“Is this my job as a surgeon sitting in a crowded rural Kenyan surgical clinic, to order tests and treatments based on a ‘guestimation’ of what my patients can afford?” This is the question Dr. Peter Bird finds himself wondering in his article “Perspectives from a weary surgical oncologist in Sub-Saharan Africa.” In it, he talks about the plight of a surgeon whose ability to save lives is hindered by financial and accessibility barriers, particularly in terms of delivering care to patients who cannot afford the out-of-pocket costs for care. In this specific case, Dr. Bird’s patient Muthoni and her family were unable to raise the necessary funds for her treatment, despite attempts to secure additional funding through a loan. In low- and middle-income countries (LMICs) like Kenya, patients such as Muthoni and their families seeking essential surgical care may face the prospect of financial hardship or impoverishment due to burden of out-of-pocket costs.
Imagine being faced with the need to raise your annual gross income in cash to cover essential health care costs for yourself or a loved one. And even then you may not be able to cover all the costs that arise. Despite efforts of facilities such as AIC-Kijabe Hospital which seek to bridge the surgical gap, surgical care cannot be sustainably delivered for a population through donations and charitable organizations alone. In his day-to-day work, Dr. Bird and many other surgical providers like him are faced with difficult choices. As stated by Dr. Bird: “I don’t want to be the one destroying a family financially by suggesting relatively expensive therapies that might not work. But neither do I want to lessen their chance of cure.My advice can devastate a family for a generation.” These are impossibly difficult choices and highlight the many obstacles faced by providers and patients in a system where access to essential and life-saving surgical care is not guaranteed.
The G4 Alliance and our member organizations remain committed to advocating for integration of emergency and essential surgical, obstetric, trauma, and anaesthesia care as part of universal health coverage and as part of the primary package of health care.