Compare and Contrast; Here and There

Today was our last day at the UN refugee Ama’ari camp. It was great to come back to one of the camps I worked at 3 years ago to conduct my public health research assessing healthcare accessibility of Palestinian refugees. The results indicate that refugees do not face many obstacles to  reach the clinic due to the pervasive and integrated efforts of the United Nations. Health clinics are located in nearly every camp and new mobile clinics have been opened to provide care in rural communities inaccessible to the main clinics. I highlight my research in a separate page. Other services that are provided to the refugees includes education and social services.

I wanted to take some time comparing and contracting my experiences working at the University of Iowa Hospitals and Clinics (UIHC) with the UN health clinics. The services at the camps are only primary care with any complicated cases referred to hospitals in the West Bank or to Israel depending if those services are available within the occupied Palestinian Territories. As James and Michael have explained, the doctors spend a very brief period of time with the patients and will see 75-100 patients in one day per doctor, per their reports and from my own observation. We are taught that the arriving to a diagnosis is 90% history and 10% physical exam – this is a concrete example. The number of patients I would see at the UIHC would be ~40 patients in one day as I recall. The next question that arises is the patient outcomes with reduced patient time. After reviewing the UNRWA annual Health 2009 report, I was impressed to see that there has been a substantial reduction in infectious diseases and increase in maternal and child care. In fact, the Palestinian refugee population (~4 million) is 98% fully vaccinated in the age group 1-3 as compared to the ~77% in America. Other measures of healthcare were also impressive given the political turmoil of the region.

With the future of healthcare in America unclear in the context of increasing insurance, reducing reimbursements, and increasing healthcare spending! I can’t but help think about the incredible efficiency of the clinic and the free primary care services they provide within the time and financial constraints of the UN. The UN has been providing health services for 60 years and I would consider them well adapted to the environment and the “business”. It would be useful to learn from their system and perhaps apply them to the future healthcare system of America. This is a far stretch of the imagination as the American system involves a lot more patient rapport building, comprehensive history and physical exams in the context of defensive medicine practices. But in some ways, it’s an interesting mental exercise to grasp that 4 million refugees receive primary care services for a fraction of the equivalent cost in America. There are many reasons for that including the premise that a system that works in the West Bank does not necessarily work in America, and vice versa. Nonetheless, it is an opportunity to observe the social construct of healthcare in the refugee camps versus American hospitals.

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