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Individual vs. public health

Year: 1993
Setting: Mendi Hospital, Southern Highlands province, Papua New Guinea
Position: Chief medical officer for Chevron

Chevron is contributing to the budget of Mendi Hospital in the capital city of the Southern Highlands province. Each year, the hospital director sends a financial request to the company’s medical department, and this is my first time to review and approve it. Curious about how the money will be used, I phone the director to request a list of the equipment and medical supplies most needed. I can hear some irritation in his voice. Several weeks later, I receive the document, and I go through it with great interest to find out priorities I may have overlooked. To my astonishment, the items at the top of the list are TVs, VCRs and wheelchairs. There is no correlation between the list and the main causes of mortality and morbidity in the area. I set up an appointment to meet with the director.

A few days later, after a short helicopter flight and car ride, I am at the hospital. It is dilapidated. The paint peels off the walls, there are cobwebs in the corners of the ceiling, the floor is covered with dust, some windows are broken and faucets leak in the bathroom. These sights do not put me in a good mood. After a short wait, I face the director. We engage in small talk, but soon turn to hard topics and I ask a few provocative questions: How many doses of polio vaccine could one buy with the money for a new wheelchair? How many mosquito nets could one buy for the cost of a TV? How many needles could one buy for the cost of a VCR?

My colleague seems to be recalibrating his approach but does not give up. He has one more weapon to use on me. He takes me to the wards and shows me a few diabetic patients with bilaterally amputated legs. These men and women have no means of getting around on their own and people have to carry them. One of them (I found out later) is an influential local politician. I am stirred but not shaken and regroup quickly when I see two kids with polio atrophic legs playing in the yard. I suggest a new list that better reflects the urgent medical needs of the local patients. I receive it a few days later, and it is the beginning of a positive and productive relationship with the hospital based on a sound foundation.

Lesson for the doctor: When working in developing countries, choices can be hard to make. Conflicts may arise between individual and collective benefits. Avoiding waste must be a priority.

Yann Meunier, MD, is the health promotion manager for the Stanford Prevention Research Center. He formerly practiced medicine in developed and developing countries throughout Europe, Africa and Asia. Each week, he will share some of his experiences with patients in remote corners of the world.

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