Perhaps I should put it down to re-entry culture shock. In the last 14 years of working in East Africa as a medical missionary I have had many opportunities to experience that very special bitter sweet detachment when you arrive back into your own culture and realise that you are a stranger and see your own home culture through the eyes of an alien. With practice it’s a feeling that can be overcome in a short time before you make too many social gaffs and leave your friends and family glancing at each other in embarrassment. The rural areas of Africa have to be poorest medically speaking in the world and the statistics suggest that life expectancy in sub-Saharan is equivalent to 1840 in England and Wales. This has a particular poignancy for me as an anaesthetist as the date of 1846 is generally regarded as the discovery of anaesthesia. So I think I am entitled to some degree of medical re-entry culture shock when I return to UK.
However re-entry culture shock is not an altogether negative experience. As in any crises situation it’s also a time of opportunity and a time to reflect and learn. So this time I am left with one word which alone sums up my assessment of the amazing advances in UK and the appalling comparison with medical care in Sub-Saharan Africa. The gap of medical care available in the developing world in comparison with medical care in the developed world is widening with every modern advance but its not the advances in medicine that this time put me into some kind of shock. Infact it’s the advances in veterinary medicine which have shocked me rather than the advances in human medicine and I have to conclude that the comparison can only be described as obscene.
Open heart surgery is now available for domestic dogs and cats in the developed world whereas in Sub-Saharan Africa most of these patients requiring such expensive care are sent home to die assuming they even reach a hospital. Is it possible in generations to come the medical community will wonder at how we could tolerate such an obscene disparity of care. As a young hospital doctor in the late 60s and 70s it was an exciting time for the speciality of anaesthesia. Cardiac surgery was taking off and intensive care units had been established as a facility for the big urban centres but still had to make an impact in the districts. As a young anaesthetic resident the cardiac rotation was a prized experience. We knew that on this rotation we would learn so much that would benefit our own professional development and give us such experience to manage better the critically ill in other areas of hospital practice. Invasive monitoring in theatre, the fundamentals of intensive care and cardio-respiratory support, the assessment of patients, the management of dysrhymias were the foundations of a new era. We knew that this was the future of modern hospital medicine and we would be a better part of that future after our cardiac rotation. I am sure the young veterinary surgeons and anaesthetists must be relishing open heart surgery for dogs and cats in a similar way. In the 60s and 70s the development of hospital intensive care units was given a major boost as open heart surgery progressed so I am sure the same process will take place for animal intensive care units now.
However re-entry culture shock is not an altogether negative experience. As in any crises situation it’s also a time of opportunity and a time to reflect and learn. So this time I am left with one word which alone sums up my assessment of the amazing advances in UK and the appalling comparison with medical care in Sub-Saharan Africa. The gap of medical care available in the developing world in comparison with medical care in the developed world is widening with every modern advance but its not the advances in medicine that this time put me into some kind of shock. Infact it’s the advances in veterinary medicine which have shocked me rather than the advances in human medicine and I have to conclude that the comparison can only be described as obscene.
Open heart surgery is now available for domestic dogs and cats in the developed world whereas in Sub-Saharan Africa most of these patients requiring such expensive care are sent home to die assuming they even reach a hospital. Is it possible in generations to come the medical community will wonder at how we could tolerate such an obscene disparity of care. As a young hospital doctor in the late 60s and 70s it was an exciting time for the speciality of anaesthesia. Cardiac surgery was taking off and intensive care units had been established as a facility for the big urban centres but still had to make an impact in the districts. As a young anaesthetic resident the cardiac rotation was a prized experience. We knew that on this rotation we would learn so much that would benefit our own professional development and give us such experience to manage better the critically ill in other areas of hospital practice. Invasive monitoring in theatre, the fundamentals of intensive care and cardio-respiratory support, the assessment of patients, the management of dysrhymias were the foundations of a new era. We knew that this was the future of modern hospital medicine and we would be a better part of that future after our cardiac rotation. I am sure the young veterinary surgeons and anaesthetists must be relishing open heart surgery for dogs and cats in a similar way. In the 60s and 70s the development of hospital intensive care units was given a major boost as open heart surgery progressed so I am sure the same process will take place for animal intensive care units now.
In 1846 the first successful anaesthetic to be publicly demonstrated was ether and this agent is the mainstay in rural Sub-Saharan Africa now as its properties of safety and cost make it the best choice. Of course for open heart surgery in domestic animals a newer generation of anaesthetic agent is available which for me only to accentuates the obscenity
Perhaps I will come through this culture shock and learn to accept this appalling disparity of care between domestic animals and human beings with some equanimity and avoid any embarrassing social gaffs or perhaps this article is a sign of my underlying inability to adapt. After all you have a right to be at ease in your home culture. At the moment though I am hoping that I do not adapt. Am I suffering from a severe form of speciesism or is there a global underlying racism that allows this obscenity to be tolerated?
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