Malawi Stats
On account of the magnitude of the HIV/AIDS epidemic and the incidence of STIs unsafe sex is the most important of the risk factors selected (Table 4). Malnutrition and water and sanitation come next in importance.AIDS is the number one cause of death in Malawi and malaria accounts for 30 percent of ALL outpatient visits. I have yet to find a figure for what percentage of medical care goes to AIDS.
But I bet if you got AIDS and malaria under control via non-medical means and put more resources into BASICS including but not limited to nutrition, water and sanitation, you could drastically cut MEDICAL expenses while seeing productivity go way up in the country.
One of the things that aggravates me -- and I talk about this SOME in comments on Hacker News at times -- is we call MEDICAL care "health care." It's not. It's a SUBSET of HEALTH care.
Reality:
- Good nutrition is health care
- HOUSING is health care
- Adequate sanitation is health care
- Education is health care
- Human rights is health care
- Enlightened attitudes towards sex and birth control is health care
- In a nutshell: "Living right" is health care
I haven't seen a doctor in something like 18 years and the last doctor's visit I recall going to was for a chest x-ray to have records to bring to a program in Georgia that helps disabled people get jobs because I was trying to prove I qualified for their services. FORTUNATELY, just before I finished the intake process, I got a job at Aflac because these people were going to keep me underemployed and poverty-stricken FOR LIFE if they got their hooks into me.
Meanwhile, I am steadily getting healthier for cheap while poverty-stricken by figuring out how to eat right for my defective body, focusing on germ control and similar basics.
In a nutshell: I have been supporting a family of three on well under $20k/year for many years while getting healthier and not seeing any medical professionals and two of us have CF which can cost an average of around $250,000 annually JUST for medical care, not counting other expenses (like eating a LOT more because you don't absorb nutrients). So we have been avoiding roughly half a million dollars annually in medical care by focusing on nutrition and germ control as first lines of defense.
Average education level in Malawi is low, something like a sixth grade education level. GDP per capita is around $554/per year.
And I'm feeling like they desperately need more basics, not more hospitals and doctors. Medical Internet Literacy and educating both health care professionals and ordinary people about common-sense approaches to treating some of their biggest problems (AIDS, malaria) would likely do them more good than trying to support expensive "western"-style hospitals with doctors and x-ray machines and yadda.
I have read that Native Americans lost to European settlers in part because they were enamored of European "shiny tech." They thought guns were cool and abandoned the boy and arrow for buying guns.
Unlike arrows, bullets cannot be made from sticks and feathers found out in the natural environment. The oils used to lubricate guns was not a thing they had any ability to make, so they used tallow -- animal fats -- and it turns hard in cold weather, causing guns to misfire or not work, so they would sleep with their guns to keep them warm enough to be able to fire at all.
Shiny modern tech can be wonderful but if you don't have the education and adequate development to use it properly and maintain it properly, it can be an unsustainable burden.
I live in a small town in a fairly rural corner of my country and I keep an eye out for interesting tech development in Africa in hopes of borrowing ideas from what works there for my hopes of improving rural and small-town development in the US. Tech can be a huge help in such settings but only if you adapt it and develop it for the constraints and reality on the ground and not just import "big city" tech and practices, which are often ill-suited to the realities of this very different environment.
I am not going to provide citations. I was digging around on my phone last night and although I live in the future and my laptop KNOWS the search terms I used on my phone, it doesn't give me the same results and I didn't keep records of my searches and all the stuff I looked at last night.
One stat I recall seeing: Malawi cannot provide three health care professionals per health care facility and that's some basic expectation that spiffy global health care orgs would like to see or recommend. In fact, they have something like 1 doctor per 20,000 people and these stats are given in "per 10,000 population," so 1/2 doctor compared to most countries having multiple doctors per 10k.
One of my big beefs with modern medicine -- as compared to MY CHILDHOOD experiences, so not that many goddamned years ago -- is that doctors don't know their patients, treat their patients as individuals instead of as part of a family and unlike when doctors used to visit you at home, they have no idea how you live and may not even know to ask for info they no longer see with their own two eyes. They treat patients like specimens in a petri dish and decide which drugs and surgeries to add to the mix without even really understanding the CAUSE of health problems.
I can remember as a kid going to a clinic with siblings and cousins and ALL OF US getting shots so we didn't pass the same problems around for fucking ever. So it got STOPPED in ONE visit.
I LOVE this video (below) and how the small town "country" doctor tells the visiting big city doctor (roughly) "Nice work. You were about to crack open a kid's chest to cure a case of diarrhea." and also hands the parents a can of soda pop and says "That will be 65 cents."
And I can't help but wonder how much the world is performing expensive, invasive procedures because too few doctors know their patients well enough to hand them a sixty-five cent remedy for the REAL problem. The US gets "jokingly" (not so jokingly) called "The third world country of America." Some of our rural, small town areas have terrible conditions in terms of infrastructure and "development" more typically found in that no doubt out-of-date phrase Third World Countries.
Years ago, I saw an episode of probably Sixty Minutes that profiled a woman doctor who moved to a small town in a poor part of America and she talked about "You go to their house and you see the porch is broken and that's how he got injured, so you get on the phone and make some calls to get the porch fixed."
Malawi is largely dependent on outside aid currently for most of its medical care. It's too poor and underdeveloped to have a "homegrown" medical system.
Some of that, like the malaria vaccine that has been introduced, may well do a world of good. And some of it is probably too little, too late and they could do more good for fewer resources by "fixing the broken porch" -- adequate water, sanitation, education, nutrition, etc.
On probably some OTHER episode of Sixty Minutes, someone wanted to make a list of basic procedures and cover those for the entire state he lived in using federal funds for our emergency medical coverage thingy Medicaid, which is not how Medicaid is supposed to be used and it presumably never got approved.
We do the same stupid shit in the US: Wait until your poverty lands you in the ER and then cover expensive "heroic" measures for fucking free "out of compassion."
Right. Sure. You got loads of "compassion" for my sorry ass. And probably also a parcel of ocean front property in Arizona you would like to sell me. CHEAP. Lots of beach. Just keep looking. The water is surely there SOMEWHERE what with all this SAND around.
One hospital in the US got tired of being bled by very ill homeless people and decided to arrange housing for them and PAY for it and their overall expenses went way the hell down. It was far cheaper and more effective to put homeless people in housing than let them bleed their ER for "compassionate" care in the lying bullshit name of "Aren't we such NICE PEOPLE?"
No, you fucking aren't. If we were NICE PEOPLE, there would be a lot fewer homeless in the US for you to PRETEND to fucking care about when their poverty lands them in the ER over and over and then you label them "homeless frequent flyers."
So I'm thinking Malawi would likely be better off using the internet or similar to support the work of LOCAL clinics in villages, traditional healers ("medicine men") and midwives who KNOW THEIR PATIENTS and how they live and pour more funds into basic essential development over modern hospitals "donated" by rich and famous foreigners which likely have (painfully high) carrying costs that Malawi is expected to cover because MOST grants and the like will pay for the building but not to "keep the lights on" so to speak.
YOU typically get to find some way to pay for that.
Though if you wanted to actually close any hospitals to divert the money to better uses, you would probably need to FIRST improve outcomes via other methods, DOCUMENT it, get DATA to back up your argument and make your case. Though with malaria accounting for 30 percent of outpatient visits and AIDS accounting for 35 percent of deaths, if those dropped substantially, you might see demand for medical care drop by as much as 75 percent, at which point you could start firing staff, shuttering entire wards and eventually go "I don't know why we keep this nearly empty hospital in the government budget anymore."
If you perform modern inpatient surgery on people, then send them home to a situation with inadequate clean water, poor sanitation and poor nutrition, you are likely seeing high rates of post operative infection killing and maiming people. The country would likely be better off in the aggregate if it traded all its surgeons for a functional water distribution system and improved sanitation.
"For illustration purposes ONLY." aka to make a point to the two or three people on planet earth who bother to read my writing. I imagine a more PRUDENT position would be to trade MOST of your surgeons for more basics, IF such a thing could be done. Or, you know, go court organizations like water.org and try to get a fuckton MORE basic essentials whatever your doctors per capita status is.
