This is the first part of a three-part series. Part 2 will appear on December 16. 1. The Band-Aid Treatment: We can cover the blood, but we aren’t stopping the bleeding. In June of 2015 I began a global journey to better learn and understand what defines quality healthcare, and to gain a firsthand view of aspects of the global healthcare systems. I visited medical facilities and communities in Singapore, Vietnam, Myanmar, Thailand, Russia, Nigeria, and the Netherlands, expecting to find profound differences in each place. Access to healthcare, to resources, and to technology certainly varied, even within the given country. Significant differences in economic means, education, and even cultural and religious beliefs definitely impacted on the medical care received by the population. However, what I found most apparent were the overwhelming similarities in terms of the main problems faced by physicians and patients; rendering healthcare, treating acute and chronic medical conditions, and basically improving the overall patient wellbeing requires supplies, equipment, facilities, and personnel that are in short supply, if available at all. The challenges are being met with a temporary “solution” that I refer to as the Band-Aid Treatment. The Band-Aid Treatment essentially states that you are “covering the blood, but not really addressing the underlying problem, the bleeding,” or more simply, stopping the appearance of the problem rather than overcoming the condition itself. Limited resources and overwhelming challenges have created this incomplete approach. I was at a private clinic in Lagos, Nigeria when this all clicked. I was speaking with Dr. Lillian Ekpo, a physician who has had unique experience in infectious diseases, playing a leadership role in the national response to the Ebola outbreak. With a so-called grassroots approach, she has provided care through her local clinic, involved with medical evaluations and treatment while incorporating the very vital role of educator to the patients and caregivers. Malaria remains a major health concern in Nigeria. Dr. Ekpo described the challenges to treating the disease, the need to control the risk environment that leads to the infection and the variable patient compliance to the medications required on a regular basis. She told me that her clinic has all the tools. That may be an exaggeration. The ailments more commonly managed in the developed countries, like diabetes and hypertension require regular and routine medical visits, chronic medications, and the understanding by the patients that these diseases must be treated even when they are not causing significant symptoms. One of the major challenges for her clinic is educating the patients to understand and accept the responsibility for the medical condition and the cooperation required for the treatment. In her words, the key is that the responsibility rests with the patients, not the physician. Understanding how to avoid at risk areas, the importance of hygiene and clean running water, and eating proper balanced diets is up to the patient. A physician can treat and prescribe, but the patient has to take responsibility for his or her own life to prevent illness and remain healthy. This problem appeared somewhat differently in Vietnam, a more economically developed country. Economic growth and the introduction of new “westernized conveniences and lifestyles,” fast food chains, and technology are creating a less active population with worse eating habits. It appeared almost as a corrupting influence, with the population perhaps ill-prepared for the negative impact on general health with these diets and sedentary lifestyle. It sounds paternalistic to say that a little kid can get into trouble if left to his own in a candy store, but growing up with these health challenging components to society in “developed countries” makes for better preparation than the sudden and rapid introduction that has occurred in Vietnam over the past two decades. While there are areas of the country still significantly challenged, Vietnam has had significant success in controlling so-called third world diseases like malaria. The “western diseases” that we are so used to in the USA—diabetes, hypertension and coronary artery disease—are sharply increasing, as is the incidence of cancer. There is a growing recognition of the importance of educating the public about these issues of general healthcare. Controlling the chronic, certainly manageable but not curable, conditions of diabetes mellitus and hypertension requires a patient understanding, even in areas of Vietnam where the facilities and supplies are more available. Worldwide, we recognize that patients don’t enjoy “going to the doctor.” They go because they have to. Yet chronic illnesses, especially diabetes, hypertension, and COPD are on the rise. Common trends including missing appointments because patients “feel fine and see no reason to go,” failure to regularly take their medication, and confusion and mistakes in taking the medications correctly. While this remains a problem worldwide, it is more widespread and more difficult to resolve in these underdeveloped countries. This can result in patterns of otherwise avoidable health crises, overmedication, and waste of resources and increased healthcare costs in places ill-equipped to deal with it. Much of the responsibility falls on the patient, and by adhering to the physicians’ treatment plans, not only can the symptoms be resolved, but the underlying pathology treated and cured. The importance of improving the patient-doctor relationship, which comes with better health education and awareness, was seen as the key to further improving overall healthcare and patient outcomes. How can physicians improve the patient relationship so they can not only treat but also cure and prevent? Technology is helping; it makes healthcare education universal and often free. It allows new ways for patients and physicians to interact, or patients to store data integral to a physician providing better care. Many have mobile phones, and that alone is vastly increasing access to medical information and disease control and prevention. Myanmar is a prime example where the value of technological innovations and a mobile phone can be seen. The vastly increasing mobile phone access, with a goal of having access to over 90% of the country within five years, is making information and communication more accessible than ever before. Already, immunization efforts, malaria control, and other health initiatives are seeing positive results as cell phone access increases. Technology is also bringing with it greater education and awareness opportunities. Mobile phones can provide the information in a fun and entertaining way. Mobile games that already exist in the United States focused on providing a fun way to learn about illnesses and how to control them (i.e. diabetes games and others). This is especially important for chronic illnesses where medical conditions need to be properly managed and monitored, encouraging and motivating patients to take better care of their conditions such as diabetes and hypertension. Twitter allows diseases and health crises to be tracked in real time. Mobile devices provide new ways to help patients with following medication directions and schedules, following up with doctors, and taking care of one’s own health by eating well, exercising, and caring for one’s body. All of this is focused on creating a better understanding and knowledge base so doctors can “stop the bleeding.” As has been told to me in so many of the places that I visited, the patients need to be aware and on board to participate responsibly in their own healthcare. Finally, I was surprised to hear that insurance coverage issues are truly international and complex. In western countries, many populations are covered by national health insurance plans. Where such programs do not exist or are incomplete, patients must select and pay for coverage or miss out on medical care. This problem even exists in the USA where many patients are either unable or unwilling to pay for insurance, leading to more limited treatment options or costly care. This is a particular problem in Nigeria, for example. Dr. Ekpo, in Lagos, described her firsthand experiences: There is a reluctance to pay for insurance because it is hard to explain to someone, especially those living in poverty, to pay for something that they don’t need now, but “may” need in the future. This understanding of the need for insurance again falls under the umbrella of improving health awareness, education, and communication between patient and physician. Certainly the underlying condition of significant poverty makes the solution so much more difficult to achieve. Arguably, of the places that I visited, the best response to addressing the issues of health was in Singapore. The government policies toward food regulation and certain social policies have a significant impact on improving healthcare and overall health. In Singapore, the government takes a very active, yet strongly indirect role. It is recommended to many citizens to always allow a few hours to digest after meals and before bedtime. The population is encouraged to go for walks after eating. The government also closely regulates food and beverages, which has a profound impact on health. Singapore is one of the only countries where food safety is managed by a one-stop statutory authority, the Agri-Food and Veterinary Authority (AVA). Firms are fined for bringing in food that doesn’t meet strict health standards. This alone has a profound impact on citizen’s dietary options and removes the particularly unhealthy foods. Singapore also monitors how frequently citizens attend casinos, approaching them if gambling appears to be a problem. Their approach to the homeless is to refer the homeless for government assistance for a job, but this can involve being sent to jail until the individual finds employment. Cardiovascular disease, diabetes, obesity, and COPD were the most common conditions patients came to doctors with in every country I visited. Prescriptions and medication were the primary treatment methods. These very different countries, with different governments, economies, in different states of development, and with vastly different access to new technology and resources, all saw physicians facing similar major health obstacles and problems. Simply put, they all recognize the same solution to the problem of improving healthcare—namely improving medical education, awareness, and establishing a better and more compliant patient-physician relationship. This prevents a Samuel Huntington type “modernization theory” conflict of interest, and provides the opportunity for a uniform approach that can be replicated globally to address these problems. The solutions may be easier to implement than expected as well. The existence of traditional and holistic medicine, and the strong roots of alternative methods in many cultures stress full body health. The better understanding of different cultures and their alternative medical treatments may provide additional outlets for treatment and improved communication, understanding and cooperation of patients, as they develop a stronger understanding of and relationship with the healthcare providers. The key to a better, healthier tomorrow isn’t the sole responsibility of physicians, patients, or governments. Physicians can only go so far, and typically that involves addressing the underlying medical condition, “stopping the bleeding.” But to truly stop the bleeding it falls upon each person and potential patient to do their part and manage and take responsibility for their health. Until then, doctors will only be able to provide prescriptions and temporary relief. Governments can provide health options and regulations to protect citizens as best they can. As we move ahead, increased awareness and education, probably facilitated by technological innovations and developments are providing promising new opportunities. However the patient-doctor relationship, that trust and that mutual understanding, is the key pillar to better healthcare for these very challenged patient populations of the developing world countries. With proper governmental support, improved infrastructure for sanitation, basic nutrition, and availability of essentials for care, doctors and patients can work together to truly stop the cause and actually cure or definitively manage and not simply temporarily treat these conditions. Featured image courtesy of Pixabay.