In the lead up to the Hospital Association of South Africa (HASA) 2017 Conference taking place in Cape Town from the 25-27 September, Correspondent at the New York Times, author of Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital and invited speaker, Dr Sheri Fink, talks about the need for healthcare system resilience in times of crisis.
I became interested in humanitarian emergencies during medical school, when the wars in the former Yugoslavia were happening. That led to contact with Bosnian medical students and ultimately a book about a Bosnian war hospital.
During my research in the Balkans, the war in Kosovo broke out, and I ended up volunteering with an aid agency, which led to other opportunities to provide assistance in conflict and disaster areas. This work is rewarding, not only because it feels useful and urgent, but also because of the opportunities it offers to learn, to bear witness, and to see remarkable humanity and resilience.
Coping with disasters
Disasters by definition involve an overwhelming strain on local resources. No health system is perfectly prepared to respond to crises, but some have much more capacity. I’ve been reporting the past few weeks on the hurricanes that hit the southern US, and while many patients experienced negative impacts on their care, the large capacity and redundancy here has allowed for a relatively quick resumption of care.
Managing infectious outbreaks
Some of the key elements to adequately cope with an infectious outbreak include the involvement of the larger public and trust in health officials’ messages; very good hygiene practices at hospitals and clinics, with the ability to isolate patients to avoid becoming multipliers of infection; and strong public health responses, including epidemiological tracking. I’d also add that the ability to offer rapid diagnosis and medical care to infected patients and quickly launch research studies can help end an outbreak and prevent it in the future.
When I reported on Ebola in West Africa, I spoke with some epidemiologists who were frustrated by inadequacies in the digital tools used for tracking the outbreak in various areas. Different systems were being used at different times in different areas, leading to some confusion and unreliability in datasets. Also, power and internet connections are not always reliable, which can add to the difficulties of maintaining web-based systems.
On the positive side, some new systems were pioneered and perhaps will provide a better experience in future outbreaks. In other mass crises, including the recent hurricanes in the US, web-based systems are increasingly being used to manage complex emergencies. However again, sometimes responders have reverted to plain old pen and paper when accessing internet sites became too burdensome in the heat of the emergency. Paper can be high technology in a disaster.
Transitioning to a universal healthcare system
My modest window into this issue of the need for universal healthcare has to do with rationing, triage and the distribution of resources. The inequities become very sharp and clear during mass crises, but they are with us all the time, whether it is in the US, where I live, or in South Africa.
Several years ago in Cape Town, I reported on the painful, life-and-death choices doctors and nurses working in the public hospitals make when forced to ration dialysis care, denying it to many who could benefit because of limited capacity. Whereas patients in the private system could access that life-extending service. Universal healthcare systems offer the promise of more fairness. However they also lead to difficult choices about what services will be offered to all.
Dr Sheri Fink will open the HASA 2017 Conference recounting the tragedy that took place at a New Orleans hospital when Hurricane Katrina devastated the city. The Conference will feature a number of international and local speakers who will together explore how to respond to the global healthcare puzzle through integrating healthcare. The world-class conference and exhibition will take place from Monday, 25 September to Wednesday, 27 September 2017 at the Cape Town International Convention Centre (CTICC). More information about the event can be found here.