12 - Evidence-based medicine in the Third World

Summary

This chapter focuses firstly on the differences between the West and the Third World, such as poverty, age of the population, disease burden, lack of skilled staff and equipment. Is simple equipment the best for resource-poor countries?

The importance of teaching evidence-based medicine to medical students is discussed, and the difficulties for the teachers of non-physician anaesthetists due to the lack of studies on the outcome of anaesthesia from non-physicians.

The Third World has huge research potential, but the major Western journals carry few studies from Third World workers. However some excellent work has been done especially when Western funding and expertise has joined hands with local workers. This is illustrated by the studies in mother to child HIV transmission carried out in Sub-Saharan Africa.

Introduction

A BBC reporter was interviewing a highly trained chest surgeon at a chest hospital in Afghanistan. There was no water supply, and the now unused theatre was filthy. The supply of drugs in the dispensary was minimal. The reporter did not understand what they were, but noticed that one box of tablets was 14 years old. The surgeon told how she had returned from the West to help rebuild her country, but the supposedly millions of dollars worth of aid never reached their hospital, so what use was she? At this point the surgeon was called to see a casualty, a road accident victim with a lung perforation.