1) How do individual physicians contribute to health care disparities? Thinking about an area of health care of particular interest to you, what research do you think could be done to either understand the effect of individual physicians on health disparities, or to decrease this effect?
Answer: In my country, Sierra Leone, physicians do contribute to health care disparity either consciously or unconsciously to patients they see. Different from a placed like the US where race is a problem, In Sierra Leone, they do that via affluences and education level. In sierra Leone, most disparities are based on tribal lines, affluences etc, for example certain tribes are considered superior to the other tribes because they are well educated and have money in essence, they are more influential. To identify these biases is difficult and complex and can be understood if you consider your own practice and what you do towards patients.
An example in my field of practice as a pediatrician in Sierra Leone, often times we make the assumptions that poorer people will not bring their kids to the hospital until they are severely sick, which is actually expected, but we tend to blame them for doing that and sometimes will not take good care of their kid or will be disrespectful to the mothers. And that could even discourage them more to bring their kids to the hospital. While with more affluent parents even when they do not bring their kid early to the hospital, we tend to pay more attention to them and treat them with respect and care.
To investigate this class disparities in access to pediatrics care, I will conduct an observation study in which I will assess the clinic attendance by class, and then will conduct in-depth interviews or focus groups to both clinicians and patients to understand how class impact the access to pediatrics care.
2) Structural issues within health care delivery are implicated in health care disparities. Please brainstorm 4 structural issues that might contribute to these disparities. Which of these are relevant to your particular area of research, and how?
Answer;
1. Access to resources: Wealthy people will have more resources (money, education, power) and therefore can afford hospital charges which will increase their hospital attendance compared to poor people with little or no resources. In Sierra Leone most patients have to pay out of pocket at the bed side, which limits those with minimal resources to access hospitals.
2. Distance to the hospital: There are very few hospitals in Sierra Leone, in fact only one pediatric referral hospital in the capital city. Many of the poor individuals live in slums and hard to reach areas, therefore access to a hospital will be difficult because they will have to pay transportation cost, and in most cases, they cannot afford it and also pay the hospital bills, they will therefore most often choose to visit either a near by pharmacy or traditional healer for the care of their babies.
3. Physician attitude towards especially poor patients: As I alluded in question 1 above, patients are often blamed by physicians for not bringing their children to the hospital early and most often shout at them, and this discourage them from accessing the hospital in the future.
4. Language barrier: Sierra Leone has about 28 local tribes but there is one common tribe that many people speak, and the other tribes which other people in the population speak is not common to everyone. And most health messages are in English and translations are in the common tribe so understanding will be affected to other people.
The most relevant structural barrier in access to pediatric hospital will be access to resources even though distance to the hospital, and physicians’ attitude also pose important challenges.