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On "clinical deserts" in global health:
Folks in global health often care about vaccinations, bed-nets, WASH & other public health measures.
This is important, but what communities first want is medical treatment for people who are sick.
Good projects address BOTH needs!
Folks in global health often care about vaccinations, bed-nets, WASH & other public health measures.
This is important, but what communities first want is medical treatment for people who are sick.
Good projects address BOTH needs!
As Paul Farmer & other clinicians in global health point out:
"People, when they are sick, are not looking to be sprayed, controlled, counselled, told about bush meat... they are looking to survive, and when they see the quality of care is not good, they are going to flee"
"People, when they are sick, are not looking to be sprayed, controlled, counselled, told about bush meat... they are looking to survive, and when they see the quality of care is not good, they are going to flee"
Farmer uses Ebola in West Africa to illustrate how dominant this "control-over-care" paradigm is in the global health, and why it has its origins in colonial medicine. See my interview: https://www.forbes.com/sites/madhukarpai/2021/02/08/ebola-covid-19-and-the-elusive-quest-for-global-health-equity/?sh=74c3ebca578e
By focusing mostly on 'cost-effective' & low-cost public health interventions, many global health programs have neglected the clinical deserts.
It is mainly clinicians in global health who constantly point out this big failure & advocate for better medical services.
It is mainly clinicians in global health who constantly point out this big failure & advocate for better medical services.
This post about @AaronLBerkowitz's book captures the essence of why clinicians in global health do what they do: they believe every person is a person and needs quality medical care https://naturemicrobiologycommunity.nature.com/posts/changing-lives-one-by-one-by-one
Global health now attracts many MDs who are passionate about ensuring medical care for the most under-privileged. See global surgery, global anesthesiology, global oncology, global child health, global mental health, global pathology, global neurology, global health nursing, etc.
I first learnt about the importance of clinical care during my public health residency training at CMC, Vellore, India, where community physicians ran a hospital (first referral unit), and had to provide clinical care.
Those days, I also learnt that a common mistake people made while launching community health projects was to push prevention, before meeting the clinical needs of the communities.
Projects like @jssbilaspur addressed medical needs in a big way, with huge impact
Projects like @jssbilaspur addressed medical needs in a big way, with huge impact
So, one key difference between "global health" and "public health" is that global health opens the space for clinicians, nurses & allied health professionals to contribute & welcomes their contributions.
This is a positive aspect of global health (with all its contradictions)!
This is a positive aspect of global health (with all its contradictions)!
But most funding agencies would likely NOT fund the provision of clinical care. This is assumed to be the responsibility of local governments, not the project.
This puts the project is a tough spot - how do you pull off a public health intervention in a clinical desert?
This puts the project is a tough spot - how do you pull off a public health intervention in a clinical desert?
As @Real_Ironist points out in his book "Epidemic Illusions" this could result in "research-without-clinical-delivery rites", as happened during the Ebola outbreak in West Africa.
"Research enterprises lacking clinical delivery platforms should be seen as part of coloniality"
"Research enterprises lacking clinical delivery platforms should be seen as part of coloniality"
To address "research-without-clinical-delivery" in LMICs would require a big shift in how we fund research & how we collaborate with others.
Researchers will not be able to do everything, but they can definitely team up with local facilities, governments, NGOs & clinical teams.
Researchers will not be able to do everything, but they can definitely team up with local facilities, governments, NGOs & clinical teams.
To close, irrigating clinical deserts is "price of admission for all who engage in the noble struggle for global health equity" (Farmer)
