Dying for resources
Dr Francesca Elloway talks about some of the other factors that add to DRC's high mortality rate
Local customs and traditions
These influence patient behaviour and the choices they make. There is often family pressure to try traditional medicines, which can, perhaps, be useful sometimes, but are, more usually, at best ineffectual and, at times, certainly dangerous. Moreover, the pressure on the family to visit a witch doctor is very strong in some areas.
The poverty trap
Many people are desperately poor and can’t afford even simple medical care, but it saddens me when they end up paying far more for the funeral of their child than they would have had to pay for basic life-saving medical care.
Priorities
At certain times of the year, local people assess tending crops as their priority and they don’t have time to take a sick child to a health centre. Given the lack of other income, subsistence farming is crucial to the whole family’s survival.
Inaccurate diagnoses
A lack of proper resources — such as good laboratories, X-rays and ultrasound machines — is added to by cultural pressure to give a diagnosis and then do something. If you are honest and say, “I’m not sure,” you are seen as a bad doctor. Aligned to that is the idea that any “proper” doctor is a surgeon, which puts pressure on doctors to do surgery even if they are not properly trained and don’t have adequate facilities.
Short-term treatment and relapses
It is easy to buy just a few tablets rather than a whole course of antibiotics or treatment for malaria. As patients don’t have much money, they will often buy enough medicine for a day and then, if they feel better the next, will not buy any more. Not only are they liable to relapse, but this also encourages drug resistance.
Cure versus prevention
When one’s salary is purely dependent on the money that patients pay for their treatment, the tendency for a doctor or nurse is to concentrate on providing medical care that generates income. Preventive measures like vaccination clinics often take a back seat, which is one of the reasons why there are so many deaths from measles, for example. In the long run, more lives will be saved by preventive medicine and education than by curative medicine.