Improvements in health care may be considered one of the great marvels of
the twentieth century. Although successful modern medicine is an everyday
fact of life in the industrial world, countless numbers of impoverished people
around the globe have merely been introduced to effective medicine. Poverty
creates an environment of poor nutrition, lack of health care, unhealthy living
conditions, and dangerous or unhygienic work (Kelleher & Klein 119). Poverty
not only excludes people from the benefits of a health care system, but also
restricts them from participating in decisions that affect their health.
The global effects of health care will undoubtedly affect the future of Physician Assistants. As health care professionals, PAs, by their own caring nature, will become more aware of the medical problems encountered everyday in underdeveloped countries. In turn, they will join the fight to improve health care standards globally. Physician Assistants will have to face a huge moral and professional dilemma, and will not be able to turn their heads and ignore the fact that impoverished people are in desperate need of standard medical treatment.
For Cameroon, a country located in Sub-Saharan Africa, the mid-20th century saw dramatic improvements in health and life expectancy brought about by technological advances, the introduction of primary health care, increased literacy, access to safe water, sanitation, and housing, and better understanding of social behavior. However, at the turn of the century, political unrest, environmental disaster, declining economic performance, unresponsive governance, weak public health infrastructure, the advent of HIV/AIDS, and the onset of globalization have all had a great impact on the welfare of the poor people of Cameroon (Ellyn). Although there are many questions surrounding the central theme of healthcare, maybe the most devastating issues involve the HIV/AIDS epidemic, malnutrition, and the lack of both modern health care and drugs.
Perhaps the very nature of this discussion involves making the important connection between the global effects of health care and its impact on medical professionals, as well as many people and organizations around the globe. In particular, the devastating effects of health care on the impoverished people of Cameroon in Africa are increasingly affecting the role of physician assistants, doctors, and other health professionals worldwide.
Impressive improvements have occurred in global health status in the past
century. Unfortunately, these improvements have not been shared equally and
health inequalities within and among countries are entrenched. The fragility
of health gains has been seen in response to economic, political, and social
changes, and civil disruption (Gentry). It is evident that there is an increasing
and urgent need for better regional and national health surveillance systems
to underpin efforts to address the complex mixture of old and new health concerns.
At the international level, it is rational to be concerned about cross-cutting issues, recurring themes, and common solutions to improve the health of the world's poor, including those in Africa. Indeed, it is also reasonable that this leads to the organization of global collaborations, alliances, and partnerships to advise and support poor countries in need of health care. In addition, encouragement from political, public health, civil society, and business leaders will also make a huge difference for government health systems to work with and advise and support development NGOs and religious institutions that are genuinely engaged in empowering communities (Macfarlane). Poverty and health disparities exist and are increasing in many countries. For effective health care to succeed in the developing parts of the world, most countries need to rebuild institutional capacity, especially providing more public funds for educational training and health care systems (Matthews).
However, many questions remain to be pondered as to why underdeveloped countries must receive funds from its rich and powerful global neighbors, in order to experience improvements in their health care system. Whatever the reasoning may be, it is obvious that developing countries cannot alter their quality of life without outside countries intervening. Moreover, global collaborations, alliances and partnerships appear to be having a very positive impact in developing countries. One such agency is the World Health Organization (WHO), which has contributed dramatic improvements in the lives of many poor people, by organizing health clinics. The future of the “globe” strongly depends on the continuation of international assistance to the world's poor.
Governments and NGOs have built clinics in poor and rural areas. Many non-governmental agencies, including several medical missions, have focused their work in developing areas, opening clinics and educating local people (Kelleher & Klein 119). Teaching more sanitary methods of living has proved to be the most important success of these clinics because it has saved millions of lives already. Similarly, the clinics' use of antibiotics and vaccines can prevent or cure diseases, which may have become epidemics in the past. According to Kelleher and Klein, the “clinics' mission is based on the most easily accepted elements of Western life: people wish to be healthy and to see their children thrive” (120). However, the problem of money and funding is recurring—many people cannot pay for medical care or even pay for travel to the clinic.
Non-governmental organizations, such as the World Health Organization (WHO), must focus on helping countries develop health care systems, which will contribute to the reduction of health inequalities, which are both responsive to the legitimate needs of people, as well as financially fair. The challenge is to ensure health care coverage for all, and organizations and governments around the globe must become better at setting priorities.
Improvements in global health status have been accompanied by a widening health and poverty gap between and within countries. According to Kasturi Sen of The Lancet,
investment in health research and development remains focused largely on the health problems of 10% of the world's richest populations, and only 10% of funds available for health research is directing at improving the health of 90% of the world's population...This disparity, referred to as the 10/90 disequilibrium, requires urgent attention.
The Global Health Forum is attempting to shift health research funds, and the World Health Organization is also focusing on changes for better health care in developing countries (Sen).
The effects of global health care impact many people across the globe, whether they are citizens of a country, companies and organizations dealing with health care policies and/or funding, or health care professionals. However, these consequences create a dipole effect—both positive and negative impacts are imposed upon these groups and individuals. The significance of the effects of global health care resides in the fact that human dignity must be respected and all humans should be entitled to standard health care. However, unless global health care improves significantly, poverty will continue to exclude people from reaping the benefits of a health care system.
While the global effects of health care impact many people throughout the
world, perhaps one of the most prominent targets includes medical professionals,
particularly the physician assistant. A Physician Assistant, or PA, is a qualified
medical professional who practices medicine under the supervision of a licensed
physician. Physician Assistants provide a variety of medical services traditionally
performed by physicians. The concept for this profession has its origin in
the early to mid-1960s as a way to enhance the provision of medical care to
people residing in medically underserved areas. The care of the underserved
remains an ongoing goal of the profession. The global effects of health care
have a direct impact on the role of the physician assistant, as well as other
health professionals. In particular, it limits and may prevent physician assistants
from attaining their professional goal of providing care to the poor, provides
hindrance to PAs expanding their practice worldwide, and poses a conflict
of dealing with moral obligation and ethical integrity of the physician assistant.
One impact global healthcare has on the Physician Assistant involves their limitations of attaining their professional goal of providing care to underserved communities throughout the world. One could logically assume that PAs are scattered across each continent, especially in areas populated with impoverished peoples. However, the fact remains that their practice is relatively limited to the United States. Although no explanation of this condition is readily accessible, one possible explanation is that PAs would first need to practice with a doctor who plans to travel and establish a practice in an underserved community. Another explanation is that the Physician Assistant profession is not yet publicized and accepted worldwide. Perhaps organizations, such as the World Health Organization (WHO), should be more aware of PAs and make them known throughout the world. In addition, PAs need to take a stand and join global organizations in order to expand their practice across the globe, focusing on poor communities. Although there are not many PAs providing medical attention in impoverished areas other than in the United States, it is highly likely that PAs will extend their helping hands and become increasingly global in the future.
The global effects of healthcare provide hindrance to PAs providing medical attention to underserved communities throughout the world. Due to unequal sharing of healthcare benefits in most developing countries, the local people remain impoverished and continue to lack sufficient healthcare. As a result, it is unlikely that PAs would be able to sustain a living in these poor communities. A lack of health care means that the PAs have to depend on governmental and non-governmental organizations to provide resources in order for them to render medical care. Although it is quite possible for this to occur, it is questionable whether national and local governments will make health care provisions to benefit poor people, because they are so poor that they can not afford to even pay a small share for their health care. Moreover, non-governmental organizations (NGOs) will provide what they allow in their budget but, due to the fact that they provide funding to countless underserved countries, resources will continue to be lacking. Therefore, it is crucial that physician assistants, as well as other pertinent medical professionals, join together with non-governmental organizations, such as the World Health Organization and Doctors Without Borders, in order to promote positive changes in health care for impoverished people in developing countries.
Another impact of global healthcare on the professional physician assistant poses a conflict dealing with their ethical integrity and moral obligation to help underserved people. As health care professionals, PAs are responsible to learn medicine inside and out, and apply their knowledge and expertise in the medical field to the treatment and care of patients. In addition, by their caring and empathetic nature, physician assistants especially have a moral obligation to provide care to medically underserved communities. However, without sufficient, or even basic, resources for medical practice, PAs are unable to provide professional healthcare in these communities. Physician Assistants can not ignore the fact that there are people suffering from illnesses which are preventable and even treatable if given the proper medical attention and advice. Furthermore, this problem poses a dilemma to the concerned PA—How do we provide care to these suffering people without the proper resources? And if we do not provide care in these communities, how is it possible to attain our professional goal? Again, the problems of a significant lack of resources dwindle the chances of providing medical advice and care to underserved communities.
The fact that unequal sharing of health care benefits in developing countries not only impacts the profession of physician assistants, but also creates hindrance to them attaining their goal of providing medical services to medically underserved communities, and perhaps limits their practice to the United States. Moreover, the global effects of health care result in the continual suffering of preventable and treatable illnesses, which could potentially be turned around if PAs, as well as other health care professionals, could gain access to resources in order to provide medical attention and advice.
Although health care has many impacts on the profession of Physician Assistants, it remains a fact that, unless action is taken, poverty-stricken people will continue to be excluded from the benefits of health care. Undeniably, impoverished communities will continue to suffer illnesses, which can be prevented and, most likely, treated, as long as medical benefits and resources are unequally shared.
Cameroon is located in Western Africa, bordering the Bight of Biafra, between
Equatorial Guinea and Nigeria. The former French Cameroon and part of British
Cameroon merged in 1961 to for the present country. Cameroon has generally
enjoyed stability, which has permitted the development of agriculture, roads,
and railways. Today, the country remains resourceful, although very powerless,
in the international system. It possesses several lucrative industries, such
as cocoa, cotton, coffee, petroleum, and lumber. However, Cameroon still finds
itself poor and indebted to the “world powers,” with 40% of its
population below the poverty line (“Cameroon”). The poor citizens
of Cameroon conceivably feel helpless and “small” in this power-hungry,
rich world. In fact, it is almost as if they are being cheated—for they
have many rich resources and still, they cannot afford to pay health insurance
and they remain ill and malnourished. The indigent people of Cameroon seem
to have no options but to wait for their global neighbors to recognize their
struggle, come to their assistance and provide aid for better health care,
including drugs and vaccines. Perhaps a very unfortunate analogy of the poor
country of Cameroon to the rich, industrialized world is: A very small needle
in a very large haystack!
HIV/AIDS is perhaps the largest and most devastating epidemic in the contemporary world. According to Michael Specter of The New York Times,
four million people were newly infected with HIV, the virus that causes AIDS, in the countries of sub-Saharan Africa last year alone. The epidemic has already killed 10 million people in that region—90 percent of the world's AIDS deaths—and because there is so little hope of access to the best drugs, at least 30 million will almost certainly die.
In Cameroon, the rate of HIV/AIDS is quickly rising, while effective action at the national level has only just begun. In addition, the great majority of people in this country have no idea if they are, in fact, infected with HIV. The fast acceleration of the AIDS epidemic in Cameroon poses a threat of “killing up to 25 percent of the population” (Harden). However, these numbers could possibly be even greater than expected. In a Capitol Hill Hearing on March 8, 2000, Democratic Representative Thurman stated,
AIDS is indeed a plague of Biblical proportion, and it's claiming more lives today than all the wars waging on the continent of Africa combined. AIDS is now the leading cause of death of all people of all ages in Africa, and the progression of this pandemic has outpaced all of our projections (“Hearing”).
AIDS, this continuously devastating disease and human tragedy, will continue to kill countless numbers of people across the African continent, including the impoverished people of Cameroon (Balter). Consequently, not only will thousands of children be left orphaned but, in addition, this epidemic will further impair an already burdened health care system.
Another issue of great concern in regards to health care in Cameroon involves malnutrition, which is the major underlying condition of poor health worldwide. According to Kelleher and Klein, malnutrition poses a much broader problem: poor diets make people more susceptible to a wide range of diseases that might otherwise be avoided (120). The malnutrition problem is directly related to economic innovations in cash crop farming in Cameroon. Many farmers used to grow food for use by family and communities. However, they now produce food for a distant market. Today, they grow major cash crops, such as cocoa and coffee, which add nothing in the way of nutrition to a diet (120). As a result, families living in Cameroon remain malnourished and susceptible to avoidable diseases.
In addition, Kelleher and Klein mention that the modern economic situation has also had an impact on the most basic form of human foods, mother's milk. Nursing becomes a problem since the physical condition of a mother affects both the quality and quantity of her milk, and most of the time the mother is not available for regular feedings (121). Moreover, the fact continues that millions of people remain hungry in Cameroon, and they are suffering greatly from malnutrition.
A final, and perhaps the most important, issue concerning health care in Cameroon involves both a lack of an effective, modern health care system as well as a lack of drugs to fight preventable illness. According to Dr. Nganele, who was born and raised in a middle-class Cameroon family, health care in Cameroon is universal. The government pays for health care; the hospitals are free. But there are private hospitals as well, which means that if you don't want to go to the government hospitals and you have money you can go to see private physicians and private hospitals. The government also provides free medical education (qtd. in Greene).
According to the Capitol Hill Hearing, access to palliative care and treatment of opportunist infections are essential components to successful health care (“Hearing”). However, it is highly unlikely that the poverty-stricken people of Cameroon will gain access to this type of care anytime in the near future. Michael Specter maintains that with an average of ten dollars to spend on each person's health every year, African countries, such as Cameroon, “have no money for tests, for fancy drugs or for complicated support networks.” With such a small amount of money allotted toward individual health care, “more people die, more livelihoods are destroyed, and fewer people can afford any kind of insurance” (Ransom).
A plethora of people in Cameroon die from a lack of medical attention, particularly many children who die from chronic diarrhea resulting from water and food contamination. It is estimated that a hundred thousand children die annually from easily preventable diseases (Ransom). These ailments go untreated, or perhaps badly treated, not just because the poor are unable to afford the drugs they need, but because the drugs themselves simply do not exist. According to McNeil, Africa accounts for one percent of world drug sales, while North America, Japan and Western Europe account for 80 percent. It is for the latter three countries that drug companies invent a stream of high-priced, highly profitable drugs. Although the main problem is that the poor cannot afford the much-needed drugs, it is evident that pharmaceutical companies are responsible, in part, for the lack of preventive health care and drugs. According to Dr. Pecoul, head of the Doctors Without Borders campaign for affordable drugs,
pharmaceutical companies will always aim for maximum profits by marketing a new obesity drug rather than pioneering a novel malaria drug...when new vaccines or medicines are developed, most of the world's population is left out of the picture (McNeil).
Consequently, poor coverage and inadequacy of health facilities means that people die of disease and hunger.
As a PA, it is critical that we continue to be knowledgeable on how the rest of the world lives and how we can better serve them as medical professionals. Just as the effects of global health care are impacting the medical profession, PAs can, in turn, reverse this equation and make a greater impact on global health care. Physician Assistants, as well as other medical professionals, need to take a stand and join forces with each other in order to provide impoverished people with the medical attention they deserve. Without this medical attention, these poor people will continue to suffer. Their populations will proceed to deteriorate due to the HIV/AIDS epidemic, malnutrition, and lack of both modern health care and drugs.
PAs will become innovative in global health care in that they will serve as a means of providing education, medical advice, and medical treatments. Educating medically underserved communities serves to teach the people how to reduce their risk of HIV/AIDS, as well as teaching them how to maintain a healthier diet and to be wary of unsanitary living conditions and water. PAs will also function in providing them with the knowledge and understanding of how their bodies' function, with hopes to promote a healthier lifestyle. In addition, the improvement of health care in Cameroon and other impoverished countries heavily relies on the support of outside funding. Although more and more PAs will be working to provide better health care to medically-underserved communities, it is unfortunate that this can only be done with the help of outside factors, such as the World Health Organization and the World Bank.
What I learned from studying this case—the effects of global health care on the impoverished people of Cameroon—includes the fundamental moral and ethical obligation to fulfill the goals of my profession, which is to provide care to medically underserved communities. Although this may be done locally in the United States, it is imperative that Physician Assistants focus on their goal and really contemplate the overall concept of that goal. It is critical for PAs to expand their horizons and expand the boundaries, which provide limitations to the scope of their practice. That is, it is necessary for PAs to join other organizations and work together in order to provide medical attention to underserved peoples throughout the world.
It is inevitable that poverty will continue to exist in our world. However, it is important that we try to prevent the calamities associated with it—an environment of poor nutrition, lack of health care, unhealthy living conditions, and dangerous or unhygienic work. Poverty excludes people from the benefits of health care, as well as restricting them from participating in decisions that affect their health.
The African country of Cameroon experienced dramatic improvements in health care during the mid-20th century. However, changes at the turn of the century have had a great impact on the welfare of the impoverished people of Cameroon, inhabiting this country. Perhaps the most devastating issues surrounding the central theme of health care in Cameroon involve the HIV/AIDS epidemic, malnutrition, and the lack of both modern health care and medications.
The overall global effects of healthcare will no doubt have a profound effect on the future of the Physician Assistant. As health care professionals, PAs will become increasingly aware of the medical problems encountered everyday in developing countries, such as Cameroon. They will have to face the moral and ethical dilemma posed by the unequal sharing of health care, and will join the fight to improve health care standards around the globe.
The industrialization of Cameroon is essential if the country is to reap the benefits of globalization, thereby increasing economic prosperity. Moreover, the poverty-stricken people of Cameroon will, perhaps, prosper and gain access to modern medicine similar to that of the industrial world. Eradicating poverty and, thus, making the successes of modern health care a universal reality appear to be the ultimate goals surrounding the issue of healthcare in Cameroon. Incidentally, these goals cannot be attained without the assistance of Cameroon's rich global neighbors. However, with their help, some of the most devastating health care issues such as the HIV/AIDS epidemic, malnutrition, and lack of effective health care and drugs may be alleviated in the African country of Cameroon, with the aid of physician assistants.
Balter, Michael. “AIDS Now World's Fourth Biggest Killer.” Science. 14 May
1999. Online. Proquest. 29 September 2000.
CIA. “Cameroon.” The World Fact Book. Online. Lexis-Nexis. 18 September
2000.
Ellyn, Glen. “Health Care Issue in African Region.” Presidents and Prime
Ministers. July/August 1999. Online. Proquest. 29 September 2000.
Gentry, Carol. “A Surprisingly Popular U.S. Export: Managed Care—Just Call It
Something Else.” The Wall Street Journal. 20 December 1999. Online.
Proquest. 20 October 2000.
Greene, Donna. “Leading Minorities to Better Health Care.” The New York
Times. 19 March 2000. Online. Lexis-Nexis. 15 September 2000.
Harden, Blaine. “The World: Into Africa.” The New York Times. 27 August
2000. Online. Lexis-Nexis. 18 September 2000.
“Hearing of the House Banking & Financial Services Committee: The Global
AIDS Crisis.” 8 March 2000. Online. Lexis-Nexis. 18 September 2000.
Kelleher, Anne and Laura Klein. Global Perspectives: A handbook for Understanding
Global Issues. Upper Saddle River, NJ: Prentice Hall, 1999.
Macfarlane, Sarah. “Public Health in Developing Countries.” The Lancet. 2
September 2000. Online. Lexis-Nexis. 15 September 2000.
Matthews, Hugh. “UN Report Warns that AIDS Epidemic is Still Out of
Control.” British Medical Journal. 28 November 1998. Online. Proquest. 20
October 2000.
McNeil, Donald G. “Medicine Merchants: A Special Report.” The New York
Times. 21 May 2000. Online. Lexis-Nexis. 18 September 2000.
Ransom, David. “The Dictatorship of Debt: 3rd World Debt Enriches the
Powerful at the Expense of the World's Poor Majority.” New Internationalist.
May 1999. Online. Lexis-Nexis. 15 September 2000.
Sen, Kasturi. “Global Health Status: Two Steps Forward, One Step Back.” The
Lancet. 12 August 2000. Online. Proquest. 20 October 2000.
Specter, Michael. “Doctors Powerless as AIDS Rakes Africa.” The New York
Times. 6 August 1998. Online. Lexis-Nexis. 18 September 2000.
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