To the Himalayas!

Image/facts borrowed (stolen?) from the BBC and healthcare.wurk.net

The World Health Organization's latest report estimates that 4 million health workers are needed in order to overcome the extreme shortage; over 1.3 billion people have no access to basic care. There are not enough physicians, nurses, and other staff being trained, but further to this, many skilled workers are flocking away from where they are needed to more developed areas, such as North America and Western Europe.

In the face of the growing HIV/AIDS epidemic and the possibility of an Avian Flu pandemic, there are too few workers with too little knowledge to provide the necessary care, patient education, and preventative measures.India and Nepal are among the countries cited as having a critical shortage of healthcare workers, although on the whole, Africa is most in need. Sub-Saharan Africa has only 3% of the world's health workers to deal wiht 24% of the global burden of disease. Certainly economic status as well as conflict or unstable governments play a huge part in this disparity.

My response: Reversing the direction of skilled healthcare worker flux

I’m fortunate enough to be attending a medical school with a strong ‘grassroots’ interest in Global Health. The topic is even built into our curriculum; one of our courses, “Doctor, Patient and Society” is designed to encourage us to think about the social determinants of health, among other things.

Despite this climate of international interest, most of my class will stay in Canada. There is a physician shortage here, especially in Rural Family Practice, and some aspects of our program are obviously meant to groom us to practice in this field.

It is possible to combine domestic (Canadian) practice with overseas work, in circumstances where working exclusively in developing countries just isn't possible. As a medical student with free summers, I actually have much more flexibility than a salaried physician or one who runs their own clinic. The problem is, I have less time and experience to share.

It’s been difficult to find an organization that has a sustainable program of care in a developing country, minimal operational costs (maximal transfer of funding to patient care), and still attempts to uphold the ethics that apply to cross-cultural care. I will be a member of medical trek to the Himalayas that encompasses most of these points, but it is only a start. We will deliver drugs, patient care and education, and learn a lot from the experience. The work I’ll be directly involved with, the physical and mental preparation for which I am documenting here, will only touch about 1300 of those 1.3 billion people without access to care. It still counts.

By no means are these trips a long-term solution. I think in the long term, such initiatives need to focus on the idea of “train the trainer.” This buzzphrase is found with increasingly prevalence in groups interested in global healthcare and education; it means that rather than having an initiative disappear when the foreigners go back home, we should educate those who are part of the local infrastructure to take over a program and make it their own.

However, in the interim, they may help to bridge the gap between the current lack of physicians and the long-term goal of attracting them / retaining them in the areas of most need. I imagine that a program of incentives – especially in Africa – may be part of the answer.