The combination of my new position with Linksbridge working on global health issues and the recent New York Times article on the death of Peace Corps volunteer Nick Castle (NYT Peace Corps Death), has brought back memories from my time as a Peace Corps health education volunteer in Malawi. These memories serve as a reminder of why I do the work I do.
At my post—a rural health center 16 miles down a dirt road, no electricity, no piped water—there are few resources to treat sick patients. Paracetamol (essentially Tylenol) is used as a default treatment for the majority of patients that come to the health center, whether or not it is the appropriate treatment, because it is the only drug available with any consistency. Vaccines are brought in once a month by motorcycle since the cold chain cannot be maintained at the health center. Despite this environment, in which the public sector is limited in its ability to ensure access to appropriate treatments (due to an array of interconnected issues including insufficient funds for drug procurement, weak supply chains, and corruption), one day in a rarely opened drawer I find bottles upon bottles of Mectizan, a prophylactic for onchocerciasis (river blindness). I had heard about the Mectizan Donation Program when I worked for Merck years before. The fact that the drug was at my site, where few resources were available, was one piece of evidence to me that improved access to medications could be successfully achieved through partnership between the pubic and private sectors.
A young woman who has given birth at home, comes to the rural health clinic with postpartum hemorrhage. She won’t stop bleeding. The health center doesn’t have the medicines or expertise to treat her. Instead of calling for an ambulance to take her to the district hospital where she can receive appropriate care, the staff waits. And waits. Hours pass while she continues to bleed. Eventually I am told by the staff that she is going to die anyway and it is better that the death count is not increased at the district hospital. Apparently maternal mortality is not being tracked at the rural health center.
The memories above are just two of many that link to my current work. I can see now, after years of working in international public health, how these personal experiences were not isolated incidents but link to broader public health issues. Issues of access, misaligned incentives, poor quality of care, under-paid health care staff. I can see how they point to the need for health system strengthening, training, and the benefit of drawing upon the strengths of both the public and private sectors to address complex health issues. These realities continue to drive my desire to contribute to international public health.
In terms of Nick Castle, to me the conditions of his death in part reflects limitations with the broader health care systems in developing countries; where the link between diarrhea, dehydration, and the risk of death is not well understood by caregivers, where malaria is as common as a cold and thus often not taken seriously, where the pressure to improve (likely internationally imposed) indicators can trump the desire to try to save a human life. It is a reminder of the importance and necessity of the work of global health philanthropic entities.