healthcare access in LMICs
Around 2 billion people around the world lack proper access to surgical care or advanced medical care. On average, low-and-middle-income countries (LMICs) have fewer than two operating rooms and one trained surgeon per 100,000 people. Due to this, treatable maladies often result in death. In 2011, around 5 million people died of injuries in LMICs. The barrier between proper medical care and patients is the cost of care. More often, the costs of admission, medications and food are based on the strained economic conditions of impoverished countries. The shortage of medical professionals in LMICs has been identified as one of the most significant obstacles to achieving health-related U.N. Millennium Development Goals (MDGs). One can see the severity of this lack of healthcare access in LMICs in countries such as Mozambique, with only 548 doctors for more than 22 million people.

Lack of Medical Professionals

The absence of medical professionals in LMICs is often due to the poor economic situation of these countries. This results in limited financial resources to support a good healthcare system and provide proper training for doctors. Even when training is available, many skilled doctors work overseas due to others offering them a better medical career abroad, leading to a lack of healthcare access in LMICs. The British Medical Journal claims that “African countries have lost about $2.6 billion…training doctors who are now living in western countries.”

On average, there is less than one doctor for every 20,000 people in Chad. In addition, an equipment shortage in Chad means there are fewer than four hospital beds for every 10,000 people. Furthermore, inequitable distribution of service is a major problem in these countries. Due to a limited number of doctors being available to treat millions of people, often patients with a higher income receive what little medical support is available. Those of a lower income in these countries find it more difficult to afford treatment and especially cannot afford emergency medical procedures.

Consequences for Patients

Lack of trained medical professionals often means that diseases, surgeries, injuries and complications often result in death. Disease is excessive and often untreatable in these countries. Medical procedures often require advanced training and experience to be conducted successfully. The demand for these procedures greatly exceeds the supply of surgeons and institutions, leading to low healthcare access in LMICs.

For example, 90% of those who are visually impaired live in LMICs. According to the World Health Organization (WHO), 80% of cases involving visual disability are preventable. Eye surgery, an effective method of treating blindness, is rarely available. Furthermore, according to the National Library of Medicine, 6 billion people in LMICs lack access to safe and affordable cardiac surgery.

According to WHO, 94% of all maternal deaths occur in low- and lower-middle-income countries. Many women facing birth complications rarely have access to trained professionals who can handle these complications. Sometimes, doctors with insufficient training may perform emergency procedures improperly, resulting in debilitating injuries or even death. Furthermore, 99% of hemorrhage-related peripartum deaths occur in LMICs. These problems all stem from the fact that a qualified medical professional attends less than 50% of all births in LMICs.

Rising Cancer Rates

Another consequence of a poor global healthcare system is the rising cancer mortality rates in LMICs. More than half of the 10 million cancer deaths in 2020 occurred in LMICs. When comparing the healthcare systems of different regions, high-income countries usually spend around five to 10 times more per person. As a result, less than 50% of those diagnosed with cancer in high-income countries die from the disease. On the other hand, 66% of those diagnosed with cancer in LMICs die from the disease. This is mostly due to the fact that LMICs do not have the resources for treatment facilities or radiation therapy centers.

Organizations Making an Impact

Organizations like the Medical Education Partnership Initiative (MEPI) support the training of doctors to improve healthcare access in LMICs. MEPI works to increase the number of new healthcare workers, strengthen medical education systems and build clinical and research capacity in LMICs. Charities such as Mercy Ships send volunteer surgeons to provide lifesaving surgical procedures and invite local doctors to expand upon their surgical skills alongside the volunteer surgeons. Mercy Ships also provides mentoring programs for surgeons, anesthesia providers, ward nurses, operating nurses and biomedical technicians. By providing new medical tools and resources, constructing new medical facilities, providing training for local professionals and working with local governments, Mercy Ships leaves a long-lasting impact.

Poverty and disease are closely related. In order to have significant improvement in global health, economic development of LMICs and improved medical education is essential. The growing disparity in surgical access and other health services requires urgent attention. We can put this into action through the comprehensive development of healthcare access in LMICs.

– Arya Baladevigan
Photo: Unsplash

Bolus, Outdated Medical Routine Endangers African Children
In 2011, a group of researchers published results in the New England Journal of Medicine suggesting that the Western method of treating shock leads to a higher mortality rate among African children. Despite these findings, the WHO has yet to revise its shock treatment process- potentially risking the lives of thousands.

For decades, seriously dehydrated patients in Europe and other developed countries were treated with large quantities of fluid in a 15 minute drip known as a bolus. Until the 2011 trials, this practice had never been tested in a clinical setting. Named the Fluid Expansion As Supportive Therapy (FEAST), the trials enlisted over 3,100 African children suffering from shock and tested the effectiveness of bolus-treated patients versus non-bolus treated patients.

The results stunned doctors and led to a premature shutdown of the trials due to an excessive number of deaths. Overall, researchers concluded that the presence of bolus significantly increased 48-hour mortality in critically ill children. Bolus-treated children had an 89.4% survival rate whereas the non-bolus treated children had a 92.7% survival rate.

Put shortly, out of every hundred children treated, more than three died from the bolus treatment than those who were rehydrated more slowly.

Possible explanations for the perceived discrepancy between African and European success rates include better hospital facilities in Europe, access to ventilators, and the increased severity of the cases in Africa. Until a similar trial takes place in a developed country, doctors will not be able to definitively explain continental differences.

However, as Sarah Boseley reports in The Guardian, the WHO 2013 edition of the Pocket Book of Hospital Care for Children still lists a 20 ml/kg bolus as an acceptable method of shock treatment.

A recently published paper in the British Medical Journal expressed concern that the number of children meeting the WHO’s standard definition of shock “might expose substantial numbers of children to harm.” Based on the known number of children along the Kenyan coast treated for shock ranging in the millions, the BMJ believes continued rapid fluid resuscitation treatment could produce “hundreds of thousands of excess deaths.”

As a preeminent leader in global health and safety, the WHO’s actions directly influence the lives of millions. Their continued use of a highly questionable practice reflects poorly on the organization, and postponing a response only weakens their influence in the developing world.

Emily Bajet

Sources: The Guardian, The Guardian Heath, BMJ, The New England Journal of Medicine, Modern Ghana
Photo: The Guardian