All healthcare providers decide in someone else’s place, for someone else. In doing so, they take their place in a long long tradition, that of medical paternalism. Patients are treated as children, incapable of making decisions about themselves. How then are we supposed to deal with patients like the street children of the Democratic Republic of the Congo, who are not part of our health-care system, who refuse care and prescriptions? Their refusal of caregivers forces us to seek strategies to dispel the conflicts, adapt outselves to the situation (self-medication, drug sales outside of dispensaries, etc.), but especially to rethink the relation between caregivers and patients. This does not mean abandoning the authoritarian patriarchal model for total relativism; the use of drugs such as antibiotics is and must remain surrounded by all the precautions necessary to avoid the further development of resistance; it does mean training and informing. The task facing us is that of health education and promotion, a long and continuous process, centered on patients and integrated with their care, aimed at making them capable of managing their disease. This procedure is part of a pragmatic approach: beyond the asymmetry involved in any relationship of power, it is essential to establish informed confidence, to look for adhesion and not constraint. Only this pragmatism can incite young people with sexually transmitted diseases (STDs) to use modern medicine and comply with the dosage instructions. Effective treatment of STDs is, according to WHO, one of the most powerful weapons in the battle against AIDS transmission.
Education for self-administered antibiotic therapy: a pragmatic and ethical alternative for the treatment of STDs for the street youth of Kinshasa in the Democratic Republic of the Congo (RDC)
Leyka MB, Baum PM, Diadié M, Kiyombo M, Mupenda B.
IRSS/HELESI, UCL/ Belgique, Clos Chapelle-aux-champs 30, 1200 Woluwe-Saint-Lambert, Belgique. basuab
Sante. 2009 Oct-Dec;19(4):217-25.