Hey, Hillary, Fix This!

In my last installment I mentioned one Yalie who is President, so I decided to open this essay by mentioning another Yalie who wants that same job—and who claims to have ideas about how healthcare can be improved. During a previous trip to Zimbabwe, I wrote Ms. Clinton, a Methodist, and invited her to visit Africa University. She did not reply (her loss), but if she had come, she could have observed healthcare problems with both familiar and unfamiliar stripes. Unlike Ms. Clinton, when it comes to healthcare I do not speak as one who has authority. I report only what I am told, and I could easily be very wrong. Furthermore, here in Zimbabwe most of my sources are academics. Clearly that fact should make you take my words with two grains of salt.

In Zimbabwe healthcare is a legal right of citizenry. In theory, you can walk into a hospital and see a doctor for about the price of a Hardee’s Thickburger. (Deno, you can see where my mind is.) In practice, however, there are almost no doctors to be seen. This shortage is not, primarily, a function of the nation’s educational system. The Brits were social snobs and frightful racists, but they did lay the foundations for a decent educational infrastructure. The Rhodesians built upon this foundation (mostly for whites, of course, but that would change) and created a first-class university. Since the Revolution, Zimbabwe has prized education over any other public goal. So, yes, you can become a well-educated doctor in Zimbabwe. But in recent years few locally educated physicians or surgeons have chosen to remain in this country. Some ran because of the money or because they did not want to “waste” their first-rate education in a perceived Third-World backwater. Others left because they could not face soaring patient loads, declining access to First-World drugs, and OR-desperation reminiscent of a MASH at Pork Chop Hill. I do not judge the motivations behind Zimbabwe’s doctor-flight; nor would I suggest any long-term solution. I do know that, for now, a public-service model is crashing. And, for now, neither will a private-enterprise model succeed. The median income in Zimbabwe has dropped to roughly $1US/day; that does not buy a whole lot of modern healthcare.

The current doctor-shortage is an example of the bad news, of things that are going very wrong. But we South Carolinians are officially enjoined to hope so long as we breathe, and therefore I shall list five small reasons for continued optimism.

(1) For reasons of patriotism, conscience, or down-right obstinacy, many doctors and other healthcare professionals do elect to stay in Zimbabwe. Maybe they agree with my grandfather, a Depression-era physician in rural South Carolina: “For a real doctor, the hard times are the good times.”

(2) Under a new national policy, most locally educated doctors will decide to stay for at least a while. When a young woman or man finishes medical school at the University of Zimbabwe, and when she or he completes the Zimbabwe equivalent of board certification, that person will be licensed to practice medicine. However, the University will not award a medical degree until the semi-graduate has served at least two years in-country. (No M.D.? No cushy job in Johannesburg or Houston.)

(3) Africa University has opened its Faculty (= College) of medicine and health sciences. This Faculty is now certified to offer the MSc. in Public Health. Theoretical training emphasizes models of community-delivered care, and aspirants complete their Masters fieldwork in areas where health services are desperately needed. The idea, based in Wesleyan theology, is that the methodical practice of good works will lead to a second blessing of perfected, lifelong commitment. To me, it sounds worth a try. [Note, Wofford pre-meds: If you’ve got some extra time and money, and if you don’t get into your favorite med school on your first try, maybe you should consider doing an MSc. in Public Health at A.U.: how you reckon that’d look on your next application? Later, all doctored up, you might return to this country and offer some real service.]

(4) A few volunteer ex-pat doctors are doing heroic work in Zimbabwe. With my usual naiveté, I initially assumed that these folks were seeking some sort of martyrdom. But maybe I was wrong. Here’s an approximate quote from a surgeon whom I interviewed on an earlier visit to this country. “I admit it. I was getting bored with American medicine. But here I get to be doctor again. Hey, this is fun. In fact, I haven’t had so much fun since I was a senior resident. I just hope I can figure out a way to get some more sleep.”

(5) As Paul Farmer told us last spring at Wofford, economically enforced medical triage can be a heart-breaking exercise. Still, it does seem to me that Zimbabwe is expending some of its public healthcare funds in appropriate manners. Anti-retroviral drugs are in short supply (except, of course, for megabucks in a highly lucrative black market). Government policy differentially shunts this supply toward pregnant women. And I am told that the rate of infant AIDS has dropped appreciably. Scarce healthcare resources are also concentrated for tuberculosis treatment, which is said to be free, available, and epidemiologically effective.

OK, folks, please remember that my commentary above is based on casual conversations, not real evidence. Now I really need to get back to work, and besides, I’m sure you’re tired of reading this long stuff. I wish you health for you—and good healthcare ideas for Hillary.