India vs. South Africa doctors by speciality

Spreadsheet

Healthcare practitioners in Africa

According to the World Health Organization (WHO), there are approximately 300,000 doctors in Africa, which is equivalent to a ratio of 1.55 doctors per 1000 people. This is significantly lower than the global average of 3.43 doctors per 1000 people.

The number of doctors in Africa is unevenly distributed, with some countries having a much higher ratio of doctors to people than others. For example, South Africa has a ratio of 4.3 doctors per 1000 people, while Ethiopia has a ratio of 0.2 doctors per 1000 people.

Many factors contribute to the shortage of doctors in Africa. These include:

A lack of medical schools and training programs

Poor working conditions and salaries

A high rate of brain drain, with many doctors leaving Africa to practice in other countries

The shortage of healthcare practitioners in Africa has a significant impact on the health of the population. It leads to longer wait times for healthcare, lower quality of care, and higher mortality rates.

Several organisations are working to address the shortage of doctors in Africa. The WHO, for example, is supporting the development of new medical schools and training programs. The African Union is also working to improve working conditions and salaries.

Despite the challenges, there has been some progress in addressing the shortage of healthcare practitioners in Africa. The number of medical schools in Africa has increased by more than 50% since 2005. The number of medical graduates has also increased significantly.

The continent needs to invest in medical education and training, improve working conditions and salaries for doctors, and reduce the rate of brain drain.

According to the World Health Organization (WHO), there were approximately 1.31 million nurses and midwives in Africa in 2018. This is equivalent to a ratio of 1.79 nurses and midwives per 1000 people. This is significantly lower than the global average of 3.4 nurses and midwives per 1000 people.

The number of nurses and midwives in Africa is unevenly distributed, with some countries having a much higher ratio of nurses and midwives to people than others. For example, South Africa has a ratio of 5.6 nurses and midwives per 1000 people, while Ethiopia has a ratio of 0.4 nurses and midwives per 1000 people.

There are a number of factors that contribute to the shortage of nurses and midwives in Africa. These include:

A lack of nursing schools and training programs

Poor working conditions and salaries

A high rate of brain drain, with many nurses and midwives leaving Africa to practice in other countries

There has been some progress in addressing the shortage of nurses and midwives in Africa. The number of nursing schools in Africa has increased by more than 30% since 2010. The number of nursing graduates has also increased significantly.

Universal Adoption of Electronic Health Records 01

Health literacy is the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others. It is a complex concept that encompasses a range of skills and knowledge, including:

Basic literacy: This includes the ability to read, write, and understand simple instructions.

Health knowledge: This includes knowledge about health, diseases, and treatments.

Critical thinking skills: This includes the ability to evaluate health information and make informed decisions.

Communication skills: This includes the ability to communicate with healthcare providers and others about health-related issues.

Health literacy is important for everyone, but it is especially important for people with chronic diseases, older adults, and people from low-income and minority communities. These groups are more likely to have difficulty understanding and using health information, which can lead to poorer health outcomes. Social capital is the network of relationships between people and the resources that are embedded in those relationships. It can have a positive impact on health literacy in a number of ways:

Access to information and resources: People with strong social capital have access to a wider network of people who may be able to provide them with health information and resources. For example, a person with a strong social network may be able to ask their friends and family for recommendations for doctors or hospitals, or they may be able to get help understanding complex medical information.

Social support: Social support can help people to cope with stress and to make healthy lifestyle changes. For example, a person with a strong social network may have people who can help them to quit smoking or to eat healthier.

Accountability: Social networks can provide accountability for healthy behaviours. For example, a person may be more likely to stick to a workout routine if they have friends who are also working out.

Empowerment: Social networks can empower people to advocate for themselves and to get the care that they need. For example, a person with a strong social network may be more likely to ask their doctor questions or to challenge a diagnosis.

Overall, social capital can play an important role in improving health literacy. By providing access to information and resources, social support, accountability, and empowerment, social capital can help people to make informed decisions about their health and to improve their overall health and well-being.

Here are some examples of how social capital can be used to improve health literacy: A community group could organize a workshop on health literacy for people with chronic diseases.

A faith-based organization could provide support to people who are trying to quit smoking.

A school could partner with a local health clinic to provide health education to students and their families.

A social media group could provide a space for people to ask questions and share health information.

Clinical documentation

The importance of excellent clinical documentation cannot be overstated, as it plays a critical role in ensuring that patients receive the appropriate treatment, paying for medical services, and protecting healthcare providers and facilities from legal liabilities. The documentation process is how medical professionals communicate with each other about a particular patient's medical history and current health status. Medical professionals must document all diagnoses, treatments, and procedures accurately and thoroughly.

Documentation requirements are essential in healthcare settings because they provide the basis for patient care planning, reimbursement, and research. When it comes to patient care planning, providers use the documentation to plan and track each patient's progress. In terms of reimbursement, payers like insurance companies and government programs depend on documentation for payment. For example, without proper documentation, denied claims are more likely to occur, risking lost revenue opportunities. Regarding research, documentation plays a significant role in clinical trials and studies.

Excellent clinical documentation requires attention to detail, accuracy, and consistency of the data. During the documentation process, healthcare professionals should document pertinent information about the patient's medical history, diagnoses, treatment plans, medications, and other important details. The documentation standards vary depending on the care setting, medical speciality, and type of medical encounter. However, there are basic requirements that all providers should follow, regardless of their speciality or setting.

The first requirement for excellent clinical documentation is completeness. Providers must document all necessary patient information to create a complete and accurate record. Incomplete records could result in inadequate care, unnecessary procedures, or risky medical errors.

The second requirement is accuracy. The documentation should capture the patient's history, current conditions, and interventions accurately. Errors in documentation can lead to misdiagnosis, miscommunication between healthcare providers, and increase the risk of medical malpractice. Providers should avoid abbreviations and ensure the documentation is clear and concise.

The third requirement is timeliness. Documentation must be done promptly at the time of a patient encounter. Delays in documentation can result in a loss of crucial information, affecting the quality of care provided to a patient.

The fourth requirement is consistency. Healthcare providers must maintain consistency in the process of documentation. Consistency of documentation ensures that the records make sense to other healthcare providers who may access the information.

Finally, the documentation process must also comply with state and federal regulations and patient confidentiality. Medical professionals must ensure that they do not disclose patient information to unauthorized individuals.

In conclusion, excellent clinical documentation is essential in healthcare settings because it helps provide quality medical care, minimise liability risks, make better-informed decisions, and lead to continuous improvement of healthcare services. To achieve excellent documentation, healthcare providers must adhere to the documentation guidelines specific to their specialty, use up-to-date forms and records, and maintain accurate and complete documentation. By implementing these practices, healthcare providers can streamline medical records, prevent costly errors, and enhance patient care outcomes.

Clinical Risk Management

 I will be reviewing clinical risk management.

All investigations and interventions are targeted to a specific patient so at each step it is very important that the patient be properly and correctly identified.

The standard procedure is to confirm the patient's name and date of birth. However, it is not unusual for multiple patients to appear with the same or similar names. This then necessitates an additional identifier which can be problematic.

Telephone numbers are convenient but in these times people often do not know their telephone numbers and even if they do the records may not match because numbers can change quite frequently.

Another acceptable identifier is the patient's address. These tend to change infrequently for people past their 20s. Again records may not match but asking about previous addresses is very likely to end with a match and allow for updating the patient's demographic details.

Next of kin would be the final acceptable identifier. There may be similar problems with getting a match but these are easily solved.

Having properly identified the patient, the next step is to assign the right provider.  This is something of a catch-22 situation because in order to do so one must first properly frame the patient's problem. Such problem definition is of necessity iterative. The most acute severe non-emergent problems need to be assessed by the most experienced generalist available. Emergencies require anyone and everyone immediately available to act to maintain life. Acute mild problems do not generally present for treatment.

Acute problems are generally dealt with by providers who are not familiar with the patient. Such lack of familiarity represents an information risk.

Killing me with kindness

My most fervent prayer for as long as I can remember has always been "Protect me from the kindness of strangers!"

There is a natural tendency to forgive others if they act with good intentions rather than malice if the consequences are not too negative. That line of "too negative" is however very blurry and severely contingent.

We desire a society made up of Good Samaritans. Over the long term, cooperation and kindness remain strategic champions.

The general, however, does not always apply to the particular and there are always, always outliers.

Beneficence is an outstanding moral principle, but it can never be considered to supercede autonomy. And I am always wary of those who claim to be proponents of the general good. Saints are extreme outliers.

Labelling as pathological those perspectives that do not agree with one's own especially from a position of power and/or authority is extremely dangerous as it leads to a monochromatic, dysfunctional society.

AN OPEN LETTER TO GOOGLE 2

 A great many people are pessimistic about Africa but these are percepts rather than observations. Africa has a huge population with a low population density, a low median age and a high population growth rate in addition to low infrastructure and few to no legacy systems. The regulatory environment is severely under-resourced in all respects and this means a low friction environment with outstanding prospects for innovation.

This is an exhortation to Google to create a new paradigm. I am very interested in being part of this solution. I have previously stated that Google has no moral obligation here. I see it as an opportunity to transition to something greater: we are currently a very primitive civilisation and I have seen no credible discourse about what comes after the information age. The data-information-knowledge pyramid is conceptually incomplete and I do not believe that wisdom falls on the same pyramid or is in any way related.

What is in it for Google? Institutional immortality and personal longevity; the evolution of information as representative currency; the moral vanguard of human evolution and longevity.

If we accept that human lives have intrinsic value and that meaningful, productive lives are desirable and that there is value in extending humanity’s footprint beyond earth and our current solar system and that this can be done without sacrifice and within a reasonable time frame then there is no good reason not to attempt it.

“All progress is due to unreasonable men.”

I have no interest in making the rules and/or enforcing them. Truth be told, I have little interest in rules as it is. I have some interest in the purposes that rules serve especially if those purposes are important.

I believe that human lives are important and that social capital is important and that social networks are considerably more important than most realise. Human evolution is too slow and represents an existential bottleneck that needs strategic foresight and concerted action.

I am not a good Samaritan. I am a medical professional who is no longer satisfied saving one life at a time. I do not have the resources to change the world but I believe in the power of collective interest and collective action to realise the miraculous. Our current collective ability to orient and adapt is woefully inadequate and is sorely in need of a new paradigm.

AN OPEN LETTER TO GOOGLE

 There is no theoretical limit to human lifespan. Given this, humanity's most essential task is to extend productive longevity. Doing so will necessarily require improvements in energy use and efficiency, computation and information use and efficiency.

The Kardashev scale can be extended from energy to information. These two are intertwined and mutually reinforcing with the advantages that information evolution is easier and less costly and so a natural driver.

Google's mission to organise the world's information is admirable but somewhat lacking because its focus is efficiency rather than effectiveness. Information is to be used and its value can be inferred from its utility in driving the overarching goal of longevity and its supporting goals of energy and computation.

Google is neither the world’s saviour nor its protector and so it has no obligation to extend or modify its stated mission, but I believe that its founders did and do have the intention of making the world a better place to the best of their ability. We should in no way be limited to our past selves.

Covid provides us with an opportunity to drive the virtualisation of all health and medical information because of its public utility now when all systems are overwhelmed. And Africa which lacks the bloated over-regulated detrimentally enforced healthcare policy framework of much of the world can benefit enormously from an electronic platform for healthcare that is available to both consumers and providers at no cost.

Google excels at freeware in exchange for large datasets. It is a technology-driven organisation with a good reputation and the means to scale.

Africa lacks many things, but it does not lack poverty, disease and disability.

So, Google, would you at all be interested in extending your mission and in so doing make an appreciable difference to the burden of disease and disability in Africa?

Histogram Emergency Department Registrations 1999-2016

https://goo.gl/9fzRdn 

Emergency Department Crude Death Rates per Thousand Admissions 1999-2016

https://goo.gl/7DE9Sy  

Top 20 Diagnoses 1999 - 2014 DGH Emergency Department

Soft Tissue Injury		161091
Fracture Closed		62130
Laceration		58940
Sprain		49566
Minor Head Injury		47758
Other		34639
Contusion		19398
Did not wait		15918
Chest infection		13162
UTI		12930
NSAP		12391
Other Eye		11062
Rheumatological		10748
Other GI		9778
NSCP		9422
FB Eye		8620
Angina		8378
Upper RTI		7970
Abrasion		7945
Gastroenteritis		7878

Top 20 Diagnoses 2014 - 2016 DGH Emergency Department Totals

Soft Tissue Injury		24022
Did not wait		23792
Other		12552
Fracture Closed		10356
Laceration		6837
Minor Head Injury		6683
GP OOH		4718
Sprain		4468
Soft Tissue Infection		3231
ACS Suspected		2749
UTI		2591
DVT Suspected		2570
NSCP		2520
Chest infection		2490
CDU Transfer		2366
NSAP		2213
Other Neurological		1942
Acute Exacerbation COPD		1789
Other GI		1756
Vasovagal Syncope		1578

Top 20 Diagnoses 2014 - 2016 DGH Emergency Department

goo.gl/aA9qmN 

Emergency Department Mortality Time of Arrival vs Age 1999-2016

https://goo.gl/x0VMGa