This is what it looks like when the a country has no more than two or three doctors, and, at best half a dozen nurses, for every 100,000 patients:
Sick people don’t come for care until they are very sick, if they come at all. When they arrive they can look forward to spending the day waiting. The care may not be worth the wait if the only health care personnel around don’t have enough training to make diagnoses, prescribe appropriate treatment. And people who are hospitalized need to bring their families along – hospitals don’t have the staff to meet patients’ needs.
In that scenario, doctors from other countries – ones like the United States, where the ratio of doctors to patients is more like one to every 400 people – come and pitch in, providing critical services, but when they leave, the situation remains unchanged.
The physician making rounds won’t be followed by a cluster of 10 medical students, but 30 or 40, jostling to hear, see, learn from what the doctor is doing. Because a shortage of doctors also means a shortage of people to train new doctors, so the cycle of depleted, inadequate health care, with treatable illnesses leading to preventable deaths, continues.
This is the situation in sub-Saharan Africa, which bears nearly 25 percent of the global burden of disease, but with less than 3 percent of the global health workforce, described today by an American doctor and a Malawian doctor who are part of an initiative to change that. The initiative, the Global Health Service Partnership, is the combined effort of the Peace Corps, the President’s Emergency Plan For AIDS Relief, and the nonprofit Boston-based Global Health Service Corps.
The American doctor is Dr. Vanessa Kerry, who launched the Global Health Service Corps after standing up and asking a question at a presentation by two former Peace Corps dirctors, and then current director, Aaron Williams, at Harvard’s Kennedy School of Government a few years ago.
A self-proclaimed geek who decided to become a physician after dissecting her first frog in middle school, she had been drawn to global health after a trip to Viet Nam with her father, then U.S. Sen. John Kerry, now Secretary of State. The impact of what she saw there was deeply troubling she said. While she emphasizes that she was, and remains aware of poverty and inequity at home in the United States, she had never seen conditions equaling what she saw there: people without shoes, adequate clothing, living by the side of the road, without even hope.
“I am still confused about how so many people live in poverty without options,” she said. “There needs to be an engagement with the world to rectify that.”
One of the ways to do that is by recognizing the right to health and the capacity to deliver it are universal, said Kerry, who has worked in Rwanda with Partners in Health, and who is a physician at Massachussetts General Hospital. “We knew what was missing was education,” she said.
So, at the Peace Corps presentation, her question was this: “What do you think about the idea of the Peace Corps sending doctors and nurses abroad to educate health care professional, and build health care capacity?”
Williams paused, Kerry says now, knowing, apparently what he was getting into, and then replied: “That’s a great idea.”
Williams, who stepped down from the Peace Corps in September, worked with Kerry to see the idea through from concept, to contract, to implementation. He now serves on the board of the Global Health Service Corps. The Global Health Service Partnership, announced last March, will send its first teams, three dozen physicians and nurses to three countries: Tanzania, Uganda and Malawi in July. The teams will work with local health care professionals, following their needs, to train doctors, nurses, and in Tanzania, also clinical officers, in pre-service (classroom) and in-service (bedside) settings.
The arrival of six doctors, six nurses in Malawi will make an immediate difference, Dr. Johnstone Kumwenda of the University of Malawi in Blantyre said. “They will be training trainers,” he said. “The need is very large.”
While the health workforce was about 30 percent of what it needed to be in 1989, when he began to practice, he said, the HIV epidemic has decimated it further, through deaths in earlier years, and still through illnesses associated with the virus and side effects from substandard drugs that continue to be supplied through international funding to patients.
Malawi, like the other two countries launching the partnership, was selected in part because it has prioritized education efforts, Kerry said.
On the American side, the Global Health Service Corps raises money to pay off student loans, enabling doctors to make the commitment to a year of training others. The group has raised the funds needed for the first year, and now, she said, “the clock is ticking on the second year.”
Among the supporters listed on the group’s web site is Sen. Bill Frist. He is a strong supporter, Kerry says, pointing out he is one of the authors of the Kerry-Frist Global AIDS legislation that made the President’s Emergency Plan For AIDS Relief possible.
But the most memorable support she says, came with a letter from a man thanking the group for its work, saying he wanted to be part of it, with a $15 donation. “I want everyone to feel they can be part of it,” she said.
Kerry and Kumwenda were in Washington, DC Friday, at the the annual Consortium of Universities for Global Health meeting, where Kerry moderated panels on “U.S. Global Health Policy: Opportunities for the Administration and Congress” and “Creating a Sustainable Health Professional Pipeline: The Global Health Service Partnership,” on which Kumwenda was a panelist.