Hospitalists in the Developing World
Could U.S. hospitals learn from how HM is practiced in developing nations such as Ecuador? David Gaus, MD, MS, founder and director of Andean Health and Development (AHD), thinks so.
Dr. Gaus, who spends half the year as assistant clinical professor of medicine and teaching hospitalist at the University of Wisconsin and the other half with AHD in Ecuador, was inspired to pursue a medical degree by doing development work in Ecuador. When he returned to Ecuador in 1995 to be a doctor to the poor, he discovered a major gap in the healthcare system, between undertrained rural PCPs and the specialist-heavy medical practice in the country’s capital of Quito.
Under his leadership, AHD established a hospital in the rural community of Pedro Vicente Maldonado; it opened in 2000 and now is financially self-sufficient. “The focus was on the need for cost-effective, high-quality hospital services in a country with a dearth of hospitals,” he says.
At the hospital, family-practice physicians serve as hospitalists and deal with a wide spectrum of clinical needs ranging from car accidents and complicated pregnancies to snake bites and toxic organic phosphate herbicide exposure.
“Rural hospitals can’t afford five or six types of attendings, but if you have well-trained family practitioners backed by a general surgeon, they can handle most of the spectrum of clinical needs and the chaos management,” he says. Increasingly, those clinical needs include such chronic degenerative diseases as diabetes, hypertension, and arthritis, for which Ecuador’s cadre of rural PCPs are not trained.
Dr. Gaus is planning a second hospital in the larger Ecuadorean city of Santo Domingo (population 400,000), with the support of the Ministry of Public Health and the Social Security system. The new facility, using the same model and hospitalist roles, will open in 12 to 18 months and will increase the number of three-year family-practice residency slots from six to 20.
