[Music]
Y
[Music]
how
there is something very important good and
important than important on
the human body of what nobody
nobody talks to us teaches anything when
We try to train as doctors in
this country
six years of career one or two years of
mir and up to four or five years of
specialty and in all this time nobody
he deigns to tell us in depth
about death
it is true that medicine is one of the
life sciences and not death
but after all, it’s not supposed that
the mission of doctors should be
try to avoid death we should not
therefore be more sensitized more
familiar with how to avoid it and all
what surrounds her the truth is that the
Death remains a taboo subject even
for medicine and if the death is that of
a child the problem is even greater there
something harder to digest than the
death of a child there is something else
difficult to digest that the death of a
son
in our environment luckily this every
time is more exceptional in our country
for example of every thousand live births
only three will die before fulfilling the
five years instead in the most
poor death during childhood is
a much more common phenomenon and rates
of mortality are much higher
It seems incredible but there are places in the
world in which to this day one of
every ten newborns will die during
childhood if there are any more statistics
demonstrative of the huge and brutal
inequalities between the rich world and the
poor world that someone comes and I the
teach
many of you will think that know
what someone has died from is
relatively simple and this is true
in our environment if today we put ourselves
sick here or if we have any
health problem that puts you at risk
our life we can always get closer
to a health center or hospital more
close and there you can first examine
us from top to bottom completely
apply a whole battery of tests
diagnoses and recover very
Quick all our clinical history
and arriving at a diagnosis like that is
relatively easy and what happens if we
we die on the street if we have the bad
lucky to fall fulminated in the square
colon today forensic medicine is
will be in charge of investigating what has
past
practicing an autopsy
so find out what he’s dead
a person in rich countries is
relatively simple and what of the
autopsy is not an option is a
legal requirement or that as a rule
by law we have to submit to this
instead practice in countries more
poor and particularly in the areas
rural Africa where I’ve been for years
working the photo is completely
different
in these countries on the one hand the greatest
part of the people are born and die without leaving
a trace in the statistics
many of the people die without being
never seen by a doctor or by a
health and therefore know what has
happened in these cases is relatively
difficult is what some call the
scandal of invisibility because no
appear in statistics
in fact many of these deaths do not
they matter to people but because people
is not aware that they are happening
what can we do we should contribute to
make visible these deaths we must put
a focus that illuminates them that the
present to the world but that alone is not
enough we should try to understand by
what happens so that we can design
strategies that can prevent those
preventable causes and that can cure
those curable causes and that’s where
we fail and fail a lot
as I have told you in the most
poor many of the deaths occur in
the houses and how can we investigate a
death that has occurred in a house where
nobody has seen what has happened for these
cases the world organization of the
health developed a few
years a methodology called the
verbal autopsy and what the hell is the
verbal autopsy as the verbal autopsy
it’s just an interview
structured that is done to the
relatives of the deceased person
weeks or a few months after the
death had this interview happened
aims to try to collect
the maximum information available that
help us understand what happened during
the process of the disease until the
moment of the patient’s death the
answers to the questions asked
do the interviewee to the relative of the
deceased are subsequently evaluated
by a doctor or a team of doctors or
for a computer software
what value do you think a method has
like this one that depends on the answers
of family members about something that happened
a few weeks or a few months ago that
medical training we are demanding from
the respondents to the interviewees in
contexts in which in many cases
they do not know how to read or write
The truth is that the reliability of
verbal autopsies is as low as
throw a coin into the air and this what
we see in the type of answers that
we get for example what was wrong
had the disease of the moon oysters the
disease of the moon I think this
in my notes of the race does not come out and
since when I had symptoms since
who stopped being healthy
and you who believe that he died died of
disease this is not diagnostics
these are diagnoses of
resignation to notice that the only time in
my life that has appeared cited in the
prestigious science journal
I’m saying that the autopsies
verbal are a method of shit
affirmation of which I do not take pride
affirmation of which I do not take pride
but I still subscribe completely
I turn to rehearse anyway
they will not ask me again
but let’s go back to the methods that
we use in poor countries to
try to know what a
person if this person has had the
fortunate to be able to get in touch with
the health system and has been
seen in a clinic or in a hospital
we will have a little more information
but again how reliable this will be
clinical information in a context in the
that there is a significant shortage of
qualified medical staff and in which
we have very few diagnostic methods
available I will give you the example of
Mozambique the country in which to work in
the last years and that I know better
where for a population of 27 million
of inhabitants there are barely 1,200 doctors
distributed throughout the country as you
you can imagine with so few doctors
the bulk of clinical care does not
they perform the doctors perform it
health personnel trained in a way
less rigorous more accelerated as per
example, health agents or
nurses
and that we know about the methods
diagnostics so you can have an idea
in the hospital where I work
maybe one of the best hospitals in
the whole country despite being a hospital
in a rural area we have just four
or five diagnostic methods of
laboratory available for routine
daily clinic and we can only count on
simple radiography as the only method
image diagnosis
so
the logical the derivative of all this that
I just explained is asking and
how much do we clinicians get and what
they make it so difficult when we get it right and the
only way to know how much we hit
is to compare the diagnosis that arrives
the doctor who has seen the patient before
of dying with the diagnosis produced
determined by the reference method
which is the anatomopathological autopsy and
it’s just opening the corpse and looking
by oneself our group that leads
more than 20 years working on improving
diagnostic methods available for
the diseases in the countries more more
poor has been able to confirm that the number
of errors that are made during the life of the
patient are very important and that
it’s even in half the cases
There are discrepancies between what the
clinical before dying and what the
autopsy after dying
you will ask then if you have
followed my explanation because I did not
We do autopsies in the most
poor those who pass away there are two
main reasons the first is the
overwhelming shortage of pathologists or
personal
trained to do autopsies in the
poorer countries in a place like
Spain we have a pathologist for every
15,000 or for every 20,000 inhabitants
while in Africa there are countries in
those that there is not even a single
pathologist for the entire population
but more important than the problems of
human resources that after all
can be solved with training
accelerated here we have a very problem
important related to the
acceptability of the method this is a
bloody method is an invasive method to
nobody likes the idea that their
family be open in channel has
observed inside and has been returned
with a scar that goes from the thorax
to the abdomen and I can not help it
sympathize with this feeling so much
although the autopsy completes the autopsy
conventional is the reference method
be the best way to investigate
that a person has died, reality is
that this method is limping
acceptability is a method that therefore
is not feasible in these environments and
how can we then get out of this
Apparent blind alley because
know what people die from is
essential to be able to design
health policies is essential for
put in place measures that prevent
these deaths is also very important
to better manage the scarce
financial resources available to
these countries
for health
and here comes the eureka idea of this
talk that did not occur to me alone in the
bathtub like Archimedes but my
colleagues the pathologist already a clear order
menéndez epidemiologist are also parents
of the creature and we were not the three
together in a bathtub the researchers
We usually put our eureka moments
in much less glamorous places like
for example the laboratory
as we can
autopsies look for oneself the
inside of a body without opening it like
we could get samples of the
main organs of the organs more
important as the brain as the
lungs like the liver in a way
less invasive as we could
develop a method that is not
systematically rejected by the
communities or by relatives in
duel and the only way that we are
happened was using this kind of
needles
I will not remove the cap because
I want any misfortune to happen and what
we do with these needles, with these
needles puncture the corpses and
by piercing the corpses we are able to
get samples of the tissues more
important small tissue cylinders
like these that we can analyze in the
lab these little cylinders that
they are like noodles we can examine them under
the microscope and they will give us the
important information to tell us if
the organ from which we have taken them
We were healthy or were sick we can
say also if there was an infection
of this patient if we apply this
methodology systematically
we can understand what happens to the
main organs of the body and by
so much to have a pretty complete idea
of what was happening inside the body
and that has probably killed this
person and all this we will achieve without
just leave a visible mark on the
totally different body than
happens with the conventional autopsy and
you see that it is an idea of the simplest
but tremendously powerful our
group went to work and in the
last five years we have achieved
validate this new approach we have
confirmed that the autopsy minimally
invasive as it is known now is
a reliable method that can answer
to the main cause of death and whose
diagnoses correspond the great
most of the time with what the
conventional autopsy
for those cause deaths
Infectious diseases are very common in
poor countries the method works
particularly well it is capable of
diagnose very accurately the
name and if you hurry me up to eight
surnames of the microorganisms more
important causes of the infection and
therefore possibly responsible for
death all this is very well the
method works but the most advance
important of all this project has
what to do with the acceptability of the method
with his achilles heel we
we started with an acceptability
practically null the autopsy
conventional is an unpleasant method
is a dirty method is a method of which
many rumors are born of the most
colorful is a method that has a
bad reputation our team of
anthropologists has been able to demonstrate not only
in Mozambique but in a wide
variety of sociocultural environments
geographical and religious
this method has been much better received
by
communities
so we have a method that works
we have a method that has a good
acceptability much better than that of the
conventional autopsy and we also have
a method that is very easy to execute
anyone can learn to
perform one of these autopsies in two or
three days of training and you do not need to
a pathologist to implement what is
the consequence of all these findings
our method has been adopted and has
been implemented in a meteoric way in
up to a dozen countries in Africa and
in asia to investigate pilot
of what children die in this country and
the data that is being generated
starting from this project they have started to
change paradigms about death and
about its causes and if such a pathogen is
really much more frequent than what
we thought and if the disease is
begins to appear in places where
he believed that he had never arrived and if
there is a plausible explanation
simple and logical why some of
the prevention and treatment measures
that we are implementing
the common autopsies do not work
minimally invasive are beginning to
answer all these questions about
all with credible data finally
minimally invasive autopsies
they also have the potential to cause
a true metamorphosis of the way
in which we investigate the cause of
death who was going to tell me just do
a few years that a method born of
autopsy room was going to fill a large
part of my professional life especially
considering that it was there in the
autopsy room where I lay down the
practical examination of anatomy 1 the only
subject that he suspended in all the
career
there is life after death
no, there is not
but there is life from death I
I think that sure, sure
death can teach us a lot sure that
of so many and many premature deaths
unnecessary preventable we can take
the right lessons that allow us
avoid in the future that your place of
birth be the main
conditioning of your possibilities of
survive thank you very much
[Applause]
[Music]
Y
[Music]
how
there is something very important good and
important than important on
the human body of what nobody
nobody talks to us teaches anything when
We try to train as doctors in
this country
six years of career one or two years of
mir and up to four or five years of
specialty and in all this time nobody
he deigns to tell us in depth
about death
it is true that medicine is one of the
life sciences and not death
but after all, it’s not supposed that
the mission of doctors should be
try to avoid death we should not
therefore be more sensitized more
familiar with how to avoid it and all
what surrounds her the truth is that the
Death remains a taboo subject even
for medicine and if the death is that of
a child the problem is even greater there
something harder to digest than the
death of a child there is something else
difficult to digest that the death of a
son
in our environment luckily this every
time is more exceptional in our country
for example of every thousand live births
only three will die before fulfilling the
five years instead in the most
poor death during childhood is
a much more common phenomenon and rates
of mortality are much higher
It seems incredible but there are places in the
world in which to this day one of
every ten newborns will die during
childhood if there are any more statistics
demonstrative of the huge and brutal
inequalities between the rich world and the
poor world that someone comes and I the
teach
many of you will think that know
what someone has died from is
relatively simple and this is true
in our environment if today we put ourselves
sick here or if we have any
health problem that puts you at risk
our life we can always get closer
to a health center or hospital more
close and there you can first examine
us from top to bottom completely
apply a whole battery of tests
diagnoses and recover very
Quick all our clinical history
and arriving at a diagnosis like that is
relatively easy and what happens if we
we die on the street if we have the bad
lucky to fall fulminated in the square
colon today forensic medicine is
will be in charge of investigating what has
past
practicing an autopsy
so find out what he’s dead
a person in rich countries is
relatively simple and what of the
autopsy is not an option is a
legal requirement or that as a rule
by law we have to submit to this
instead practice in countries more
poor and particularly in the areas
rural Africa where I’ve been for years
working the photo is completely
different
in these countries on the one hand the greatest
part of the people are born and die without leaving
a trace in the statistics
many of the people die without being
never seen by a doctor or by a
health and therefore know what has
happened in these cases is relatively
difficult is what some call the
scandal of invisibility because no
appear in statistics
in fact many of these deaths do not
they matter to people but because people
is not aware that they are happening
what can we do we should contribute to
make visible these deaths we must put
a focus that illuminates them that the
present to the world but that alone is not
enough we should try to understand by
what happens so that we can design
strategies that can prevent those
preventable causes and that can cure
those curable causes and that’s where
we fail and fail a lot
as I have told you in the most
poor many of the deaths occur in
the houses and how can we investigate a
death that has occurred in a house where
nobody has seen what has happened for these
cases the world organization of the
health developed a few
years a methodology called the
verbal autopsy and what the hell is the
verbal autopsy as the verbal autopsy
it’s just an interview
structured that is done to the
relatives of the deceased person
weeks or a few months after the
death had this interview happened
aims to try to collect
the maximum information available that
help us understand what happened during
the process of the disease until the
moment of the patient’s death the
answers to the questions asked
do the interviewee to the relative of the
deceased are subsequently evaluated
by a doctor or a team of doctors or
for a computer software
what value do you think a method has
like this one that depends on the answers
of family members about something that happened
a few weeks or a few months ago that
medical training we are demanding from
the respondents to the interviewees in
contexts in which in many cases
they do not know how to read or write
The truth is that the reliability of
verbal autopsies is as low as
throw a coin into the air and this what
we see in the type of answers that
we get for example what was wrong
had the disease of the moon oysters the
disease of the moon I think this
in my notes of the race does not come out and
since when I had symptoms since
who stopped being healthy
and you who believe that he died died of
disease this is not diagnostics
these are diagnoses of
resignation to notice that the only time in
my life that has appeared cited in the
prestigious science journal
I’m saying that the autopsies
verbal are a method of shit
affirmation of which I do not take pride
affirmation of which I do not take pride
but I still subscribe completely
I turn to rehearse anyway
they will not ask me again
but let’s go back to the methods that
we use in poor countries to
try to know what a
person if this person has had the
fortunate to be able to get in touch with
the health system and has been
seen in a clinic or in a hospital
we will have a little more information
but again how reliable this will be
clinical information in a context in the
that there is a significant shortage of
qualified medical staff and in which
we have very few diagnostic methods
available I will give you the example of
Mozambique the country in which to work in
the last years and that I know better
where for a population of 27 million
of inhabitants there are barely 1,200 doctors
distributed throughout the country as you
you can imagine with so few doctors
the bulk of clinical care does not
they perform the doctors perform it
health personnel trained in a way
less rigorous more accelerated as per
example, health agents or
nurses
and that we know about the methods
diagnostics so you can have an idea
in the hospital where I work
maybe one of the best hospitals in
the whole country despite being a hospital
in a rural area we have just four
or five diagnostic methods of
laboratory available for routine
daily clinic and we can only count on
simple radiography as the only method
image diagnosis
so
the logical the derivative of all this that
I just explained is asking and
how much do we clinicians get and what
they make it so difficult when we get it right and the
only way to know how much we hit
is to compare the diagnosis that arrives
the doctor who has seen the patient before
of dying with the diagnosis produced
determined by the reference method
which is the anatomopathological autopsy and
it’s just opening the corpse and looking
by oneself our group that leads
more than 20 years working on improving
diagnostic methods available for
the diseases in the countries more more
poor has been able to confirm that the number
of errors that are made during the life of the
patient are very important and that
it’s even in half the cases
There are discrepancies between what the
clinical before dying and what the
autopsy after dying
you will ask then if you have
followed my explanation because I did not
We do autopsies in the most
poor those who pass away there are two
main reasons the first is the
overwhelming shortage of pathologists or
personal
trained to do autopsies in the
poorer countries in a place like
Spain we have a pathologist for every
15,000 or for every 20,000 inhabitants
while in Africa there are countries in
those that there is not even a single
pathologist for the entire population
but more important than the problems of
human resources that after all
can be solved with training
accelerated here we have a very problem
important related to the
acceptability of the method this is a
bloody method is an invasive method to
nobody likes the idea that their
family be open in channel has
observed inside and has been returned
with a scar that goes from the thorax
to the abdomen and I can not help it
sympathize with this feeling so much
although the autopsy completes the autopsy
conventional is the reference method
be the best way to investigate
that a person has died, reality is
that this method is limping
acceptability is a method that therefore
is not feasible in these environments and
how can we then get out of this
Apparent blind alley because
know what people die from is
essential to be able to design
health policies is essential for
put in place measures that prevent
these deaths is also very important
to better manage the scarce
financial resources available to
these countries
for health
and here comes the eureka idea of this
talk that did not occur to me alone in the
bathtub like Archimedes but my
colleagues the pathologist already a clear order
menéndez epidemiologist are also parents
of the creature and we were not the three
together in a bathtub the researchers
We usually put our eureka moments
in much less glamorous places like
for example the laboratory
as we can
autopsies look for oneself the
inside of a body without opening it like
we could get samples of the
main organs of the organs more
important as the brain as the
lungs like the liver in a way
less invasive as we could
develop a method that is not
systematically rejected by the
communities or by relatives in
duel and the only way that we are
happened was using this kind of
needles
I will not remove the cap because
I want any misfortune to happen and what
we do with these needles, with these
needles puncture the corpses and
by piercing the corpses we are able to
get samples of the tissues more
important small tissue cylinders
like these that we can analyze in the
lab these little cylinders that
they are like noodles we can examine them under
the microscope and they will give us the
important information to tell us if
the organ from which we have taken them
We were healthy or were sick we can
say also if there was an infection
of this patient if we apply this
methodology systematically
we can understand what happens to the
main organs of the body and by
so much to have a pretty complete idea
of what was happening inside the body
and that has probably killed this
person and all this we will achieve without
just leave a visible mark on the
totally different body than
happens with the conventional autopsy and
you see that it is an idea of the simplest
but tremendously powerful our
group went to work and in the
last five years we have achieved
validate this new approach we have
confirmed that the autopsy minimally
invasive as it is known now is
a reliable method that can answer
to the main cause of death and whose
diagnoses correspond the great
most of the time with what the
conventional autopsy
for those cause deaths
Infectious diseases are very common in
poor countries the method works
particularly well it is capable of
diagnose very accurately the
name and if you hurry me up to eight
surnames of the microorganisms more
important causes of the infection and
therefore possibly responsible for
death all this is very well the
method works but the most advance
important of all this project has
what to do with the acceptability of the method
with his achilles heel we
we started with an acceptability
practically null the autopsy
conventional is an unpleasant method
is a dirty method is a method of which
many rumors are born of the most
colorful is a method that has a
bad reputation our team of
anthropologists has been able to demonstrate not only
in Mozambique but in a wide
variety of sociocultural environments
geographical and religious
this method has been much better received
by
communities
so we have a method that works
we have a method that has a good
acceptability much better than that of the
conventional autopsy and we also have
a method that is very easy to execute
anyone can learn to
perform one of these autopsies in two or
three days of training and you do not need to
a pathologist to implement what is
the consequence of all these findings
our method has been adopted and has
been implemented in a meteoric way in
up to a dozen countries in Africa and
in asia to investigate pilot
of what children die in this country and
the data that is being generated
starting from this project they have started to
change paradigms about death and
about its causes and if such a pathogen is
really much more frequent than what
we thought and if the disease is
begins to appear in places where
he believed that he had never arrived and if
there is a plausible explanation
simple and logical why some of
the prevention and treatment measures
that we are implementing
the common autopsies do not work
minimally invasive are beginning to
answer all these questions about
all with credible data finally
minimally invasive autopsies
they also have the potential to cause
a true metamorphosis of the way
in which we investigate the cause of
death who was going to tell me just do
a few years that a method born of
autopsy room was going to fill a large
part of my professional life especially
considering that it was there in the
autopsy room where I lay down the
practical examination of anatomy 1 the only
subject that he suspended in all the
career
there is life after death
no, there is not
but there is life from death I
I think that sure, sure
death can teach us a lot sure that
of so many and many premature deaths
unnecessary preventable we can take
the right lessons that allow us
avoid in the future that your place of
birth be the main
conditioning of your possibilities of
survive thank you very much
[Applause]
[Music]
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