Spotlight: The Surgery

March 6, 2012 § 1 Comment

Getting ill in a developing country, if you aren’t from around there, is a very scary proposition. It is even more terrifying if you, like me, work in the health system and are intimately aware of the possible terrifying consequences of giving yourself up to an inefficient system. I help manage seven hospitals and health centers in the southwest region of Uganda, and I absolutely adore my job. I have developed various interventions that help to improve the health services we offer our clients. I have worked on distributing bed nets to cut malaria cases, helped to monitor the growth of potentially malnourished children in our district and developed an integrated supply chain system for the health centers. I also work as a health economist, costing the services of my clinics and looking for partners that can help support our work. That is my job and I love it, until I got ill.

The illness was not malaria, something this health system is fantastic at treating. It wasn’t diarrhea disease either; I stocked drugs for that before moving to Uganda. This was much more serious and I found out that I would be needing surgery. I was referred to a private clinic called The Surgery,located in Kampala5 hours from my base. Fortunately after 2 weeks of hospitalization I was discharged. Although I am doing very well, I have not stopped thinking about my time in Kampala.  I had a few surprises I will like to share.

The very first thing that surprised me was the total cost of the entire surgery and post surgical care. The procedure cost $160 without insurance. In the United States, out of pocket surgery of this type would have cost at least $1,000. While we are all aware of the prohibitive cost of health care in the US, I did not know that the difference in cost would be this great.

The other positive finding was the incredible professionalism of my caregivers. I spent more time with my physician during this episode than I have ever spent with my surgeon in the United States. He explained all that was wrong with my body to me patiently and in a language that I could understand. He took the time to explain each step of the procedure, constantly asking if I understood, and taught me about how my body works. It was as if I had the world’s greatest biology teacher. Perhaps he was an outlier, but I must say that most of the staff members I had contact with were professional and willing to teach. I got the nurses to teach me how to dress a wound and I can now do it myself.

The clinic was also focused on making sure that I didn’t come back with the same problem. They behaved and delivered care to me in a way that suggested a commitment to prevention. In the end, I realized that this little clinic in the heart of Kampala was the model every health system should attempt to emulate. The services were relatively inexpensive, professionalism in care, and finally a focus on educating their clients on how to care for their bodies. This model is what I will call a no-frills approach to delivering services. I did not have to be tested for all possible illness because the physician recognized what was wrong immediately, (which I must add is what he is paid to do). The service was professional and to the point. The cost was not as prohibitive as I imagined at first and overall I know that there is a high chance that I will not be going back to the hospital for the same condition, something I could not have said after many years of care in the United States. This is the standard. Now some will argue that the surgery’s care is expensive for the Ugandan environment and they might be right. However, if we are able to implement a social health insurance models, similar to this one in Kenya, the cost would be much less for the patients. It is surprising that I had to come to Uganda, to access the very best care, and for a much affordable cost.

This is a major lesson for policy makers hoping to create an efficient health system all over the world, not to look to the West all the time, but that great service is already here in the developing world. I believe that if this model of service delivery can be scaled, in addition to a micro insurance system, the health gains will incredible.

So I am healthy and happy and above all, I am newly inspired.

 Cross-posted on the GHC Blog.

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