Look Who it Was Random video

Physician Marc Levin: Doing the Best With What You Have

1,873 views · Published 17 June 2013 · 3:09 · Indexed 7 October 2026

Channel: Doctors Without Borders / MSF-USA · 2013 · Nonprofits & Activism

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Marc Levin, a family physician in New York City, has completed MSF missions in Chad, Niger, and the Central African Republic. Here he talks about the challenge of diagnosing and treating patients in the field, and how he coped with sometimes limited equipment and diagnostic tests.

TRANSCRIPT
I think that a lot of the things that you see with MSF are often things that you see here, in the U.S., just overseas they can often be fatal.  So things like upper respiratory infections and diarrhea in children.  You probably see more meningitis, tuberculosis, things like that.  But generally I felt I had what I needed.  There were often cases where I just wasn't clear on the diagnosis, where someone was confused.  There was one case in Chad of a teenage girl who just couldn't walk and just had pain in her legs, but the exam was normal and we had no idea why.  Children with severe respiratory illness where it would certainly be helpful to have an x-ray or a CAT scan or an EBG to figure that out.  I had another case that was in Chad where a woman came in just completely confused and we had no idea why.  Certainly something like a head CT or an MRI would be helpful in those cases, but I do feel like the vast majority of cases I had what I needed.  The common diagnoses were very common.  So malnutrition, malaria, during an epidemic, meningitis, respiratory infections, diarrhea.  I think those were the big things that I saw.  

I think that there are cases that I will always remember that I wonder, Did I make the right call and did I treat for the right things?  I think often what happens with those cases is you sort of have your differential and you treat for the top three things.  So people might be on multiple antibiotics or multiple medicines where you are really trying to cover your bases.  

We had a patient, a 14-year-old girl in southeastern Chad and she just came in and she had leg pain and I think it was one-sided, unilateral leg pain.  She had trouble walking and moving her leg.  Her exam was completely normal.  Actually I got a second opinion because my supervising doctor had come from the capitol that week, so I had her look at the leg as well and do an exam and she could actually do a more extensive exam as a woman, because culturally there were parts of the exam that I couldn't do on a 14-year-old girl.  So she did a more extensive exam and everything was normal, everything was fine except the patient said she couldn't walk and she had pain in her leg.  In the U.S. she would have had an x-ray and blood cultures and maybe an MRI to look for acute fractures or osteomyelitus.  Of course, in a displaced persons camp in Chad we didn't have any of that.  We made our best guess and we treated her for osteomyelitus, a bone infection, and we gave her antibiotics IV and about a week later she was better and she went home.  I don't think we'll ever know what that was, but that is often how you have to practice medicine with MSF when you're stumped.

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