Upon my return to the United States from Kabul, Afghanistan for a little R & R (rest and relaxation), I spent some time in a U.S. hospital system when my sister required a biopsy. As a nurse practitioner who has practiced in many places in this world, including Africa, Asia, Europe and the Caribbean island of Haiti, I sat in wonder of the U.S. medical system I had taken for granted.
To my colleagues who also work in remote places, I say, imagine a hospital with clean floors, medications available when the health care provider orders them, an efficient administrative staff, air conditioning in the summer and heat in the winter, a safety-conscious environment, meals delivered to your patients’ rooms, clean linen, disposable gloves, patient call buttons and access to mammography before a lump is palpable. These are all items normally available at U.S. hospitals. Life under these circumstances would be heavenly for those of us in the “field.” Understand that these benefits are not the norm in many hospitals around the world.
In Africa, most hospitals require families to provide meals and perform daily bathing and changing of linens. There are too few nurses to take care of too many patients.
Morocco has recently started encouraging women to get mammograms. Unfortunately, the service is not affordable for most women. In Casablanca, the Institut Pasteur reports that the pathology department is seeing more early-stage tumors. In previous years, most tumors were stage 4 specimens. It’s a sign of progress.
In Hungary, local nurses told me that, historically, disposable gloves were washed on the night shift and reused, as there was no money to purchase additional gloves. Poor funding of public hospitals in pre-European Union days demanded adjustments in techniques. The public hospitals do good work under severe budget restraints, but only privately funded hospitals can afford to comply with all the regulations and recommendations.
In Liberia, a nurse told me she thought piped-in oxygen was a wonderful idea but did not expect to see this modern equipment during her lifetime.
In many hospitals around the world, when a medication is prescribed to an inpatient for PO or IV use, the family must go to the pharmacy, purchase the drug and bring it back to the hospital for the ward nurse to give to the patient.
I remember my African housekeeper asking for extra money to treat her malaria. When I questioned her about the results of her tests, her remarks stayed with me a long time. “We can’t afford both the tests and the medicines, so we buy the medicine when we get the fever.” Education comes in many forms.
I do not want to convey an unwritten message of “Don’t get sick outside the USA.” I have seen many doctors around the world, with excellent skills and little technology, who perform some pretty impressive diagnoses. When X-rays aren’t available, listening to a chest with a stethoscope takes on different intensity. When the nearest CT is 100 miles away or in the next country, a well-performed abdominal exam by an expert physician is held in extremely high esteem.
In many countries, very little high technology is available to doctors who take care of the common man or woman. Consequently, physicians have honed advanced ultrasound skills seldom seen elsewhere.
While I am only days away from ending this R & R and returning to Afghanistan, I am gently reminded that, even though our system isn’t perfect, I am grateful that it does struggle for continuous improvement.