tropzam
Despite its limitations, the Brandt report highlighted serious deficiencies in the sharing of global wealth between the developed (North) and underdeveloped or ‘Third World’ (South) countries; the world is thus divided, both philosophically and nationally, by a ‘poverty curtain’. As responsible global citizens, members of the medical profession have an important rôle therefore, in providing a solution to those problems – not least, in the areas of nutrition, population, and hopefully in influencing the ‘arms race’.
Within the ‘Third World’, medical and paramedical personnel have an enormously important potential rôle; whilst many of those countries were producing such staff, in 1980 they still largely remained dependent on expatriates – both practically and more importantly in producing plausible strategies for a solution to these problems. That was largely because it was well nigh impossible, in most developing countries, to retain sufficient numbers of qualified doctors. The cost effectiveness of doctor-delivered health-care is relatively low, especially in rural areas of the developing world. Therefore appropriate methods of delivery of health-care had to be developed, and the medical auxiliary thus became the focus of much attention. As a revolt against bureaucracy, capitalism and high technology, and following an increase in political awareness, the Appropriate Technology Movement had been established. Much has been written on this subject in recent years; that resulted in a confused message in the minds of those seeking Utopia; one debate in particular centred around whether hospitals (including teaching hospitals) were in fact necessary in the ‘Third World’.
As an example, the population of Port Moresby, the capital city of Papua New Guinea (PNG) had been, and is presently increasing at a great rate. By any standard, the Port Moresby General Hospital (PMGH) was, in 1980, inadequate. Although opened as recently as 1957, it was no longer able to cater for the requirements of Port Moresby, let alone the whole country, and as a University Teaching Hospital it was totally inadequate. Most of the wards – until recently designated ‘Native wards’ – consisted of corrugated iron-roofed structures with rapidly decaying prefabricated walls ( figs 1.1-1.7 ). The patients were in many cases exposed to the elements, and the standard of sanitation was appalling; it was frequently impossible for a patient to get a sheet to cover a mattress, let alone one to cover him/herself. Faecal odours were so pronounced that many found it impossible to tolerate this insult to human dignity; many complained that they could not eat their meals, so great was the stench. The hospital equipment was overall archaic; it was impossible to keep the buildings clean and consequently morale at all levels – not least amongst the nursing staff – was of a very low order. After a three-hour ward-round in this atmosphere, often at a temperature of >30ºC, and occasionally with vomit and faeces lying on the floor, it was virtually impossible to make an intelligent or accurate diagnosis. This was the major hospital for a country with a population of around four million!
The situation in some hospitals in Britain in 2007 is not too different; owing to excessive bureaucracy, absence of matrons and a gross excess of lay-administrators, nosocomial infections – including multi-antibiotic resistant Staphylococcus aureus and Clostridium difficile – are rapidly becoming out of control. It has even been suggested that Britain should take lessons in hygiene from the French: a suggestion that a few years previously would have been considered risible!
Learn more
about
the author
about
the author
Health Care For All: From Chapter 1
