BY SAKSHI KUMAR
Macha, a small ‘city’ (if one can even call it that) in Zambia, is amongst the smaller settlements of this central African country. A large proportion of the locals are subsistence farmers who do not have any access to electricity whatsoever – it is, after all, a fairly new arrival here. I often find myself thanking the stars above that the local research facility provides me with access to hot water and Internet.
It is needless to say that those of us who have traveled here for research purposes are very easy to spot in the Machan community. I have grown accustomed to responses I elicit from the locals (they are either somewhat hostile or very, very friendly – rarely in between the two) and have learned to embrace both the looks of scorn and the surprise hugs. I met a doctor at the local hospital who was very eager to take me on rounds with him – he liked teaching, he told me, and said that he would love to tell me a little bit about the cases that he deals with. Needless to say, he was of the friendly variety.
Quick disclaimer: My knowledge of medicine is close to nothing. I would love to detail exactly what the doctor described to me, but that information simply went in one ear and out the other.
While we were on rounds – rather, while he was checking on patients as I stood awkwardly behind – he turned around and proudly told me that ‘this hospital has not had a death related to surgical complications in seven years!’ Realizing that he was out on a limb for me by having me follow him around, I politely accepted his statement and didn’t dare to question it. That does not mean, however, that I did not have questions to ask – I had several. How many people with potentially curable ailments died because operating on them would have been too risky and may have ruined your clean sheet? What even is your definition of surgical complication?
Don’t get me wrong – I’m not a cynic at all. It is quite possible that this statistic was completely true, and the surgeons at this hospital were especially talented. However, given the things that I saw while doing rounds, I doubt this is the case. Let me explain why:
Patients (and their families) at this hospital had to travel here from rural, isolated villages. Traveling incurs a huge cost on their budget; it is often the same amount of money as a day’s worth of food. As a result, the decision to visit the hospital is always made at the last possible minute. What may have been a simple case of appendicitis requiring a standard surgical procedure then has the opportunity to become something more dangerous and life threatening.
Of course, economically, it makes sense for the villagers to go about matters this way. After all, how many times do we feel poorly one day, only to find that we feel perfectly fine the next? I would estimate that approximately 60% of cases in this hospital were related to treatable diseases being left unseen, thus causing them to develop into more serious ailments. It seemed highly unlikely, after noticing this trend, that the doctor’s statistic was 100% accurate.
It is obvious that this pattern hardly exists in developed countries like ours– a trip to the hospital has a much lower opportunity cost than it does in developing countries. But this is not a behavior that many of us fortunate enough to have been born into well-off families know about. Amongst several other things, is simply another factor to consider when attempting to improve healthcare provision in developing countries – it is not as easy as it looks, and as much as we might wish for a magic silver bullet to solve the problem, it is evident that one simply does not exist.
Sakshi Kumar ‘ 16 is blogging from Zambia this summer. You can contact her at sakshi.kumar@yale.edu.