World health care: "Many countries have their priorities wrong"
by Pat Caraher | © Washington State University
"Evidence shows that the family medicine model is the most cost effective and provides the best care for most people." —Dr. Robert Higgins
If you are sick enough and have enough money, you can get very good medical care in most countries. Sadly, however, many nations fail to meet even the basic health needs of their people.
These are the observations of Washington State University pharmacy graduate and retired U.S. Navy physician, Robert Higgins. The former president of the World Organization of Family Doctors (WONCA) has visited 53 countries and witnessed health care practices firsthand in many of them.
"Many countries have their priorities wrong. They may provide liver transplants to the affluent, rather than basic health care for the majority," he says. Or they may spend their money building hospitals or training subspecialists.
Few people have a better feel for the pulse of global health care. In 1998, Higgins was installed as WONCA president in Dublin, Ireland. The organization represents more than 160,000 family doctors in 62 countries. As president-elect of WONCA and during his three-year presidency, he visited 45 countries. Helping nations, particularly developing nations, reform their health care system is difficult. Progress is being made slowly, he says.
Higgins was introduced to international medicine in Vietnam in 1966, a year after graduating from the University of Washington School of Medicine. He was drafted into the Navy and spent 12 months aboard a repair ship in the Mekong Delta. There he provided medical care for U.S. Navy and Marine Corps personnel and the wounded, combat injured, sick, and diseased. Most weekends he ministered to the health needs of Vietnam village people. While the work with the Vietnamese was fulfilling, he said he was frustrated knowing that "they wouldn't get on-going care."
For five years now, Higgins and two other family physicians from the Boston area have worked to remedy the situation. Their efforts focus on training more Vietnamese doctors to work in the country's rural communities. A new six-year, $1.8 million grant from the China Medical Board of New York supports the program.
Higgins has visited Vietnam more than half a dozen times, most recently in November 2002. "There's no way you can have a strong economy without a healthy workforce," he says.
Higgins and his colleagues have helped establish a curriculum and training program for Vietnamese family doctors. As part of the program, professors from Vietnam come to the United States for six to nine months to train as family medicine teachers. Three medical schools in Vietnam have been paired with three schools in the U.S.-the University of Massachusetts, Boston University, and the Maine Medical Center. The program also calls for U.S. physicians and professors to spend a week with their counterparts in Vietnam annually.
The ultimate goal is to staff some 10,000 Vietnamese commune clinics with family doctors. Higgins is confident the program will succeed. "It will take a while, but we are well on the way to doing this," he says. "Evidence shows that the family medicine model is the most cost effective and provides the best care for most people in a country." He works closely on the program with others, including World Health Organization officials.
Although lack of education is the biggest problem facing people of the world, in Higgins's estimation, he identifies AIDS as the major worldwide health care concern, along with tuberculosis, mainly in Africa, but also in other countries. He sees education and "changing the culture" as the best hope of confronting AIDS. "Or to find a vaccine, which we haven't been able to do yet."
"Of course, starvation is another big issue that needs to be addressed," he says. Malaria still hasn't been controlled in some countries. Polio cases, once nearly under control globally, have nearly tripled in India in the first half of 2002. If they [residents of India] had good health care, they would be getting their polio shots or oral vaccine, he says.
Higgins considers family medicine "the most interesting place to practice" because of its wide variety of medical cases, and "not knowing what is coming next." Family doctors learn to know their patients better, because they see them in continuity. "I've delivered babies, set fractures, done hospital work and pediatrics," he says. "Family medicine is the most needed specialty."
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