On the outskirts of Rwanda's volcanoes, resides what is known as a cultural village. This is where former poachers who have seen the light and no longer hunt gorillas, golden monkeys and antelopes. Now they demonstrate the olden skills, in a society where people may speak on their cell phone (for less than thirty seconds, this is how price conscious they are), while carrying a yellow jerrican, on their way to get clean water. They show us their war dances, where the star has maybe twenty teeth; they lead us to the king's castle, which is really an extended hut, and they take us to see the witch doctor.
The quack, draped in fur, stands by an improvised wooden table laden with plants. In his first demonstration he takes mortal and pestle, pounds a few green leaf, pours some water (definitely not mineral or bottled...) on the goo, and presented us with jadish liquid which I pray to God we would not be requested to drink. The translator grins. "This is for the wedding, when the man is worried about the first night," he explains, and the witch doctor eloquently says "Viagra". More medication follows for various ailments. Whether or not it helps I will never know, but what I do note is that the village physician begins the encounter by closing his eyes and singing. When he is done singing we cry out "guma guma", which is the local equivalent to bravo. The translator, going back and forth between English and the local Kenya-Rwanda, interprets the song we've just heard: "Just like the spouses have to respect each other, and the children have to respect the parents [amen to that!], so does the medicine have to respect me."
I can see why a patient would have to respect the doctor, let alone trust them. But to trust the medication? To actually have a relationship with it? In a way, it's ridiculous. And in a way, it makes so much sense. Because, let's face it, we are not so different than the villagers coming to see the guy draped in fur and opening wide to absorb the fluid he pours down their throats. We may be educated, we may get our medicine from Western trained professionals wearing white coats, not animal furs, we may be able to say that the pill we're taking contains 200 milligrams of Ibuprofen, but, if pressed hard, how many of us would be able to explain just what this does or how it chemically operates? Trust in medical institutions has been widely studied. It is generally low. Trust in medication has not been looked at, but, if you don't trust it, why would you take it? Research in the UK finds that parents' decisions not to vaccinate against measles, mumps, and rubella (MMR) - despite assurances and campaigns by the UK government-stemmed largely from lack of trust in messages about the safety of these vaccines. The point is that as patients, we cannot really detect the quality of the care we get, or the medication we swallow. We need to trust the Mercks and the Novartises of the world, that they put in the active ingredients and nothing but, that they follow the dosage on the packaging, and, essentially, that they take good care of us. And I don't mean this in a belittling, paternalistic way, or my shared decision making will beat me up. But I do think that trust and respect are imminent in the act of medicine. Somehow, great labs are not enough, the human touch and human sense of being properly taken care of are the crucial, or missing, ingredient, regardless of whether we see a Harvard graduate doctor, or a Rwanda quack.