After my first year of medical school, I decided to spend my summer break volunteering with Wuqu’ Kawoq | Maya Health Alliance and learning Kaqchikel, one of the Mayan languages still spoken today in the Guatemalan Highlands. In medical school, I have classes like Biochemistry, Anatomy and Physiology, and Immunology. We are supposed to learn how the human body functions and how to fix it when it is not functioning well. Medical ethics is not explicitly a primary focus of our studies, but ethical decision-making is just as much a part of medicine and healthcare as knowing how the body works.
Every decision a doctor makes has consequences. And every decision or policy of a healthcare system has consequences that must also be considered. Are we headed in a better direction? Are we as a healthcare system, as healthcare professionals, doing our best to create the best health outcomes? I think doctors are apt to forget this as their scale is the individual patient. They are trained to consider what the best options are for each individual case, for each patient. But the truth is that we are all connected, that globally we only have a finite amount of resources, be that monetary resources, personnel, training capacity, tools and equipment, time, or knowledge.
I recently watched The Life Equation, a new documentary that brings questions like these to the forefront. The Life Equation features a patient who Wuqu’ Kawoq helped to access treatment for cervical cancer. She could never have afforded the treatment herself. The documentary pointed out that the amount of money spent on her treatments was enough to cover preventative care options, like malaria prophylaxis or water filters, for many people. Instead this money went towards treatment of one woman’s terminal illness. So what would you do? Attempt to treat an often fatal cancer in one patient or fund efforts to avoid the development of preventable diseases in dozens of other healthy people?
While money is always an issue in healthcare, both for healthcare organizations and for policy-makers, this question is often more salient in resource-poor settings, where people scrape together funds to cover basic treatments that would be readily available in other settings, such as a gynecological exam. I saw this dilemma in action when I shadowed one of the Wuqu’ Kawoq doctors. While treatment for malnutrition is relatively simple to provide to children across the various departments that Wuqu’ Kawoq serves, treatment for kidney failure, which in its final stages requires a kidney transplant, is virtually impossible for many patients in Guatemala due to the cost and the complicated process leading up to transplantation. A decision must be made. Do you attempt to fix the more acute, more fatal disease that has already begun to wreak havoc on one patient? Or do you put your resources into cheaper efforts that can have larger scale, longer term effects?
In today’s world of technology, data, and analysis, the makers of The Life Equation asked whether data could be used to answer this question. At the most basic level, the question being asked is, ‘how much is one life worth?’ But a good life means something different to everyone. What The Life Equation made clear was that healthcare professionals and those making decisions about healthcare policy cannot use numbers alone to make decisions. Number of lives. Number of years. These are often used to measure the impact of a medical intervention. But these do not show the full picture. To get the full picture, you must talk with your patient, you must listen to your patient.