Care is Where You Live

Marie Rowe is one of the Albert Schweitzer fellows and is a medical student at East Carolina University in NC. Her blog has just begun describing her fascinating experience in Gabon, Africa - home to the Albert Schweitzer Hospital.

A recent entry talked about a recent contact with a woman who had this chest x-ray.  I don't think you need to be a radiologist to realize that this heart is way, way too big for normal. Consider that the heart normally occupies only about 1/2 the chest cavity (framed by the ribs) and mostly on the left side of the chest. This heart is nearly 90% the width of the cavity and considered to be significant cardiomegaly (enlarged heart).

The case is sad, but Marie really points to the larger picture beyond the x-ray and this case. Should access to appropriate medical care matter, she pontificates, where someone lives? In this case, living in or near Gabon prevented this patient from gaining access to clinical pathways of care that are considered "standard" in the modern world.

It's sad to say, but Africa is not unique in this area. Example a fellow student recent severely injured his ankle here on Statia. It is obviously injured, black and blue and is difficult to walk on. In order to get proper care and determine the extent of injury beyond physical exam, he needs an X-ray. The X-ray here has been "down" for nearly a year with no evidence of return anytime in the near future. Want good care? Board a plane for St. Maarten or other distant shores.

The disparity of access to care and technology in medicine is in fact based on where you live. This consideration cannot be overemphasized for many populations, particularly those with chronic disease. This simple dynamic also contributes to access to care in developed countries as well as underdeveloped. The distribution of both technology and providers is at the core of access and as a global people, we have yet to breech solving this problem.

It is unfortunate that the issues identified by Albert Schweitzer, and the core objectives of the fellowship that Ms. Rowe is working in, have not changed since Dr. Schweitzer.

Remember 9-11-01. Hard to believe it is 7 years ago.