The real Third World

Letters

CJEM 2000;2(3):150-151

To the editor:

Having returned to Canada after 6 months in the real Third World, I found many issues of CJEM awaiting my attention. Much to my dismay, the first one I opened contained your editorial1 regarding the "third world." You use the phrase "third world" to describe what you believe to exist in Canada's health care system. It is quite apparent that, while you are faced with a many problems in the emergency department (ED), you are completely out of touch with the Third World. Permit me to take you to the real Third World.

Picture a small hospital set amongst terraced farmlands. It is unlike any of the small hospitals that dot Canada's rural landscape. This facility is functional but lacks many items you or I would consider basic or essential. Supplies are limited, costly and, typically, out of date. Equipment is old and donated, but usually functional. Basics such as electricity and running water are unreliable and cannot be taken for granted. This is not the case in Canada.

Your patients have problems, and there is no denying this fact. Illness is a universal phenomenon, but some people are blessed with more opportunities to lead healthy lives. Others are faced with difficult choices and no opportunities. What do you say to the children who suffer from rickets, intestinal parasites and recurrent infectious disease because basic public health measures are not available? How do you tell a mother that her premature infant is not likely to survive because there are no neonatal intensive care facilities? How do you tell a 32-year-old mother of three that she will die of kidney failure because dialysis is not available? These questions are not relevant in Canada because primary and preventive health care measures are well established. Your ED patients have problems, but they do have access to primary, secondary and tertiary health care. Patients in the real Third World don't.

You complain of the long waits and lack of space for your patients. What would be your response if these patients had to wait for days just to see a physician, let alone a specialist such as you? Walking for days just to find a doctor is not uncommon in the Third World -- that is, if a doctor is available at all. More often than not, a lay medical practitioner is a patient's only contact with the health care system. Your patients are able to see well trained generalists and specialists. Patients in the real Third World are not as fortunate.

I applaud your effort to make a point regarding the intolerable waits imposed on patients due to the ongoing health care crisis. Like you, I have the same problems accepting referrals from rural and remote centres. Finding an inpatient bed for a sick patient, even one in my own ED, is rarely easy. Unlike you, however, not for an instant do I consider our health care system to be comparable to the Third World. Perhaps it's all a matter of perspective, but I would welcome the opportunity to change your definition of the Third World.

Russell D. MacDonald, MD
Assistant Professor
Emergency Medicine
University of Manitoba
Winnipeg, Man.

Reference

  1. Innes G. Welcome to the Third World [editorial]. CJEM 2000;2(1):6,60.