Saturday, January 15, 2011

Is There a Doctor in the House?

So-called health care experts often point to developing nations and say, "See? Even (insert povery stricken country here) provides (insert random medical treatment here) to its poorest citizens while the United States spends its money on advertising, bloated administrative salaries and Viagra."

The so-called health care experts often ignore the actual, day-to-day medical care systems and whether or not features of these systems might be adopted in the U.S.  Dakar is fortunate in some respects.  As an urban center, the best care facilities in the country are located here, health insurance is available here and most of the medical professionals in the country live here.  But to truly get a flavor of Dakar health care, I thought I might share stories from three different health care incidents.

One of my students complained, "The doctor didn't show up yesterday."  After further inquiry, I learned that in Senegal, you dial a number and a fully equipped vehicle and trained professional arrives - AT YOUR HOME OR OFFICE - to treat you.
If it is an emergency, they will transport you to a health care facility.  I need to do a bit more research on this, but from what I understand the doctors affiliated with this practice are essentially moonlighting!  Doctors earn relatively little compared to their U.S. counterparts when paid for their government work, so to earn additional money they need to be entrepreneurial.  Entrepreneurial does not mean, "figure out ways to bilk the insurance companies", so score points for Senegal's health care system for its ability to provide government-sponsored care to the poor while allowing its medical experts the ability to earn additional money using market-based techniques.

How is the quality of health care?  The next anecdote is from personal experience (and BEFORE I learned about the above SOS home health care visits).  I'll save the gory details, but I was severely dehydrated and absolutely could not drink enough fluids to replace what I was losing; I was unable to pinch even a bit of skin on my arm.  I rarely use the U.S. health care system, so to ask to see a doctor in Senegal was a big leap of faith for me.  I desperately needed an I.V. to get some fluids in my system and was willing to take a chance...

As a member of the upper crust here in Senegal, my driver took me to a very nicely appointed clinic - complete with tropical fish tank - on a Sunday morning.  After providing my health insurance card, I was told the total fee was $60 of which I was responsible for 20% with my co-pay.  I waited in a nicely appointed patient room and a guy entered about twenty minutes later with a large briefcase filled with medical stuff.  He was not "African", unless it was Algeria or some other area where the Whitest Guy in West Africa might even be able to camoflage himself.  In fact, he kind of looked Mexican.  He never introduced himself and could have been the janitor for all I knew (with apologies due to all Mexican janitors who may have completed medical school).

He listened to me recite my symptoms and my request.  I thought about trying to explain myself in French, but with my accent and under-achievements in mastering this tribal language, I was afraid my version of  "I do not feel well" might somehow be translated as "I have swallowed an entire goat." 

The guy (who might have been a doctor) performed a couple of routine tests on me.  By routine, I mean he pressed my stomach with his hands, took my blood pressure, listened to my pulse and used a stethoscope to check my breathing. 
Then, he pulled out a notepad and wrote me a prescription for an antibiotic, pain medicine and the prescription strength equivalent of Imodium.  He never drew any blood, so there was no way he could have known if I had a bacterial or viral disease.  When I said again that my reason for coming was because I was severely dehydrated and asked again about getting a fluid IV, he looked at me reassuringly and responded, "You should drink some water."  So, there you have it: $60 for expert medical advice to drink some water.  My six year old daughter performs a similar routine on me with her doctor kit back home, but doesn't charge me $60. 
I left the clinic to get my prescription filled and went back to sprawl out on a couch completely unsatisfied with the health care experience.  That's when one of my colleagues/housemates entered.  He, too, was not feeling well.  The difference is that he went directly to the pharmacy.

He explained his symptoms to the pharmacist and asked for an antibiotic and a pain reliever.  The pharmacist asked if he had a prescription.  He, in turn, asked the pharmacist for a notepad and wrote down, "Antibiotics and pain reliever" and signed it "Dr. Haider."  Now, in all fairness, my colleague has an earned doctoral degree. In mathematics.

The pharmacist looked at the fresh prescription signed by the good doctor and dispensed one box of antibiotics and a pain reliever...


  1. Oh this is good! Imagine if we all had our own Rx pad? Gosh I can barely get anything filled at the pharmacy without a driver's license these days. Incredible.

  2. Well, it does have it's ups and downs, and it appears you can get whichever ones you want if you have a notepad. Cool.