Opinion
The Radiologist and Health Care in the Developing World 1 James T. Lambeth, M.D., and Richard H. Chamberlain, M.D. Medical care and medical education in the United States and other developed countries evolved against different social, technical, and economic backgrounds than exist in developing countries. Failure of the visiting radiologist to consider these factors and work within a system designed for the specific radiological problems of the host country may be nonproductive. INDEX TERMS:
Opinions. Radiology and Radiologists
Radiology 116:231-232, July 1975
• The medical problems and priorities faced in developing countries are not the same as those of developed countries. The Western radiologist's training and background do not automatically make him suited to deai with the health problems in the developing world, where "health" must mean the health of the country as a whole if the gap between the developed and developing world is to decrease. In countries with annual national health budgets on the order of $1-10 per capita, a common situation in the developing world, medical priorities must differ from those in more affluent nations. The luxury of placing the major ernphasls on curative medlclne- cannot be afforded; rather, it is necessary to emphasize those aspects of medical practice which prevent disease and maintain health and those simple corrective curative measures which give a high proportion of return to a productive life. The visiting radiologist has the opportunity to examine all problems of a developing country-social, political, economic, educational, and scientific-and advise in the design of solutions to those problems. In the role of adviser and educator, he has the responsibility of evaluating the role of radiology in overall health care so that he will not inadvertently cause meager funds to be spent on aspects of health care which may be interesting but relatively nonproductive in terms of national health. This is a responsibility which local radiologists may be reluctant to assume, either because of pressures from colleagues to acquire the frills of Western medicine before acquiring the substance or because national or university service does not pay enough to allow them to devote adequate time to these problems. Some typical problems encountered may be cited as examples: (a) What advice should be given regarding the devel-
A recent commentary in the JAMA aptly points out the curious ineptness of traditional Western medicine and medical education when dealing with health in the developing world (1). Health care assistance is too often offered without real concern for and evaluation of the social, political, and scientific problems of the developing country (2). Since Western radiologists are sometimes motivated or persuaded to spend some portion of their time working and teaching in this developing world, it is appropriate to consider the role of the visiting radiologist and how he can be of greatest assistance in a developing country. At first glance it may seem presumptuous to be critical of what seem to be humanitarian gifts of time, talent, and knowledge; certainly the health of a developing country could only benefit from the efforts of Westerntrained radiologists. However, the result can be quite the opposite. The Western-trained radiologist may well find personal and professional satisfaction in practicing and teaching and yet be relatively unaware that his knowledge and skills are not addressed to the true priorities of health care problems of the country. The benefit to a few patients may come about at the cost of depriving tens or hundreds of others of the chance for basic medical attention because the meager funds of a limited health budget are spent inappropriately. Young medical trainees will certainly be eager to absorb the knowledge and skills offered, but this may not necessarily make them better prepared to understand the health priorities of their country. Finally, the people in a developing country may be so encouraged by the visiting "expert" to copy the priorities in developed countries that they do not appreciate or face the country's own fundamental medical problems, thereby delaying adoption of solutions tailored to local health care needs.
1 From the Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa. Accepted for publication in March 1975. ~h
231
232
OPINIONS
opment of radiotherapy and nuclear medicine when there are insufficient funds for chest radiography in a country with a 10-20% incidence of tuberculosis? (b) What are the indications for a detailed fluoroscopic gastroduodenal examination when the backlog for such examinations exceeds three months? (c) Should one teach time and temperature processing in a country where unstable electric power prohibits reliable exposures with the conventional equipment available? (d) Should special procedures which are expensive in terms of time, talent, and money be encouraged when the majority of a nation's people with fractures, acute pulmonary disease, and acute abdominal afflictions have no access to basic diagnostic radiology because of shortage of funds, staff, and basic equipment? (e) How far should technologist training be expanded when there is no comparable program for training basic x-ray equipment engineers?
July 1975
Indeed, such problems are complex and endless. As solutions are found, these problems may blend with the problems faced in developed countries. Until that time, the visiting radiologist should be aware of the special situations which exist and be sure that his net effect is productive in terms of long-range benefit for the country.
Department of Radiology Hospital of the University of Pennsylvania 3400 Spruce St. Philadelphia, Pa. 19104
REFERENCES 1. Tavassoli M: Health in a developing world. JAMA 230: 1527-1529, 16 Dec 1974 2. Feffer HL: Health care as an international concern: a call for United States initiative. N Engl J Med 291:676-678,26 Sep 1974
The Radiologist and Health Care in the Developing World 1 James T. Lambeth, M.D., and Richard H. Chamberlain, M.D. Medical care and medical education in the United States and other developed countries evolved against different social, technical, and economic backgrounds than exist in developing countries. Failure of the visiting radiologist to consider these factors and work within a system designed for the specific radiological problems of the host country may be nonproductive. INDEX TERMS:
Opinions. Radiology and Radiologists
Radiology 116:231-232, July 1975
• The medical problems and priorities faced in developing countries are not the same as those of developed countries. The Western radiologist's training and background do not automatically make him suited to deai with the health problems in the developing world, where "health" must mean the health of the country as a whole if the gap between the developed and developing world is to decrease. In countries with annual national health budgets on the order of $1-10 per capita, a common situation in the developing world, medical priorities must differ from those in more affluent nations. The luxury of placing the major ernphasls on curative medlclne- cannot be afforded; rather, it is necessary to emphasize those aspects of medical practice which prevent disease and maintain health and those simple corrective curative measures which give a high proportion of return to a productive life. The visiting radiologist has the opportunity to examine all problems of a developing country-social, political, economic, educational, and scientific-and advise in the design of solutions to those problems. In the role of adviser and educator, he has the responsibility of evaluating the role of radiology in overall health care so that he will not inadvertently cause meager funds to be spent on aspects of health care which may be interesting but relatively nonproductive in terms of national health. This is a responsibility which local radiologists may be reluctant to assume, either because of pressures from colleagues to acquire the frills of Western medicine before acquiring the substance or because national or university service does not pay enough to allow them to devote adequate time to these problems. Some typical problems encountered may be cited as examples: (a) What advice should be given regarding the devel-
A recent commentary in the JAMA aptly points out the curious ineptness of traditional Western medicine and medical education when dealing with health in the developing world (1). Health care assistance is too often offered without real concern for and evaluation of the social, political, and scientific problems of the developing country (2). Since Western radiologists are sometimes motivated or persuaded to spend some portion of their time working and teaching in this developing world, it is appropriate to consider the role of the visiting radiologist and how he can be of greatest assistance in a developing country. At first glance it may seem presumptuous to be critical of what seem to be humanitarian gifts of time, talent, and knowledge; certainly the health of a developing country could only benefit from the efforts of Westerntrained radiologists. However, the result can be quite the opposite. The Western-trained radiologist may well find personal and professional satisfaction in practicing and teaching and yet be relatively unaware that his knowledge and skills are not addressed to the true priorities of health care problems of the country. The benefit to a few patients may come about at the cost of depriving tens or hundreds of others of the chance for basic medical attention because the meager funds of a limited health budget are spent inappropriately. Young medical trainees will certainly be eager to absorb the knowledge and skills offered, but this may not necessarily make them better prepared to understand the health priorities of their country. Finally, the people in a developing country may be so encouraged by the visiting "expert" to copy the priorities in developed countries that they do not appreciate or face the country's own fundamental medical problems, thereby delaying adoption of solutions tailored to local health care needs.
1 From the Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa. Accepted for publication in March 1975. ~h
231
232
OPINIONS
opment of radiotherapy and nuclear medicine when there are insufficient funds for chest radiography in a country with a 10-20% incidence of tuberculosis? (b) What are the indications for a detailed fluoroscopic gastroduodenal examination when the backlog for such examinations exceeds three months? (c) Should one teach time and temperature processing in a country where unstable electric power prohibits reliable exposures with the conventional equipment available? (d) Should special procedures which are expensive in terms of time, talent, and money be encouraged when the majority of a nation's people with fractures, acute pulmonary disease, and acute abdominal afflictions have no access to basic diagnostic radiology because of shortage of funds, staff, and basic equipment? (e) How far should technologist training be expanded when there is no comparable program for training basic x-ray equipment engineers?
July 1975
Indeed, such problems are complex and endless. As solutions are found, these problems may blend with the problems faced in developed countries. Until that time, the visiting radiologist should be aware of the special situations which exist and be sure that his net effect is productive in terms of long-range benefit for the country.
Department of Radiology Hospital of the University of Pennsylvania 3400 Spruce St. Philadelphia, Pa. 19104
REFERENCES 1. Tavassoli M: Health in a developing world. JAMA 230: 1527-1529, 16 Dec 1974 2. Feffer HL: Health care as an international concern: a call for United States initiative. N Engl J Med 291:676-678,26 Sep 1974
