Jones & Bartlett Learning Medicine Blog

This is the follow-up blog post from Tarascon Publishing Author, Matthew Dasco, MD, MSc.  Click here to read Part 1 of the Botswana and Human Resources for Health post.

This is the first in a two-part blog series from Tarascon Publishing Author, Matthew Dasco, MD, MSc.

Part 1:

The world’s burden of disease and human resources for health are not well aligned.  While sub-Saharan Africa has 24% of the world’s disease burden, it only has 3% of the world’s healthcare workers.  On the other end, the Americas region has 10% of the world’s disease burden but 37% of its health workers.

The Joint Learning Initiative (JLI) has calculated that the minimum number of health care workers (doctors, nurses, and midwives) in a population to achieve and 80% coverage rate of skilled birth attendance and measles vaccination is 2.5 per 1000 – countries with fewer than this number run a very high risk of not achieving the health-related millennium development goals (JLI, 2004).  57 countries in the world have been designated by the World Health Organization (WHO) as in this state of “crisis” with regards to human resources for health, which translates to a global shortage of roughly 2.4 million health workers (WHO, 2006).

(Chart from Kerry, 2011)

My first contact with the disparity between disease burden and human resources for health occurred while I was attending on the internal medicine wards at Princess Marina Hospital (PMH) in Gaborone, Botswana.  PMH is the largest of two public sector tertiary care referral hospitals in the country.  In our department, there were six general medicine teams, an oncology service, and a nephrology service – each was assigned an internal medicine specialist.  The department consisted of two Cubans (a pulmonologist and a nephrologist), a Chinese generalist, an Indian generalist, a German oncologist, an Egyptian cardiologist, and a smattering of Americans working through university partnerships.  I found it odd that there were only two Batswana internal medicine specialists working there – they were among a very small number that had received specialty training abroad and returned to their home country to practice.

Global Health Blog - December 2011

I just got back to Botswana after attending the Emergency Medicine in the Developing World conference in beautiful Cape Town, South Africa!  It was exciting to meet so many emergency physicians, residents, paramedics, and nurses from across Africa.  Emergency Medicine (EM) is one of the newest specialties in the world with a 30-year history in the United States, and a 10-year history in South Africa.  EM training programs have recently launched in Ghana, Tanzania, Ethiopia, and in Botswana.  The conference was a good opportunity to compare notes, share experiences, and discuss future collaboration.  We even have our own medical journal now, the African Journal of Emergency Medicine, and my team from Botswana co-authored a paper describing the history of our work:
Development of Emergency Medicine in Botswana

Alongside academic EM training programs, we are all working to build acute care, emergency, and pre-hospital services in our respective countries.  The sustainability of these models will depend on the success of our advocacy in demanding these services from the health systems in which we work.  New international campaigns focusing on road traffic injuries (the decade of action for road safety launched this year) and non-communicable diseases will hopefully overlap with and reinforce our efforts...

Dr. Joseph Esherick Monthly Blog - June 2011

Safety checklists have been adopted by numerous industries to prevent errors and save lives.  Checklists have been used for decades by industries as diverse as the aviation industry, construction companies, and professional chefs to prevent mistakes.  In medicine, checklists have been used in the operating room to prevent surgical errors and for central line placement to prevent catheter-related blood stream infections (CRBSIs).

The pioneer of safety checklists in medicine is Dr. Peter Provonost who spearheaded the Michigan Keystone ICU Project that ended in 2006[1].   The checklist used for central venous catheter placement is simple and involves only five key steps that are rooted in evidence-based medicine:  wash your hands; cleanse the insertion site thoroughly with chlorhexidine; maximal barrier precautions (wear a mask covering the nose and mouth, a cap covering all your hair, sterile gown, sterile gloves and use a wide sterile drape over the patient); a nurse or observer is empowered to stop the procedure if there is any break in sterile technique; and there is a daily review of central line necessity.