July 7th Apia, Samoa

On the second day of clinic, we changed our hours from 0800 – 1600 to 1200 – 2000 to accommodate the work crowd. Business was good: 230 patients and 442 prescriptions, but I'm starting to notice a trend in the type of conditions we are treating. In Sataua, we were serving an immediate need. The people on the island of Savaii have very limited access to healthcare and the conditions we treated reflected that. We saw several conditions or disease states that were the result inadequate healthcare. I wrote earlier about the patient with elephantiasis. This condition can be completely avoided if the filariasis is treated early. We also saw a lady that had a large cyst on her upper leg that prevented her from sitting properly and dramatically decreased her quality of life. The examples go on and on, but if it was not for our clinic many of the patients on Savaii would still be suffering.

In Apia, healthcare is much more accessible. The city's main hospital is in the center of town and care for Samoan citizens is nearly free. Samoans need only pay a $5 tala administration fee to obtain their medical record. The actual care is free. As a result, the conditions we saw in Apia were much more acute. Gone were the progressive complications of long neglected diseases; replaced with simple cold symptoms or muscle aches and pains. On the whole, this is a good thing. Such basic conditions reflect a fairly healthy society, but we are missing a golden opportunity.

Each day we saw more and more patients. When asked why they waited in such long lines to be seen by us instead of going to the hospital, the nearly unanimous answer was that the quality of care we were providing was far superior to the local hospital. This is the opportunity we are missing. We are setup in a community center. All the local translators and helpers are volunteers with no medical background. Instead of treating simple conditions that the local doctors are already capable of treating, we should have been working alongside the local healthcare providers. Had the local medical community been represented at our clinic two things would have happened. First, we could have had a tremendous exchange of knowledge. There were several tropical skin conditions that our physicians had never before seen. The local physicians would certainly know better how to identify and treat these diseases. Furthermore, we could have taught them more advanced treatment procedures and diagnostic techniques. Secondly, the peoples' faith in their local healthcare system would be strengthened had they seen their physicians and nurses working, as equals, alongside our team. We could have helped them identify why the public views their health system as inferior and helped them improve. By treating only short term conditions in total isolation from the local health system, we have set ourselves up to achieve only short term goals. The people in Apia clearly need our help, but a more lasting contribution would be to help them improve their health system thus rendering our services unnecessary.