The Contrast Between American healthcare and AMPATH

This week I spent most of my time attending the AMPATH clinician training session. The remarkable feature of this training session was that they were effectively able to provide 60 clinicians with all the tools and knowledge they needed to effectively manage the majority of issues HIV infected patients seen in Kenya will face. It made me think about training sessions I had attended in America. So many of these sessions were focused on highly theoretical, complicated topics which rarely were encountered in clinical practice. Most training sessions sponsored by the pharmaceutical industry are often focused on educating providers about the latest drug on the market rather than describing the proper us of the simplest drugs which are most commonly prescribed. I admittedly am guilty of this as well. In presentations I’ve had to give, it was always more interesting for me to discuss the novelty of an innovative new drug rather than concentrate on the nuances of using our time-tested drugs which would have a much greater impact on the treatment of many more patients. I started thinking about what the goal of my previous presentations were. I came to the conclusion that it had very little to do with improving patient care and a lot to do with impressing the people I was presenting for by teaching them random facts about a new drug or idea that they will rarely if ever use. I think this example is a microcosm for how the US healthcare system operates. So much of our time is focused on thinking about the things that we can do with our skills to get reimbursed. The unique feature about the AMPATH approach is that they look to see what patients need and find the people to make those things happen. This may seem to be a subtle point but I think it is the keystone to the success of AMPATH. After living in Boston for a year in the Longwood Medical Area I was reminded of this phenomenon on a daily basis. This area has the highest concentration of hospitals in a one mile radius in the world. These are by far some of the best hospitals in the world with Beth Israel Deaconess Medical Center, Brigham and Women’s Hospital, Mass General Hospital, Dana Farber Cancer Institute, and the Joslin Diabetes Center to name a few examples. Was this massive concentration of hospitals a result of patient need or the desire to be associated with and tap into the wealth of resources housed within the Harvard Medical School and Harvard community? Keep in mind that this is one of the more affluent areas in the country and the most impoverished areas are typically the ones with the greatest healthcare needs. In contrast, AMPATH has built satellite clinics throughout Western Kenya to make care accessible for patients who previously had to walk >10 miles just to make their monthly appointments. As you look around at the US healthcare system, you will see countless examples of this. This is to be one of the expected consequences whenever you make healthcare a market based commodity.