Resource Reality Check

Published on July 8, 2014
Publisher Logan Plaster writes about the innovation necessary for EM in a resource-limited world.

I remember walking around the exhibit floor at a recent EuSEM conference with an emergency physician colleague. At every booth, a proud spokesman hocked his wares and every time we walked away, my friend would shake his head. “Sounds great,” he’d say each time, “but we can’t afford it.” At every turn, he offered me his DIY, do-more-for-less solution to the shiny, wiz bang tech on offer. Why? Because he was from a resource-limited environment . . . known as the United Kingdom. Far from the so-called “developing world,” he was experiencing the kind of tightening budgets that lead to limits in care and training.

In the world of global emergency medicine, countries are often stratified by economics—those who have and those who have not. Where we used to say “third world,” we now call a country a “resource poor” or “resource limited” setting. Even the term “developing country” has fallen out of favor because it implies that all countries are developing along the same “Western” trajectory. Ask the Bhutanese how they are “developing” and they’ll eschew GDP in favor of their excellent Gross National Happiness figures.

Clearly, availability of resources is relative. The United States spends more than $8000 on healthcare per capita, compared with $1621 in Qatar and $126 in India. However, with the USA up to its eyeballs in debt and the UK considering privatizing the NHS, it’s clear that we live in a resource-limited world and we need to manage healthcare accordingly.

Docs who have worked in varying international settings (i.e. our readers) get this better than most. They understand that there is best evidence, and there’s practical reality. Depending on where you practice, you might not always be able to get a specialist consult. And if you’re in a rural setting, there might only be enough blood on hand to save a couple major trauma patients at a time. What do you do? You adapt. In this issue, Manuel Hernandez talks about design improvements your ED can implement without breaking the budget and Haywood Hall writes about how simple, lo-tech emergency obstetrics courses can markedly improve maternal mortality rates.

As healthcare budgets across the world continue to shrink, EPI will be working to share the innovative spirit of the “global” emergency physician with EPs everywhere. By doing so, EM will become well situated to guide healthcare systems in the delivery of effective, resource-appropriate care for the world’s sickest patients.

This letter originally appeared in Issue 13 of Emergency Physicians International.

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