It is very expensive to deliver poor quality health care to poor people in a rich country
-the man, the myth, the legend: Dr. Paul Farmer
After jumbling times at the International AIDS conference and realizing after the fact that I had missed a presentation by both Paul Farmer, a physician that co-founded Partners in Healthcare, AND Elton John, I was relieved to know that Paul Farmer was coming to Gallup, New Mexico to present.
Paul Farmer has written extensively on inequalities on a global scale in health care, as I have only read one of his books (now signed!) "Infections and Inequalities" I will be primarily drawing from this, his talk, and personal experience. What I found fascinating about "Infections and Inequalities" is that it provided data to support truths that I had already experienced. At the risk of sounding like a cliche 20-something year old American girl (which I am), it took a trip to a third world country for me to see that the problems of Africa are not so distant from the problems at home. I saw the same disease states in the homeless population of Boston as I did in Tanzania, namely tuberculosis and HIV.
Paul Farmer remarks in his book that an analysis of the cause of death for the worlds wealthiest fifth is dramatically different than that of the world's poorest fifth, where the leading cause of death is not heart disease or cancer, but rather infectious disease. Shocking still is that likelihood of contracting an infection (or dying from infectious disease) is not determined by the country of origin, but rather from a person's socioeconomic status.
To return with my opening quote from today's lecture, I believe that Dr. Farmer intended to weigh quality of care with budget, an issue that I am confronted with daily, if not hourly, at an Indian Health Service hospital. When funds are limited, how can we ensure that we are delivering the high quality care that every patient has a right to while staying within budget restrictions?
Dr. Farmer explained that currently, much of the money going into HIV/AIDS programs is being funneled into establishing primary care programs, which benefit not only HIV positive patients, but the other members of their communities of well. When chronic disease states are well managed, the cost of care decreases as a result of decreased complications. The issue with weighing finances with quality of care is that large funds are not typically allotted to establishing good primary care. Dr. Farmer emphasized the importance of establishing structures, like the hospital or clinic itself, training caregivers, and providing community health reps as vital in improving care quality. Community health reps are people that go on home visits to ensure not only that the patient is taking medications, but also that everything else in the patient's environment is not contributing to worse health outcomes.
Providing poor quality care increases health expenditures as it does not decrease complications of chronic and acute disease states. A dear friend of mine in Tanzania became ill, was hospitalized for two weeks, and subsequently died. I returned to Tanzania to see her family and to pay back the hospital bill.
My friend's mother, Bibi (KiSwahili word for grandmother) had already sold her cow in order to make the payment. I agreed to pay her back, only to discover that the cost of a two week hospitalization at a rural hospital was ~$275 USD. The difference in cost between this and a 2 week hospitalization in the U.S. is astounding. When tourists fall ill, they are most often airlifted to the Nairobi hospital, which seems to be considered to provide the highest quality of health care within Eastern Africa. The cost of care at this facility, in addition to transport to this hospital, would have undoubtedly exceeded $275, but would my friend have lived? In healthcare, as in most things, you get what you pay for.
Paul Farmer emphasized that many things comprise the health of a patient. He believes that poverty, political unrest, and unemployment among other things are disease states. Changing a patient's situation in life has dramatic effects on their health. Many interventions we can make, such as sending out community health reps or CHR, can make an impact through helping the patient to find a more stable living situation or even help to repair things in the patient's home (the example he gave was of a CHR sent out to provide education on diabetes but instead helped to repair a patient's roof). Ensuring a patient's nutrition status can dramatically change their health status as well, to paraphrase Dr. Farmer:
I am excited to say that I will soon be receiving a nobel prize for discovering that the cure for malnutrition is something called "food".
Simple, but stable, interventions can go a long way.
-the man, the myth, the legend: Dr. Paul Farmer
After jumbling times at the International AIDS conference and realizing after the fact that I had missed a presentation by both Paul Farmer, a physician that co-founded Partners in Healthcare, AND Elton John, I was relieved to know that Paul Farmer was coming to Gallup, New Mexico to present.
Paul Farmer has written extensively on inequalities on a global scale in health care, as I have only read one of his books (now signed!) "Infections and Inequalities" I will be primarily drawing from this, his talk, and personal experience. What I found fascinating about "Infections and Inequalities" is that it provided data to support truths that I had already experienced. At the risk of sounding like a cliche 20-something year old American girl (which I am), it took a trip to a third world country for me to see that the problems of Africa are not so distant from the problems at home. I saw the same disease states in the homeless population of Boston as I did in Tanzania, namely tuberculosis and HIV.
Paul Farmer remarks in his book that an analysis of the cause of death for the worlds wealthiest fifth is dramatically different than that of the world's poorest fifth, where the leading cause of death is not heart disease or cancer, but rather infectious disease. Shocking still is that likelihood of contracting an infection (or dying from infectious disease) is not determined by the country of origin, but rather from a person's socioeconomic status.
To return with my opening quote from today's lecture, I believe that Dr. Farmer intended to weigh quality of care with budget, an issue that I am confronted with daily, if not hourly, at an Indian Health Service hospital. When funds are limited, how can we ensure that we are delivering the high quality care that every patient has a right to while staying within budget restrictions?
Dr. Farmer explained that currently, much of the money going into HIV/AIDS programs is being funneled into establishing primary care programs, which benefit not only HIV positive patients, but the other members of their communities of well. When chronic disease states are well managed, the cost of care decreases as a result of decreased complications. The issue with weighing finances with quality of care is that large funds are not typically allotted to establishing good primary care. Dr. Farmer emphasized the importance of establishing structures, like the hospital or clinic itself, training caregivers, and providing community health reps as vital in improving care quality. Community health reps are people that go on home visits to ensure not only that the patient is taking medications, but also that everything else in the patient's environment is not contributing to worse health outcomes.
Providing poor quality care increases health expenditures as it does not decrease complications of chronic and acute disease states. A dear friend of mine in Tanzania became ill, was hospitalized for two weeks, and subsequently died. I returned to Tanzania to see her family and to pay back the hospital bill.
My friend's mother, Bibi (KiSwahili word for grandmother) had already sold her cow in order to make the payment. I agreed to pay her back, only to discover that the cost of a two week hospitalization at a rural hospital was ~$275 USD. The difference in cost between this and a 2 week hospitalization in the U.S. is astounding. When tourists fall ill, they are most often airlifted to the Nairobi hospital, which seems to be considered to provide the highest quality of health care within Eastern Africa. The cost of care at this facility, in addition to transport to this hospital, would have undoubtedly exceeded $275, but would my friend have lived? In healthcare, as in most things, you get what you pay for.
Paul Farmer emphasized that many things comprise the health of a patient. He believes that poverty, political unrest, and unemployment among other things are disease states. Changing a patient's situation in life has dramatic effects on their health. Many interventions we can make, such as sending out community health reps or CHR, can make an impact through helping the patient to find a more stable living situation or even help to repair things in the patient's home (the example he gave was of a CHR sent out to provide education on diabetes but instead helped to repair a patient's roof). Ensuring a patient's nutrition status can dramatically change their health status as well, to paraphrase Dr. Farmer:
I am excited to say that I will soon be receiving a nobel prize for discovering that the cure for malnutrition is something called "food".
Simple, but stable, interventions can go a long way.
