African medicine

I thought this was a good example of how medicine works different here:

Yesterday we saw a 40 yo Somali man. He had urinary urgency. We tested his urine which only showed a very high specific gravity, which is normal for Africans who have chronic dehydration. We encouraged him to drink more water, but clean water costs money, so simply education does not solve the problem. With the differential, we figured the most likely cause was Benign Prostatic Hypertrophy. In America you would consider prostate CA in your differential, but it would be no use to test for it here because even if he did have it, nowhere in the country would treat him for that, even in here in the capitol city, and at 40 he is considered to have lived a full life. We did not do a rectal exam. Even though this wpuld have been good medicine, a Somali man would not culturally accept two women sticking their fingers up his butt.

We did not have an alpha-blocker to treat his condition, but we did have an old Tricyclic Antidepressant that has a side effect of urinary retention. So we gave him this and if it works, he can come back for more.