October 28, 2013

Okay, so I think the blog issues are sorted out and I should be able to post a little more often.  The last couple of weeks have been somewhat quiet as we have been trying to get patients ready for the operating room.  The primary issue is financial.   There is great need here, for treatment of the usual acquired and congenital heart diseases that we see in the US, in addition to a significant burden of rheumatic heart disease.  Thanks to some NGO’s, there is funding for many of the pediatric congenital cardiac patients.  There is much less funding, though, for the adult patients.  These “adult” patients may be as young as 9 years old or may be the parent of many children who will be left without a parent without the necessary cardiac surgery.

I used to rationalize that in countries where there is significant or extreme poverty (recall that a large portion of the world’s population lives on less than $2/day), that things are less expensive.  In my experience in developing countries, this is generally untrue.  Things of similar quality are as expensive or more expensive than they are in the U.S.  Local produce is generally inexpensive, but comparable with public markets in the U.S.  Anything that is packaged or imported is quite expensive.  What is different is the way that people live when they are living on a very low income.  Houses are built without building codes and frequently without electricity or running water.  Cooking here is often done on a wood fire (indoors or in a separate building near the house).  Protein sources, including beans, are expensive and therefore not eaten every day.  Schools all require tuition, so if a family is able to generate an income a significant percentage goes toward school fees, books, and uniforms; if the breadwinner gets sick the children may have to withdraw from school.

We are able to perform cardiac surgery for costs somewhat lower than the U.S. for a few reasons.  Of course, salaries are lower in general.  We do not have liability insurance, although the hospital does pay taxes on its staff.  We do not have $30,000 ICU beds, $8000 Operating Room tables, brand new equipment, or infinite disposables/single use equipment.  Due to generous donations from various foundations, hospitals, and individuals, we are still prepared to deliver high quality cardiac surgical care.  However, medications, prosthetic cardiac valves, cardiopulmonary bypass supplies, and so forth are still expensive and must be purchased if they have not been donated.  The staff must be paid regardless of the number of cases that we are doing.  Therefore, cardiac surgery is still either prohibitively expensive or a great sacrifice for patients and their families.  It is quite humbling to know that the patient that you are about to care for might have sold land or even their house in order to have surgery.