The health systems of most underdeveloped countries have one thing in common: the total absence of health insurance. The entire cost of illness is borne by the patient and their family. If we add to this problem low and uncertain incomes, the result is patients who often do not have enough money to pay for their health care. In the best cases, we have patients who will be content to pay only for the minimum and essential care since they cannot afford more. This very often leads to insufficient care.
Patient spending in a hospital is generally based on 2 components:
- Expenses related to diagnosis: Complementary biological and imaging tests
- Expenses related to care: Medications and care
The impact of poverty and the indigence of the patients will weigh as much on one component as on the other. The patients will only agree to undergo an examination if they are convinced that it will bring vital information. Similarly, among the prescribed drugs and treatments, they will spend only on what seems to them vital in the immediate future or essential to save a life in the short term. The direct consequence is an increase in morbidity and mortality, and an increase in costs per relapse and re-hospitalization, frustration, etc.
There is, therefore, a major problem in the practice of medicine in poor areas:
- How do we convince the patient it is worth their money?
- How do we make them realize the degree of urgency and dangerousness of the pathology?
It is recognized worldwide that an image is worth a thousand words and images are what ultrasound offers us.
The whole world is learning a little more every day to appreciate the diagnostic and therapeutic value of ultrasound, but one of the most impactful elements that can be achieved with ultrasound is communication, the transmission of information.
The disease is no longer just abstract. We can show it to the patient, we can see his eyes fill with gratitude when he finally manages to see what is hurting him, what has caused him so much worry. We go from the abstract to the concrete.
If this is already a plus in developed societies where the patient wants to satisfy his curiosity, get information, and understand, in underdeveloped countries a new aspect emerges. The patient can see what he is going to spend his money on, why he will pay for transport from a village to the city to see a specialist or carry out an expensive examination, why he will accept that a needle is inserted into his body, why his stomach will be opened.
Ultrasound can literally boost compliance with treatment and it seems to be magic that the benefits of ultrasound are the same regardless of the environment.
To illustrate my remarks, I present to you a 50-year-old patient, with high blood sugar levels for 3 years, which was not monitored because she believed that she could control this with plants and bark. On examination, we found a painful epigastric mass in the left hypochondrium, which was mobile with respiration. The ultrasound found a voluminous left renal abscess. Thanks to the ultrasound image, and the comparison of the two kidneys, I was able to convince the patient to travel to the city, to pay for an abdominal CT-Scan (the price of which represents her wage over 4 months) and to undergo ultrasound-guided percutaneous drainage (Figure 1).
The benefits of communication with ultrasound are even greater when it comes to point-of-care ultrasound (POCUS). You are the examining doctor, you tell the patient what you suspect, you scan their body to answer the questions you have asked, and when you have the answer, it is a moment of bonding and complicity between you and the patient that only those who use POCUS can understand. BEAUTIFUL!!!
Any doctor practicing in rural areas, remote areas, or poor areas should learn to do POCUS. With online learning, everything is accessible now. Free or inexpensive online courses and scholarships for developing world doctors should be strongly encouraged. Ultrasound societies must look into offering such content. Universities should as well because the future of health will develop with POCUS.
If we want to help poor countries progress, knowledge sharing must be at the center of the priorities. We need to take into account inequalities that result in health personnel who most need POCUS are also those who are not able to afford training whether online or face-to-face. It is necessary to ensure that there are elite developing-world doctors who have mastered POCUS, and who will be able to teach it to others and thus participate in the popularization of ultrasound.
Let’s democratize ultrasound, and save lives.
Yannick Ndefo, MD, is a general practitioner in Cameroon and a POCUS ambassador for POCUS Certification Academy.
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