The following rant comes courtesy of a speaker to a group of volunteer developers working on OpenMRS, who recounted her experiences of volunteering as a doctor in India.

Naturally, when you go under the knife for a surgical procedure, you’d want the surgeon using the latest, most advanced techniques, as demonstrated by empirical evidence.  Health systems want the surgeons to use the most efficient technique, expressed in positive outcomes per money spent.  You’d expect that in today’s world, you’d get one of the two, or perhaps somewhere in between.

Say that the latest technique uses robo-surgeons. Let’s call that technique Z.  It was pioneered in a university teaching hospital at enormous cost, because they’d never built one before; there’s no commercial provider of the equipment yet, so technique Z hasn’t percolated to wider practice.  Most other hospitals use techniques X or Y, one requiring more, highly trained staff, and the other requiring fewer staff but a couple of expensive pieces of equipment. Techniques X and Y are variations on T, U, V and W, some of which date back to the early sixties, and stem off from technique S.  If you look at textbooks, S is mentioned by name, and T, U, V and W have one- or two-sentence descriptions because while major leaps forward at the time, they’re now obsolete in the era of X and Y.  The medical textbooks describe how to do X and Y in detail.

In developing countries, you don’t have either the many staff, the highly trained staff or the expensive pieces of equipment.  U, V and W are all unavailable because of this. T uses equipment that can’t even be procured any more and certainly isn’t lying around waiting to assist with surgery now.

The developing world needs medical and surgical texts that don’t demand powerful diagnostic tools, expensive equipment or highly specialized staff.  A competent surgeon can do their work without any of these; they’ll get worse expected outcomes, but those outcomes will be better than inaction.  There are no textbooks currently available to instruct a surgeon with limited resources.  Even battlefield surgeons expect to stabilize their patient and ship them off to much better hospitals.

The ongoing progress in medicine is leaving behind the poorest and most vulnerable on our planet; our indifference to the preservation of these old methods are affecting us now, in ways I would never have guessed at.