Tuesday, July 29, 2008

The Best of both Worlds

As I said in my post Aphorisms VI, Dr Rant pointed me to this excellent article, "The Best of both worlds: How primary care can save lives and money" by David Haslain, President of the UK Royal College of Royal Practitioners. Read it.

He argues convincingly about the cost and life-saving of primary care (GPs/family doctors in the community) and the relatively higher expense secondary care (specialist doctors and hospitals).

When I arrived here in this small island state of 1000 km2 off the coast of Africa in 1989 there were seven secondary care centres (hospitals) that also did the primary care. I.e. if you suspected you had malaria, you went to the A & E department of a secondary care facilty. Andif there were obviously more urgent cases than your own, then you would wait - no targets here. Out-of-hours just one doctor would staff A & E. If something specialised cropped up, s/hewould get on the phone to the specialist who would turn out of bed.

Some ten years ago I was walking in the mountains here on a Sunday when, in torrential rain, I slipped and the blade of the machete I was carrying embedded itself in the ground and my hand ran down its length deeply slicing the third three fingers of my right hand. Fortunately, I had a roll of toilet paper and a small towel in my rucksack, and we (I was out hiking with my good friend Vicente) wrapped up my hand and walked the remaining two hours back to the car. Then we drove another hour back to the capital with me steering one--handed and Vicente (having no driving license) manipulating the gearstick when I told him I'd depressed the clutch (fortunately, steering is on the left here).

Vicente wanted us to go straight to A & E. I said "Fuck that ... we're wet, we're covered in mud, I've survived three hours of arduous hiking and driving, I want to tell my partner (of the time) what is going on .... and more than anything I want a cup of tea!."

Half-an-hour or so later Vicente cycled home and my partner drove me to A & E at six pm. The doctor on duty looked at my fingers and called the Chinese surgeon - who spoke neither the national language nor English; The nurse in attendance was pretty savvy and managed to translate some, and as my Bachelor's degree, many years previous, had been in Chinese we managed to establish some communication. Diagnosis - I had severed my tendons in five places in three fingers - yup he was capable of doing micro-surgery on tendons but the surgical facilities to do micro-surgery were not available here.

A local anaeasthetic injection for finger surgery is painful, very painful. A very thin flexible needle is inserted deep between your digits and it hurts like fuck. I have seen someone faint from the pain.

So I asked him when I could have the stitches out - the reply was "three days, three weeks ...". Suddenly, my long-lost Chinese returned.

Fortunately the healthcare system here has been reformed.

Now we have one major secondary care centre in the capital city. We have what might me termed "polyclinics" in three towns, in which two have beds and midwives available.

Then in the rest of country we have health-centres whose services range from a malaria test to basic dental work.

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