written sources – in the form very well-preserved papyri. The evidence from Egypt covers both human medicine and veterinary medicine.

Documents covering human medicine include the Ebers Papyrus, the Berlin Papyrus, the Edwin Smith Surgical Papyrus and many others. Some of these documents date back to 2,500 BCE, containing a mixture of innovative thinking and religious interpretations of the causes of sickness. Some illnesses were attributed to the gods, while some could be treated.

The Kahun papyrus is the earliest record of veterinary medicine in the world.

Medical knowledge is, without reservation, one of the most important developments by Africa, that it contributed to humanity. Documents left by the Egyptians provide evidence of not only the practice of medicine but also the specialisation of physicians and the early use of various titles for physicians with different specialisms.

Imohotep, the architect, vizier and physician to King Zoser, of the third dynasty, was deified by Egypt as Imouthes and later made it into the Greek pantheon as Askelepios, the god of medicine.

Thanks to the Smith Papyrus, we have a very good idea of the surgical treatments ancient Egypt had mastered. The Smith Papyrus is a copy of a manuscript composed under the Old Kingdom, between 2600 BCE and 2400 BCE. It focusses on bone surgery and external pathology, covering forty-eight cases. In each case, the author writes in the following manner: ‘Instructions concerning [such and such a case]’; followed by a clinical description: ‘If you observe [such symptoms]’. The descriptions of symptoms are precise and are followed by the diagnosis: ‘You will say in this connection a case of [this or that wound]’, and, depending on the case, ‘a case that I can treat’ or ‘the case is without remedy’. If the surgeon can treat the patient, the treatment to be administered is then described in detail, for example: ‘the first day you will apply a bandage with a piece of meat; afterwards you will place two strips of cloth in such a way as to join the lips of the wound together … ‘.

Some of the treatments documented in the Smith Papyrus are still used today. Egyptian surgeons could stitch up wounds and set broken bones using wooden or pasteboard splints. And there were instances when the surgeon simply allowed nature to take its own course. In two instances, the Smith Papyrus instructs the patient to maintain his regular diet.

The methodical approach of the Smith Papyrus illustrates the skill of the surgeons of ancient Egypt, and also that knowledge was transferred to other countries and future generations – to Africa, to the Near East, to Asia, to the doctors attached to Egyptian expeditions to foreign lands (“army doctors”).

From written history, we know

  • that foreign sovereigns, like the Asian prince of Bakhtan, Bactria, or Cambyses, brought in Egyptian doctors,
  • that Hippocrates ‘had access to the library of the Imhotep temple at Memphis’ and
  • that the Greek physicians of antiquity had access to Egyptian medical writing.

Among the Niger-Congo civilisations, people facing persistent illness or misfortune turn to a doctor-diviner. The Western interpretations have influenced the pre-judgements about what skills doctor-diviners /witch-doctors use. Based on studies, ‘a witch doctor’ in West Africa tended to be men or women that were knowledgeable about medicines derived from natural sources, efficacy of those medicines, and people skilled at reading people. Witchcraft was outlawed in certain Niger-Congo civilisations, although the definition of witchcraft differs from Christian ideas.

Their customers would be those less knowledgeable.

The job of the doctor-diviner was to diagnose the cause of illness or misfortune and prescribe remedies.

Bone-setting was practiced by many groups of West Africa (the Akan,[2] Mano,[3] and Yoruba,[4] to name a few).

Bibliography

[1] Unesco General History of Africa Vol2 Chapter 5

[2] Ariës, Marcel J. H.; Joosten, Hanneke; Wegdam, Harry H. J.; Van Der Geest, Sjaak (2007-04-16). “Fracture treatment by bonesetters in central Ghana: patients explain their choices and experiences”. Tropical Medicine & International Health. Wiley. 12 (4): 564–574. doi:10.1111/j.1365-3156.2007.01822.x. ISSN 1360-2276.

[3] Harley, George (1941). Native African medicine with special reference to its practice in the Mano tribe of Liberia. Cambridge, Mass: Harvard University Press. p. 26. ISBN 978-0-674-18304-9. OCLC 598805544.

[4] Oyebola, DD (1980). “Yoruba traditional bonesetters: the practice of orthopaedics in a primitive setting in Nigeria”. The Journal of trauma. 20 (4): 312–22. ISSN 0022-5282. PMID 7365837.

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