the luxury of western medical care

McMaster University Medical Centre (by zavero on Flickr)

After taking a toddler to one of the world’s poorest countries with one of the world’s highest patient-to-doctor ratios, I have a great appreciation for access to Western medical care. Simon Oczkowski, a recent graduate of the medical school at McMaster University in Hamilton, Ontario (Canada), wrote about two experiences with rabies during a trip to Uganda. One from the perspective of a medical student observing at Mulago Hospital in Kampala:

“There’s an interesting case you should see if you have time,” said the attending physician cheerily. “You should look up his condition in your book and take a history. It might be good for a case write-up when you get home.”

We had just stepped into the casualty department, hoping to catch some of the evening’s action. It seemed as though the action had found us. Puzzled, one of us asked what the patient had.

“Rabies, a classic case,” the physician said. She paused. “But I’m not sure what to do about it.”

And another from the perspective of a possible bat-bite whilst on holiday at Murchison Falls National Park:

Despite my protests, consults with the local Mulago doctors, and personal research, I knew that the doctors at home were probably right. If I had been bitten by the bat, and if it had carried rabies, the only rational thing to do would be to minimize the chances that the disease would spread throughout my system. The severe consequences of infection were too great to avoid taking all necessary precautions…“Look, health care is practised differently in Uganda than it is in Canada … and since you can’t get the immunoglobulin there, your best bet really is to come home. So quit stalling in Kampala and start making arrangements to fly back as soon as possible.”

What would any of you do in a similar situation? I can say that when the mini-me was sick and we had exhausted the abilities of the local health workers in Mchinji, Malawi, we drove in the middle of the night (a danger in itself) to a clinic run by a missionary doctor, an American trained at two really good medical programs in the US. Whatever negative feelings I had about missionaries in Africa, my health insurance company wanted to medically evacuate my daughter and this missionary doc was our last in-country attempt to get her better. (I now appreciate that there’s a lot we can learn from missionaries.) Just a few months later, when the mini-me broke her arm, we drove to a different pay-for-service clinic run by a British pediatric orthopedic surgeon. (They do excellent work there, both for-profit and not.)

Should I feel guilty that I took my daughter to Western doctors when she needed medical attention in Malawi? My mother would say, “Of course not.” In fact, she’d say I should feel guilty for taking my daughter to a country where childhood mortality is so high. I empathize with Simon’s write-up of his experiences with rabies in Uganda because I believe the inequality of access to medical care is an injustice, yet I am not willing to stand in some false-conscious sense of solidarity by not seeking out the best medical care. When I’m in Malawi, I take anti-malarials. I’m not of the belief that Westerners who catch Malaria whilst on a trip to Africa know any better the African experience or that by getting sick in such a way metes out some sort of justice (even after an impassioned conversation with a new colleague that such is the case).

HT: Michael Kevane at the FAVL blog.