Healthcare Inequality, Ethics & Developing Countries

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. It is graphically depicted when looking at a map of the distribution of ICU beds across Brazil. In the north, an area of greater disadvantage, there are far less ICU beds per capita. Flavia continues her day, but the challenges do not stop. She checks WhatsApp later in the morning and is inundated with issues pertaining to medication shortages and equipment supply issues. The issue of a broken defibrillating is upsetting, but not unexpected – to the point of her staff using humour to cope with the desperation of the situation. Later in the day 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. That being said, Flavia can see the progress that is made and at the end of the day, she and her team remain happy in doing what they do!

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