Where Did the Doctors Go?

The United States has always been known to hoard resources such as energy and power, but it surprised me to hear that healthcare is on the list as well. While our healthcare system is certainly no where near perfect, we are stealing resources, such as doctors, from other countries particularly the developing world. Despite accounting for only 10 percent of the global disease burden, the America's have 37 percent of the world's health care workers and spend more than 50 percent of the worlds healthcare budget. On the other hand Africa, which has 24 per cent of the world's disease burden, has a mere just three per cent of the world's health-care workers and accounts for less than one per cent of global health-care spending.

This graph shows the great disparity between the number of physicians in developed and developing countries. This data is old and the difference has only increased since. 

Furthermore, it is not even the case that doctors are not being trained in these countries, but rather that 25 percent of doctors and five percent of nurses trained in Africa have opted to work in developed countries. The countries who need the aid the most have been the hardest, for example Zimbabwe has lost thirty four percent of its nurses and Ghana has lost 26 percent of its doctors. But honestly, who can blame the doctors who want to go to another country where they will have a much higher success rate in patient treatment, as well as a higher standard of living for themselves and their families. 

However, this has left the citizens of these developing nations out to dry, and the World Health Organization has estimated that more than four million more health-care workers are needed in 57 countries, mostly in Africa and rural parts of Asia, to even begin to fix the medical disparity between the developed and developing world. Realistically, even with extra money for medical training and foreign doctors, it just isn't possible to have enough doctors in these developing regions, particularly in rural areas of Africa and India. Training doctors takes time, and motivating these doctors to work in these regions is tedious. Therefore, I believe that the answer lies in new information and communication technology to reform healthcare in these developing areas. Obviously doctors are irreplaceable, but amongst this shortage of doctors and exponentially growing diseased population it is imperative that technology be put in place that can act as a supplement to doctors. This technology has already touched the lives in the lesser endowed parts of the world why not apply this to healthcare as well? ICT technology will be able to reform the healthcare field particularly in developing countries where often times many treatable illnesses result in death because of a lack of communication. 

Villager taking the temperature of a rural boy in India
he will then send this information via SMS to a
doctor in a more developed part of the nation for a diagnosis
and prescription.

The concept of the Tele-Doc put into place in rural India is the idea I see as promising to reform healthcare in the developing world. TeleDoc essentially allowed village health workers in India to serve as real doctors to populations in dire need. It provided hand held mobile devices to village health workers, trained in primitive diagnostics, in India permitting them to collect information about patients and then communicate with doctors in other locations through pictures and SMS,  who could then use a web application to help diagnose and prescribe for patients.  The goal of TeleDoc was a low cost healthcare option for those areas often underserved by the healthcare system and thus better combat illness and disease in these areas. It is much cheaper to have a local villager, trained in diagnostics, collect data than a doctor go on site, thus saving thousands of dollars right there. Additionally, this will allow the doctors to help more people, more efficiently which is especially important where doctors are a scarce resource and time literally is lives. The benefits of the TeleDoc program are endless, from improved care since many of these villagers had never seen doctors in their lives, to job creation for the village. TeleDoc offers the opportunity for village men and women to earn an income by conducting basic medical help to their fellow villagers and in this way ensure that a large share of healthcare revenue remains in the local economy. It is a self-sustaining system, which will ensure its success. I think one of the most appealing parts of this system is the idea of a remote doctor. 

Research makes it plain and clear that doctors are able to diagnose many diseases from a remote location with adequate pictures and diagnostics from the site, especially when it is in an are where the disease is highly prevalent. For example, the diagnosis for malaria has clear signs that can be assessed by a doctor with the right information sent by a village professional. Thereby the patient is helped, the doctor retains a cushy lifestyle in a developed nation and a local villager is earning income from running basic diagnostics that ordinarily would require a doctor on site to perform. The TeleDoc revolutionizes the medical field in that it creates doctors out of ordinary citizens. As our speaker Jody Ranck asserted, it is clear that these basic check up procedures do not require four years of an expensive medical school and rather can be performed by the average joe with a bit of training. Many of the patients who can be helped will be those who would likely have died from simple curable diseases, and teleDoc's will also be integral in spreading awareness and prevention of diseases. This would be particularly useful to combat HIV in Africa. 

TeleDoc allows rural children access to check-ups. Teachers
can even act as pseudo-doctors.

Furthermore, I think the idea that even the poorest of countries deserve to have access to help from high quality doctors in developed countries is intriguing. Why are the poor in less developed countries deemed unworthy of good medical care. The UN has deemed healthcare a right, and it is atrocious that with the high level of technological capabilities why should we not extend the resources of the developed world to these developing countries if the cost is minuscule? My mom who is a psychiatrist in Kentucky is advocating for increased tele-medicine, where doctors video-chat with patients who can't come in physically to see them. In many of these developing countries there are millions of citizens who have gone through great trauma and psychological issues run rampant, this would be extremely useful. Specialists are especially short stocked in the developing world and through the use of video chatting victims of the genocide in Rwanda, or rape victims in India to show two examples can be helped by remotely located specialists. 

Despite the clear health benefits of this and other initiatives to minimize the use of doctors many in the medical field are hesitant. They fear that this type of impersonal medicine is a threat to the doctor patient relationship. "It essentially dehumanizes medicine"- according to one doctor who is against reforming the medical system in this way. Additionally, many bring up the point that doctors must be going to medical school for the four years for some good reason, if they could do it in less it is probably society would have changed its ways by now; however, this rule has stayed in place for decades now and has led to the creation of knowledgeable and capable doctors. I agree that the knowledge of a doctor really can't be replaced. However the workers that are trained are not trained to be doctors, they are instead merely an agent to collect information and who are collected to doctors. ALthough this is an indirect means and people may say it lacks the human touch isn't this indirect care better than no care at all? I call upon the argument that "Data is Care." The use of modern technology such as the phone makes healthcare more efficient for large quantities of people and most importantly more effective, which is profitable to patients and thus illustrates a level of caring by the medical professionals. Another argument made is that diagnoses made this way have the ability to be largely inaccurate. I agree that the methods of data collection need to be examined to be as effective as possible to ensure accuracy, however this threat of inaccuracy is no reason to abolish the idea. The solutions to the healthcare issue in developing countries is so limited as it is, every possibility to provide help to these nations should be considered, even if it bypasses the traditional scope of medicine and alters the traditional role of the medical professional.

The world will always need doctors, it is simply the type of doctor needed that will evolve. Clearly the traditional doctor patient relation is irreplaceable in some cases and it will always continue to be an integral part of society. However, medicine needs to evolve to adapt to the growing needs of the human population. Doctors need to rise to the challenge, and to the new technology that does enable us to provide effective widespread treatment if harnessed correctly. The growing population of the world needs healthcare, and to create this widespread access use of technology is imperative and inevitable.