Student nurse Jessica Pudlo's Commentary in this issue on her experience with hospice care in Ghana reminded me of my own experiences with healthcare in developing countries. I share her gratitude for the modern, safe approach to healthcare we enjoy here in the United States. Sure we have our problems-lack of access for many, unaffordable pharmaceutical and hospital costs, and a country divided on what role the government should play in healthcare. With that said, we can still count on a level of quality not enjoyed by most of the world's population. On a medical mission to Guyana several years ago, I witnessed a hospital with one ventilator but no one who knew how to operate it! Guyana has the highest rate of suicide in the world (World Health Organization, 2014), most often a result of pesticide ingestion. The critical need for these patients is intubation and respiratory support with a ventilator. The nurses told us many of the victims regret what they admit was an impulsive act-a cry for help rather than a true desire to die. They beg to be saved, yet the infrastructure and economic realities of healthcare in a developing country prohibit this advanced level of life saving care. The nurses are left to care for a patient who will soon die, and they will care for the person with few resources. On the same trip, my colleague who is a urological nurse practitioner examined an older gentleman who came to us for care, complaining of abdominal pain. She found a large mass in his abdomen, indicative of advanced cancer. With no hospice care available, the best she could do was tell the family to take him home and keep him comfortable. We were sad to think of what this patient and his loved ones would face in the days ahead without the support of palliative or hospice care.
Author Missy Stober contributed an article this month about the benefit of palliative care for many home care patients suffering from pain or other unpleasant symptoms associated with the advanced stages of illness. Not only does palliative care reduce symptom burden, it saves the healthcare system a lot of money related to reductions in overall cost of care, emergency department visits, and repeat hospitalizations. Patients receiving palliative care are also much more likely to have advance directives in place and eventually die in their own homes (as most desire) with the support of hospice services. Palliative care services have also been shown to improve communication between patients, families, and care providers. Overall satisfaction with palliative care services is very high.
As much as I appreciate the healthcare system in the United States, I know we can do better. We spend twice as much money on healthcare as does France (The Organization for Economic Co-operation and Development, 2011), with 17.1% of our gross domestic product going to healthcare (The Commonwealth Fund, 2016). This is well beyond what any other developed nation spends, and we are the only developed nation without a universal healthcare system (The Commonwealth Fund). Our northern neighbor, Canada, spends only 10.7% of its gross national product on healthcare yet their life expectancy is 81.5 years compared to 78.8 years in the United States (The Commonwealth Fund). In fact, a recent study found that Canadians with cystic fibrosis live, on average, 10 years longer than their counterparts in the United States (The Star, 2017). This is a remarkable difference and points to the importance of universal access to healthcare.
So, while I'm grateful for what we have, I am hopeful the future will bring improved access and affordability to all citizens of our nation.
Best wishes,
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