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04.05.2021

This Is What Doctors’ Offices Look Like Around the World

What does health inequity look like? In many places, it looks like the place you go to receive care. And where you live means everything.

An overcrowded waiting room. An unsanitary bed. A tent in a crowded market.

The physical space where people receive medical care can say a lot about health inequities. And the spaces can range wildly around the world.

If you happen to be born in Japan, you would enjoy universal health coverage and would be free to choose one of the 8,000 state-of-the-art hospitals available at little cost. But if, instead, you were born in Lesotho — where the average life expectancy is 34 years shorter — you might have to travel long distances over rocky terrain or be evacuated to South Africa in a life-or-death emergency.

It’s a problem in the U.S., too: quality of health services can vary wildly across states, especially among the urban-rural divide, and particularly in minority or indigenous communities like Navajo Nation.

Health is a fundamental human right. But building a more equitable world is not possible without investing in local health care workers — and the spaces where they work. Here’s what those spaces can look like in different contexts around the world.

Colombia

medical staff walks down hospital hallway with pregnant women sitting on both sides waiting for treatment
Colombia has received the largest influx of Venezuelan refugees and migrants, and many of them need urgent health care. Clinics and hospitals are flooded with patients in need of treatment and attention, and there aren’t enough health workers to see all of them. Photo by Charlie Cordero for Project HOPE, 2019.
medical staff takes vitals of patient in overpacked hospital
A large influx of Venezuelans pushed health systems near the Colombia-Venezuela border to the brink. Photos by Charlie Cordero for Project HOPE, 2019.

Colombia is host to more than 1.7 million Venezuelans — a population shift that has significantly strained health care facilities near the border. Waiting rooms like the one at Erasmo Meoz University Hospital, above, have been filled to capacity, the hallways lined with patients waiting hours to be seen.

Thousands of Venezuelans give birth in Colombia every year, leading to dangerously fast turnarounds in hospitals near the border: women who give birth in the morning can be discharged in the afternoon, while those who deliver in the afternoon may receive just one night in the hospital.

Malawi

man in a yellow shirt stands in front of a medical tent
In a busy village square in Malawi, 25-year-old Peter waits for the results of a rapid HIV test he received thanks to Project HOPE’s support in 2019. Project HOPE’s HIV programs have helped hundreds of thousands of people access testing and treatment in countries with high rates of HIV. Photo by James Buck for Project HOPE, 2019.
man in yellow shirt gets finger pricked by medical professional
Inside a tent in a busy village square, 25-year-old Peter receives a rapid HIV test. Photos by James Buck for Project HOPE, 2019.

Where do you get your HIV test if you’re a traveling vendor in a local market in Malawi? For Peter, you get it in a tent.

Malawi has made incredible health gains over the past several years, yet it remains a country of great challenges. Even as AIDS-related deaths have been cut in half over the last decade, 1 million people in Malawi still live with HIV — many of whom do not receive medical care due to access or income.

That’s why Project HOPE helped provide rapid HIV tests here: so that vendors like Peter could get tested where they are, instantly. It’s a solution that works for the local community, and for Peter. In less than 10 minutes, he’ll learn he’s tested negative.

Bahamas

eagle-eye view of hospital with damaged roof
Hurricanes can cause long-term damage to primary health clinics that impact quality of care for years. When Hurricane Dorian struck the Bahamas in 2019, it tore the roof of of Coopers Town Community Clinic, flooded the hallways, and ruined large amounts of supplies and equipment that impacted people’s ability to receive everyday care. Photo by James Buck for Project HOPE, 2019.

Health care standards in the Bahamas have increased thanks to recent investments in health care infrastructure, but in a nation of more than 700 islands, access to that care can change in an instant.

That’s what happened when Hurricane Dorian struck the Bahamas in 2019, devastating Abaco and Grand Bahama Islands and rendering multiple clinics nonoperational. Coopers Town Community Clinic, above, serves about 4,000 people on Great Abaco Island, the epicenter of the storm. In the critical moments following the storm, Dorian destroyed critical supplies, ruined lab tests, and left thousands of people without electricity, gas, or a way to communicate.

Sierra Leone

door entry to the Kangaroo Mother Care Ward in Sierra Leone
shot of hospital in Sierra Leone
New mother Musu with her baby in Sierra Leone
Sierra Leone has just 250 doctors, making health care out of reach for most of the rural population. Photo by James Buck for Project HOPE, 2019.

There are fewer than 250 doctors in all of Sierra Leone, a nation of 7.6 million people — one of the worst doctor-to-patient ratios in the world. Life expectancy is just 57 years, and the maternal mortality rate is the worst on earth. In a country that is largely rural, health care access is extremely limited, making motherhood a life-or-death scenario.

Project HOPE is investing in Sierra Leone’s health care by helping establish Special Baby Care Units, as well as training health care workers in essential interventions like Kangaroo Mother Care, a simple intervention in which the baby is protectively wrapped skin-on-skin to the mother’s chest for warmth, creating a kangaroo-like pouch that simulates the womb. In places where resources are limited, it’s a life-changing practice for babies who need it most.

Indonesia

Health care access in Indonesia
Equipment used by midwives in a local Puskesmas, or large public health center, in a rural village called Cisalam in Baros sub district. Generally the midwife sees 10 to 15 mothers per day. The doctor comes on Wednesdays so often there are as many as 35 patients at once.
Mother getting a sonogram in Indonesia
There are currently 177 maternal deaths per 100,000 live births in Indonesia — a ratio more than twice as high as the SDG target of 70. Improving care in rural communities is a crucial step in closing that gap. Photo by James Buck for Project HOPE, 2019.

For women in rural Indonesia, the health network connecting villages to formal care is too expensive or too far away. Small village clinics, called posyandus, report up to public health centers, called puskesmas — clean, well-equipped facilities that are staffed to handle deliveries. Puskesmas are key to reducing high mortality rates, but many women forgo them to deliver at home using dangerous traditional practices.

Project HOPE saw a way to help bridge the gap: supporting the puskesmas with new equipment like infant warmers and blood pressure equipment, as well as training midwives to walk alongside women throughout pregnancy and delivery. Volunteers meet with new mothers every month during pregnancy, encourage them to deliver in the puskesmas, hold monthly wellness clinics in villages, and check in frequently to make sure new mothers are breastfeeding and immunizing their newborns.

In the last five years, this work has made the difference between life and death for tens of thousands of mothers and newborns.

Mozambique

Aftermath of Cyclone Idai in Mozambique
Aftermath of Cyclone Idai in Mozambique
When Cyclone Idai devastated Mozambique, some essential health care — like cholera vaccines for children — were given outdoors. Photos by James Buck for Project HOPE, 2019.

In the wake of a once-in-a-lifetime storm, health care often happens wherever you can get it.

That’s what life was like in Mozambique following Cyclone Idai, one of the worst tropical storms to ever hit Africa, which rocked Mozambique with winds over 120 miles per hour. With tens of thousands of people displaced and widespread outbreaks of cholera and malaria, more than 1.8 million people were left in urgent need.

Project HOPE deployed medical volunteers into the immediate aftermath of the storm, which included helicopter flights to some of the country’s hardest-hit rural areas. Immediate health care was provided wherever it was possible, outside the clean, quiet context of a doctor’s office, whether beneath the shade of a tree or in a crowded village square.

Dominican Republic

Outdated hospital in the Dominican Republic
New equipment in the Dominican Republic
Project HOPE’s Saving the Newborn initiative has helped update critical equipment and infrastructure in the Dominican Republic. Photos courtesy Project HOPE staff.

Though most women in the Dominican Republic give birth at a hospital, there are still many obstacles in the way of a safe delivery. A shortage of equipment, poor infrastructure, and a lack of training lead to high numbers of preventable neonatal deaths.

Project HOPE is working to give mothers and babies in the Dominican Republic a safer start at life, partnering with the government to renovate health care facilities and give mothers a brighter and cleaner place to give birth. We brought in new equipment like delivery beds, vital signs monitors, incubators, and ventilators, then spent a year training nursing staffs on how to use and maintain it, ensuring the impact would last.

The result? Inside the Doña Reneé Klang Maternity Hospital in Santiago — where the neonatal mortality rate was 40% higher than the rest of the country — the rate dropped 81% in just one year.

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