Ethics in HealthcareHealth EquitySMACCHealthcare Inequality, Ethics & Developing Countries

Healthcare Inequality, Ethics & Developing Countries by Flavia Machado

Flavia Machado gives you the ins and outs of a day in the life of an ICU doctor working in Brazil.

She addresses healthcare inequality, ethics, and the challenges she faces in a developing country.

By sharing a blow-by-blow account of a day at work, Flavia demonstrates the challenges and inequality that exists. And whilst poverty is shocking, Flavia believes inequality is worse.

Flavia’s day begins in the morning with a ward round. Critical bed shortages mean that the clinicians have to make impossible decisions – which patients will get allocated one of the scarce beds?

At 07:00am every morning, Flavia and her colleagues in the ICU have to play God. Inequality is plain to see.

Furthermore, location impacts the distribution of ICU beds across Brazil. For example, in the north there are far less ICU beds per capita.

Flavia continues her day, but the challenges do not stop.

Next, she is inundated with issues of medication shortages and equipment supply issues. For example, the issue of a broken defibrillator is upsetting, but not unexpected. Her staff use humour to cope with the desperation of the situation.

Then, Flavia has clinical decisions to make. However, she cannot rely solely on her clinical reasoning and skill as a doctor. There are external pressures that exist – from judges, from industry, from scientist and researchers – and she feels all of them.

Sometimes, Flavia feels the strain of operating in these challenging conditions in a middle-income country. Sometimes she feels the futility of it all, like pushing a stone up a mountain, or filling the impossible to fill vessel. Healthcare Inequality and Ethics in Developing Countries is a serious concern.

Ultimately, Flavia is grateful that progress is being made and at the end of the day, she and her team remain happy in doing what they do!

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Flavia Machado

Flavia Machado is professor and head of the Intensive Care Session of Anesthesiology, Pain and Intensive Care Department at the Federal University of São Paulo in Brazil. Machado is board certified in internal medicine, infectious diseases and critical care. Dr. Machado is one of the founders of the Latin America Sepsis Institute–LASI. She was the president between 2008-2011, vice president between 2012-2015 and is currently its CEO. LASI is devoted to awareness raising, quality improvement and coordination of multicenter studies in sepsis field. She is part of the executive board of the Global Sepsis Alliance and the executive committee for the World Sepsis Day. She serves on the 2012 and 2016 board of the Surviving Sepsis Campaign International Guidelines. She integrates the International Sepsis Forum (ISF) council since 2014. She is also a member of both the Executive and Scientific Committee of the Brazilian Research in Intensive Care Network-BRICNET.