The price of critical care

The practice of intensive care medicine is intuitively associated with the use of sophisticated and expensive machines.  In this context, the availability of such services would only be reserved for resource rich places.

A pediatric intensive care specialist returned to the United States after a two week mission in a field hospital in Haiti. Troubled by what he saw,    he shared his views with a prominent figure in the critical care medicine community on how to develop a better system of critical care for the children of Haiti.  The critical care expert replied "...the focus should be on clean water and vaccination."

Think about this, as long as there are hospitals, critically ill patients will exist, regardless of access to intensive care services. The same is true in resource limited countries.  The availability of technology or limitless resources does not define critical care medicine.  The larger questions to answer are: What is the appropriate level of intensive care that is applicable to a particular region?  What aspect of intensive care should be and can be delivered?  How do we prioritize the delivery of such services?

The advantages of critical care education of health care professionals in resource limited areas has many advantages: It enhances the perception of needs from the community, improves preventive measures and primary care efforts, boosts the confidence of health care professionals and dramatically decreases their "failure to rescue".  Training providers in the delivery of a higher acuity will improve the overall quality of care.  Curriculum developers need to think about  the opportunities for candidates to become versatile in both resource-rich and resource-poor settings. "A liberal is a person who believes that water can be made to run uphill.  A conservative is someone who believes everybody should pay for his own water.  I'm somewhere in between:  I believe water should be free, but that water flows downhill."   Theodore H. White.

To the question recently posed on our social media site "Is Intensive medical care for children in low-resource countries is dependent on technology that is relatively expensive (breathing machines, monitors) compared to preventive measures (vaccination , clean water)"  it is encouraging to know that the majority (53%) believe that it was equally important or not dependent at all.

PULSE