Association for Academic Surgery (AAS)

by

Developing to Developed: How COVID-19 Urges Us to Contemplate a Shared Model of Global Healthcare

A Global Approach to Healthcare in Response to COVID-19

A few months ago, hospitals across the United States were adapting to something few were equipped to handle – a deficit of resources. In the initial stages of the COVID-19 pandemic, many hospitals began stocking up on PPE, ventilators, and disinfectants. Despite their best efforts to prepare for the inevitable, many began to run out of these essential supplies. To keep up with the constant fluctuation in resources, infection prevention guidelines were changed nearly hourly to accommodate a dwindling stockpile. For several hospitals, single-use N-95 masks became ‘extended use’. Ventilators were rapidly assigned to the flood of patients entering the hospital, unable to breathe due to the pneumonia caused by COVID-19. There was concern spreading amongst healthcare workers everywhere – which patient should be on the ventilator?1 Who should get the few N95s left? How do we stay safe and protect our loved ones while also trying to care for our patients?

One of the complexities of the American response to the COVID-19 pandemic was the drastic variation among how different healthcare systems were affected. This variance is multi-factorial, depending on specific hospital’s abilities to acquire resources prior to the pandemic onset as well as socioeconomic factors. The COVID-19 pandemic has magnified baseline discrepancies in access to healthcare, insurance status, and how resources are distributed. Hospitals who generally operate on a lower budget were not able to prepare as well as many academic institutions.2,3 A lack of resources left healthcare workers susceptible to COVID-19, leading to a shortage of staff and the need for personnel to self-quarantine.4

In these unprecedented times, American companies, public, and healthcare workers stepped up and rapidly developed innovative solutions to the problems COVID-19 brought to its door. Investigators reconstructed ventilators to support multiple patients simultaneously, biomedical engineers implemented UV light to sterilize N95s for reuse, and pharmacists made in-house hand sanitizer.5,6 These low budget solutions to everyday problems are just a few examples of how developed countries found creative avenues to re-purpose everyday tools in a resource-scarce environment.

While many countries experienced a shortage of medical personnel and a dwindling supply of healthcare supplies for the first time, this situation is an everyday occurrence for many developing countries. Ghana, for instance, is a developing country in West Africa of 30 million individuals with an average GDP/person of 2,200 USD compared to the US 54,541 USD. Overall, there is one physician for 7,374 individuals, however that number decreases to one physician per 26,489 individuals in more rural areas with 70% of medical school graduates leaving the country to practice.7 A majority of the healthcare provided occurs in a setting without enough medication, ventilators, diagnostic tools, and other protective equipment on a daily basis. At baseline, Ghana functions with a precipitous healthcare system and is especially vulnerable, like other developing countries, to an increased strain on resources that is brought on by pandemics such as COVID-19.

The COVID-19 pandemic has highlighted not only the disparities that exist between countries but also exposed significant within-country issues that had previously been ignored. We believe, however, that it has created unique opportunities for bi-directional learning, forcing us to finally reflect on the important insights that can be gained from many developing countries.

In order to emerge from this pandemic even more resilient, we urge the medical community to reflect on several questions:

* How do developing countries handle resource scarcity on a daily basis and how are values such as fairness and compassion factored in?

* How can mobile technology and video-conferencing platforms be used to eliminate barriers –including geographic borders– to healthcare access and capacity building?

* How can we cheaply and quickly re-purpose equipment and supplies to serve multiple functions?

* And moving forward, how can developed and developing countries work together for the betterment of each other’s healthcare systems?

COVID-19 has certainly strained the healthcare community in unparalleled ways. However, the story does not need to end there. If we have learned anything from history, it is the fact that we are strong and will overcome any challenge.  As such, let us create this new path forward together, committed to making healthcare better not only for our local communities but also our global village here in America and internationally.

 

References

  1. White DB, Lo B. A Framework for Rationing Ventilators and Critical Care Beds During the COVID-19 Pandemic. JAMA. 2020;323(18):1773–1774. doi:10.1001/jama.2020.5046
  2. Gordon SH, Huberfeld N, Jones DK. What Federalism Means for the US Response to Coronavirus Disease 2019. JAMA Health Forum. May 8 2020
  3. Wunsch H, Gershengorn H, Scales DC. Economics of ICU organization and management. Crit Care Clin. 2012;28(1):25?v. doi:10.1016/j.ccc.2011.09.004
  4. Adalja AA, Toner E, Inglesby TV. Priorities for the US Health Community Responding to COVID-19 [published online ahead of print, 2020 Mar 3]. JAMA. 2020;10.1001/jama.2020.3413. doi:10.1001/jama.2020.3413
  5. Neyman G, Irvin CB. A single ventilator for multiple simulated patients to meet disaster surge. Acad Emerg Med. 2006;13(11):1246?1249. doi:10.1197/j.aem.2006.05.009
  6. Lindsley WG, Martin SB Jr, Thewlis RE, et al. Effects of Ultraviolet Germicidal Irradiation (UVGI) on N95 Respirator Filtration Performance and Structural Integrity. J Occup Environ Hyg. 2015;12(8):509?517. doi:10.1080/15459624.2015.1018518
  7. Abdulai T, Abobi-Kanbigs DA, Joseph SKK, et al. Bridging the Inequitable Distribution of Physicians in Ghana: Factors Medical Students and House Officers at UDS and TTH Will Consider in Accepting Postings to Northern Ghana. J Healthc Commun. 2017, 2:2. doi: 10.4172/2472-1654.100059

Gifty Kwakye

Dr Gifty Kwakye is an Assistant Professor at University of Michigan and serves as the Assistant Clerkship Director for the Surgery Department. She obtained both her undergrad and medical degrees from Yale University, and holds a Master in Public Health from Johns Hopkins. She completed her surgery residency at Brigham and Women’s Hospital/Harvard and colorectal fellowship at University of Minnesota. She is board certified in General and Colorectal Surgery. Dr Kwakye’s research interest lies in improving health disparities globally, tackling colorectal cancer screening and addressing treatment outcomes amongst populations in Africa but also immigrants here in the US. She is also currently conducting research on pelvic floor disorders that occur due to female genital circumcision. She serves on the AAS Global Affairs Committee.