relatively low standard of living, an undeveloped industrial base, and a moderate to low Human Development Index (HDI) score. In developing countries, there is low per capita income, widespread poverty, and low capital formation.This hospital in Ghana is pretty much a tertiary care center, meaning that this is not your average community hospital. Like our home hospital in Michigan, a huge portion of it's patients are referred from other clinics/hospitals because they are sicker or more complex than the average patient and this Ghana hospital has more resources than many other hospitals. What kinds of resources? Well, the technology is pretty advanced (including CT, MRI, coronary catheterization, etc) and the size means that it has specialists in virtually every field (note that this means African fields; there aren't any Emergency Medicine doctors here because it's not formally a field here). Even those resources are limited (e.g. the lack of a medical ICU ward). In order to visit the ER at this hospital you must be referred by an outside clinic and there is no mandate to see everyone. If they get too full or for other reasons they can turn people away.
Most of Ghanaian health care is fee-for-service with self pay. Meaning that you pay to see a doctor, then you pay for the EKG the doctor wants done, then you pay for the medication that he prescribes you. If you can't pay for any of these steps, then the system kind of breaks down. In most cases, family will help out (and much of this is much less expensive than the US prices because it's a developing country) but it can still overwhelm patients and there are many tests/studies that don't get done because patients can't afford it. You might see that as terrible, but the question is, if the patient can't pay for it then who should? Many would say the government should, but as a developing country the government doesn't have a huge amount of excess resources, or maybe the hospital, but even hospitals have bills that they have to pay. So, while there is an MRI here, it's usually not the first test ordered. If there's a cheaper alternative to an expensive test then it's preferred. And physicians have learned to do more with less. I've seen doctors here pickup pathology on a plain X-ray that most American MD's would miss (although it's important to realize that most American MDs have access to readily available CT's scanners which pick up even more than the plain X-rays). Clinical exam skills are a lot better because labor is cheap and machines are expensive.
In the end, many hard decisions have to be made here that don't have to be addressed in the US. For example, Ghana doesn't perform kidney transplants. Meaning that if your kidneys fail, you'll likely need dialysis forever. Even in the US, dialysis is usually seen as a bridge to transplant. If there is no transplant, than the treatment might seem futile. And at 100$ per dialysis session, meaning up to 300$ weekly, long term dialysis is no longer a possibility for most people here. Thus someone here with renal failure will die, while in the US thousands each year live with donated kidneys. None of the physicians like watching their patients die, but when resources are scarce, hard decisions have to be made. Luckily, Ghana is making great strides, and as such their life expectancy has increased by about a decade. And also realize that in the end, even the US (one of the wealthiest countries in the world) does not offer universal health care to its citizens. Even in the US, prescriptions go unfilled because they are expensive, tests are not done because no one can pay, and doctors must make hard decisions about limited resources.
No comments:
Post a Comment