Turning to online ‘doctors’

By Kiundu Waweru

A pregnant woman in distress sends the following SOS via the Internet:

"Sorry to be so graphic, I can’t think of a better word, but on and off for the last couple of days I have been experiencing discharge that looks a lot like snot. It doesn’t smell and I am not in any pain. It is quite stringy. Is it normal? This is my first pregnancy so any advice is greatly appreciated!

Soon answers and advice start trickling in, the first one read: "This is my 2nd pregnancy and I’m in my eighth week. My doctor has told me it is completely normal and it is caused by change in hormones. As long as there is no bad odour or itch then it is ok."

And the second: "I am eight weeks too and I went to my doctor for my first visit. She said the discharge was normal. She said it was the hormones and the prenatal will do that to you too. If you have had your visit with your doctor they will run many blood and urine test to make sure everything is okay. You are perfectly normal! But if it does itch or smell... tell your doctor! Congrats!"

Information at a click

The above conversations takes place in a resourceful website, baby centre, that guides women from preconception, to pregnancy, birth and goes on to advice mothers until the baby is nine years old.

It is to this site that Mr Mwangi Kariuki, a graphic designer and his wife turned to when she was pregnant with their first child, now one and a half years old. When in her second month of the pregnancy, she started spotting.

"Worried, we wondered if it was normal or dangerous. We decided to turn to the Internet and luckily, we found babycenter.com, that gives you blow by blow information and my wife would track her progress weekly," Mwangi recalls.

But could they trust the site?

"Yes, we found that the advice and accounts it gave collaborated with what my wife was experiencing at the time, kind of copy and paste," he says.

Doctors’ dilemma

As Mwangi says this, he logs on to the site, and follows the timeline of the baby stopping at 18 months, excitedly he reads, "You experience a spurt in physical development, your child seems to have more energy than you can handle…Indeed, I can see that in my son," he says.

Patrick Okwena says he has to ‘Google’ his symptoms before he goes to see a doctor.

"That way I know whether the doctor knows what he is talking about. Also knowing your condition before helps you before the doctor breaks the news. The diagnosis and tests just confirm what you already know," he says.

He says the Internet was vital when he was dealing with his hypertension.

And that’s is the dilemma there for medical practitioners. The Internet has heralded a new challenge. Gone are the days patients took doctors word for it.

"Before I go to see a doctor, I ‘Google’ my symptoms and likely treatment. That way, I will know what the doctor is talking about. I will also know if he misdiagnosis my condition," says Kenneth Wambete.

Ruguru Mwangi, a public relations officer says the Internet has afforded her and many others an alternative means of information, one that you cannot hope to get from doctors.

"Once while in a meeting, I felt a sharp pain in the left side of my brain. I took out my Black Berry, logged on to the Internet and ‘Googled’ the symptoms. The results guided me. Did I need to see a doctor or just buy over the counter drugs? she says.

Mwangi says through the Internet, she can now know the ingredients of the drugs she and her children are taking.

"Before, I had to content with the incomprehensible writings from doctor’s prescriptions. Now I know what medicine I am taking and whether they are good," she says.

Mwangi says the Internet also gives alternatives.

"Armed with information, you can easily tell a quack doctor, who misdiagnoses you," she says.

Quacks take advantage

In a country where professional regulation is difficult, the Internet has also encouraged quacks to invade the medical profession.

Patrick Obuna, a teacher, says he knows of a fellow teacher who quit the professional and now works as a doctor.

"He started a clinic in the outskirts of town. All he does is ask patients to book appointments, when they go to see him. They tell him their symptoms and are asked to wait. He then goes and searches on the Internet and comes out with a diagnosis and treatment," he says.

Obuna says so far the trick has worked for the former teacher.

Despite dealing with patients who seem to ‘know it all’, doctors say the Internet is a good source of health information if used correctly.

Dr Harun Otieno, Interventional Cardiologist at Aga Khan University Hospital, Nairobi, says relying on the Internet to check your health is a fine balancing act.

"With thousands of health related sites, how do you know your source is valid? Granted, some are good, others average and others pretty wrong. Problem is, there is no online policeman to guide or help individuals," he says.

Otieno acknowledges that people with access to the Internet look for information on their symptoms, which can cause a conflict when they go to see a doctor.

"You see, symptoms are subjective, a state of feeling unwell as compared to signs which are facts after examination," he says.

In the case of Ruguru searching for symptoms of a sharp pain in the head, Dr Otieno says that she could conclude that it is something minor and probably goes for pain killers.

"But the same symptom after tests, could reveal she has internal bleeding and could need emergency surgery," he says.

Another danger inherent in relying on Internet information is when people diagnose themselves, and armed with the information they go to chemists in town and buy drugs over the counter.

"This is dangerous because some of the people running chemists are not medical doctors and they could easily mislead you," he says.

He however says the Internet could be used ‘constructively’ by doctors and patients to share information in what he calls telemedicine.

"This is whereby a person in Kisumu can communicate via the Internet with a doctor in Nairobi and get his symptoms interpreted," he says.

Also having worked for 10 years in the US, Dr Otieno says that Americans use the Internet to rate the doctors.

"People log on to websites and see ratings and comments from people about particular specialists," he says.

And Jacob Mwero who is the manager, Cardiology Services, Aga Khan University Hospital, Nairobi says recently they received an interesting case.

The patient had come to the hospital, worried but sure of her ailment.

"She had a bunch of printouts, all indicating hyperthyroid. She had experienced symptoms like weight loss, palpitations, anxiety, increased appetite, sweating and family history. When the patient shared this information with her friend, she was advised to Google, which she did and printed out," says Mwero.

The draw backs

After tests, her fears turned real and she was referred to an endocrinologist.

However, he adds, there is a draw back to relying on the Internet for health information for there is always a danger of one becoming one’s own doctor.

He shares doctor Otieno’s sentiments: "The tragedy is the most drugs are available over the counter. In Kenya, you can get even controlled drugs like morphine and codeine."

Also having lived and worked in the US for 15 years, he says that to buy drugs in the States, you must have a prescription from a doctor bearing his license number.

He however says it is important for people to be curious about their health, and seeking the right information is a good thing. "Even as doctors we feel the need of embracing the Internet to reach people," he says.

Dr Otieno concludes: "If you have severe symptoms, don’t go online unless asking for help from a qualified health provider who will advise you what to do."