The best medicine starts outside the clinic window | Bertrand Dushimumuremyi | TEDxKigali

So sweet to talk to, so lovely. So for the two days I found upon her, we talked a lot about her journey. She had been diagnosed with asthma at the age of 50 and — she told me how she had been struggling with this becoming breathless and day and even much more when we met she could not breathe without oxyen support. she was worsening. Uh one day as I continued following up on her one day, one morning I and my attending, we wanted to test her breathing capacity of the oxygen support. So I walked to her and I say, "M, you take a walk to the door and come back for us. We want to see how strong your lungs are today. " was hesitant for a moment. She knew it would be a struggle. We went on uh put off the oxygen mask and put an oxygen measuring machine on her finger and she went for her first step. What shocked me the most is that she was just merely halfway to the door, even having made less than just 10 steps. And the oxygen meter was already beeping red. She clutched her chest, silent. She was really struggling. Her blood oxygen levels were dropping so fast. Of course, for an asthma patient who was not in crisis, we wondered what was wrong. Uh what were we missing from the story? So before I go and tell you more about my patient, I would like to uh now bring you on onto how I came to meet her. So in 2021 I started my journey. I was admitted to the University of Global Health Equity where I was going to do my medicine. I thought learn the conventional knowledge about human medicine like everyone else. But uh go on spend my first two years learning about the human body, learning anatomy, physiology, the biochemistry, pathology and the pharmacology and then going to do my next four years of in hospital training where I' going to meet my patients and learn by doing. That was the way. But something surprised me. I realized that my learning journey at UG had been planned differently to the traditional medicine courses. There was a new concept that was added. My colleagues and I when we got there we introduced to a concept that connects human health, animal health and environmental health. A concept called one health. So what one health simply told us was that the health of humans and the health of their environments are simply one thing. They are so interconnected. If the environment is sick then humans are sick as well. And if animals are unwell we too also unwell. We learned that uh to be better treat our patients we needed to understand their environments. We need to understand where they lived. So to say this, it was a revelation for me indeed and uh I would just like to say one thing medical training is really heavy. Adding all these new courses, climate change, prenatal health and even more much more. It was interesting but at times it felt like we are going overboard. Why learn all that information? For me, this was until I joined the student one health innovation club at the university so at SOIK everything became real. I learned and I brought all the one health lessons to life through engaging in different activities, visiting conservation parks and doing community engagement activities. I understood that one health is much more than we think. I understood what it is like in practice. I understood that the health of humans and the environment

was inseparable. So when I went on to my hospital training now all the skills I learned from my one health classes in preoas and everything I learned from my time at the skills the knowledge the attitudes they all guided my patient management at the hospital. The understanding that our patients were much more than their symptoms had grown deeper. I understood that we cannot define patients just by the symptoms. They were the environments. They were much more. So for my next as we went on I had to go back and see my patient M. Like most of my colleagues, we had learned the best that we don't see patients as patients, but we see them much more than they are. So the next day, I walk, I go to a and for conversation, I had to probe her with a different set of questions than what we had asked her before. I went on to ask beyond her presentation to ask about her environment, her lifestyle. What we discovered for most of her life like the other 77% of people in Randa she was cooking with wood mostly touch grass which produces a lot of smoke and alongside my colleagues we identified that her continued exposure to this air pollution had led her to develop a condition called intestial lung disease. a disease that is most often misdiagnosed for asthma because of how similarly they present. In fact, a research recently done showed that more than half of ID patients are initially misdiagnosed. So for the past 28 years more about three decades M had been M's health had been worsening not because she had been denied treatment but because she was being treated for the wrong disease because no one had asked the right question. Why were we just identifying her disease just then? What would be different if these questions had been asked 28 years ago on her first clinic visit? So asking about her high environment had enabled us to discover her real illness. We changed her management adding some new medications and we also advised her on some behavioral changes to make to reduce smoke exposure and the air pollution at her home. I remember two months later I'm in the hospital going on with my daily life and I hear a tap on my shoulder. It was the old lady. It was a I couldn't believe my sight when I saw her then. She was not on oxygen support anymore. She was not breathless. She had traveled more than 30 kilometers from her home and she was here walking around the hospital coming for her followup. Not on oxygen support, not breathless. And it was so surprising to me just one environmental occasion, a single adjustment to the medication and advice on simple behavior changes and we were seeing a different outcome in just two months. This moment for me as a young doctor in training, it was surprising moment and of course it was so enlightening. I understood that the health of our people is much more interconnected to the health of our environments. If our environments are sick, then our health is too. And if they are healthy, our health is also good. So I would just like to say this is the moment for us to think about it even more. So like um 99% of the population today is facing heavy air pollution exposure. More than 3. 6 6 billion people, that's nearly half of the world population, are living in areas that are susceptible to high different levels of climate change. And because of this, we see around 8 million people dying every year. And of those, including 700,000 children.

That's around 2,000 children and 20,000 adults dying every year because our health care professionals were not trained to account for a sickened environment. So today as we come back, how many more people do we still need to see out there misdiagnosed being treated inadequately because no one asked the right question? It's not too late that we start training our doctors to ask the right questions in the long term. revising our medical training to integrate a one health approach and in the short term creating different pathways to provide doctors with these skills clubs like one health clubs like so or even creating short-term courses for those who are already in healthcare settings by training our doctors about the environment by training them in a one health approach we are training them to understand the pat uh the environment the patients live in. Not just treating symptoms, but understanding the world their patients live in. It's important to the doctors, of course, but much more important, it's important to you, the patient. We are more than just our symptoms. We are environments. We are our ecosystems. Thank you.