Dr Emma Patrick
Emma Patrick is a consultant anaesthetist working in New Zealand having trained in the UK. She has a specialist interest in obstetric anaesthesia, especially in improving maternal safety. She was a volunteer for a recent Lifebox trip to Vietnam and hopes to continue assisting in this project.
What’s the relationship between gender and healthcare?
In many low-resource countries, inequities of poverty, geography, ethnicity and gender are direct barriers to health care. They often compound the lack of resources available to women in these settings, resulting in poor outcomes – and women are much more likely than men to need access to healthcare providers.
Why is that?
Maternal mortality and morbidity remains unacceptably high in many countries due to a lack of trained midwives and access to obstetric surgical care. The sequellae of poorly managed labour and delivery results in gynaecological and bowel damage that may require further surgery and intervention.
At the same time they often lack the financial resources to pay for treatment, or the ability to leave the family and extended family whom they may be caring for. In some cases it is just not deemed important that scarce resources are spent on females.
Does lack of access have an impact on safety of surgery?
As an anaesthetist I am acutely aware that the more unwell a patient is when they present for surgery, the greater the risks from the anaesthetic and the surgery to that patient. Hence any delay in access to healthcare can result in a worse outcome.
In a low resource setting this may prove to be critical. For example if a woman arrives after being in labour for a prolonged period and requires a caesarian section, she is at much higher risk of bleeding from the surgery and afterwards. This may be in a hospital that has no blood bank or access to the multitude of interventions that can be performed in a tertiary care hospital.
What is the wider fallout?
Long-term morbidity from unsafe, delayed or no access to surgery has a huge impact of families and communities.
In many societies the communities are matriarchal in that it is the female roll to care for the extended family. The economic consequence to a family with either a disabled, chronically unwell or deceased female member can be disastrous.
And of course there are limited or no rehabilitation services, as we would expect to have access to. In effect she will become a financial burden.
What is the situation in Vietnam, where you’ve worked to deliver anaesthesia equipment and training?
Vietnam has experienced rapid economic growth over the last 2 decades. The Socialist Government has been committed to meeting the MDGs and is on target to do so. They are striving to provide a universal healthcare system and overall, life expectancy has improved, infant mortality rates have dropped dramatically and maternal mortality continues to drop.
However, communicable diseases remain a problem and there is a rise in non- communicable disease that is commonly seen in growth economies.
And as economic growth occurs, the poverty gap widens – even though a significant proportion of the population have been lifted out of poverty. That’s particularly noticeable in the ethnic minority communities within Vietnam, such as in the Northern and Central Highlands area where utilization of health resources remains low, maternal mortality high and other health indicators remain poor in comparison with the majority of the population.
The dedicated healthcare professionals that I met were working in small hospitals with limited resources and in some cases were unable to meet the minimum monitoring standard that we would expect for safe anaesthesia.
How does this change your own perspective?
We should never take for granted the free access to healthcare that is available in many countries – nor the fact that when we go into hospital for surgery we should and do expect that the doctors and health professionals have a high standard of training, equipment and safety measures to reduce error are in place.