Experts reflected on the shortage of health personnel in the COVID-19 health emergency in Latin America during the Omnia Health Live webinar "Identifying the healthcare professionals of the not too distant future: What changes can we expect?"
One of the main challenges in the Latin America region is the lack of human resources, especially intensive care doctors and pulmonologists, said Silvia Dallatomassina, surgeon and Emergency Coordinator in Latin America at MSF.
Dallatomassina also stressed that epidemiologists and specialists in public policy are needed “who can see public health policies more broadly.”
When thinking about the training of doctors, the delegation of tasks should be taken into account, as well increasing the specialisation of nursing personnel, not only because of COVID-19 but because of other chronic diseases that require it, Dallatomassina said.
According to the expert, a future post-pandemic challenge is environmental health – such as the treatment of diseases caused by chemical poisoning, as this speciality is not within the curriculum of a medical degree. Likewise the surgeon pointed out that it’s important to have a holistic method in the treatment of patients. Through such an approach during the clinical management process, for example, the victimisation of women who have suffered violence can be avoided.
Management takes on relevance
According to Juan Ramon Fabregat, MPA academic at Panamericana university (UP), three areas must work together. “One is public health with a deep knowledge of statistics and the evolution of various diseases, many of them unknown,” said Fabregat.
“The second is advances in technology that help doctors provide remote care, so it’s not necessary to have all the doctors at the patient’s bedside. Also, doctors are not the ones taking care of the patients.”
“We need to increase the level of nursing personnel and increase the level of other health professionals who can provide effective care, even more than that of doctors, and not necessarily in hospitals,” added the academic.
Fabregat warned that with telemedicine we risk dehumanising the medical field, since there is no human approach. It few put all this together, we can develop real programmes in the selection of which specialists are needed, where they should be location, and which specialties should be included in the curriculum.
Samuel Barbosa, paediatrician, public health expert and presidential secretary of the Colombian Medical College, stated that it’s necessary to improve training programmes in all countries. He mentioned that doctors in Colombia are general practitioners – they do not have any specialisation.
Patient care can be amplified by specialising in doctors. In the case of doctors in rural areas, we can improve their skills through virtual academic programmes, said the public health expert.
Technology and the patient
Another opportunity can be found in training specialists in the use of technology for remote patient care.
Juan Carlos Vázquez, professor of pulmonology at the National Autonomous University of Mexico (UNAM-INER), pointed out that one of the biggest challenges is the importance of unifying the training of specialists in the country, since there are substantial differences between hospitals and states.
“Big cities and big hospitals have good training. When you go to hospitals in other states, or when the hospitals are not so large, the training is not of the same quality,” said the expert in pulmonology, adding that this is due to different reasons such as the level of investment not being the same.
“We have very good quality hospitals and universities, but not everywhere,” said Vazquez. One of the big problems lies in both technological and educational resources since their improvement is needed to properly train doctors, nurses and specialists.
Investment is another major challenge, to ensure quality training for health professionals.
“Investment in technology, including telemedicine, is very important. In the long run, it becomes cheap,” added the UNAM academic. He explained that the lack of investment is something that has become clearer with the crisis caused by COVID-19; however, the picture is the same for other diseases. He stressed the importance of continuing education to ensure appropriate training for health professionals, as well as the review of educational programmes, as both medical knowledge and technology are advancing rapidly.
Mariana de Anda, a dermatologist surgeon at Dr Manuel Gea Gonzalez Hospital, highlighted access to technology as a challenge faced across the region in Latin America.
First-level care is better in more developed countries than in the region. “In order to have better first-level care, we need to change the way we train doctors, so that we have good general practitioners and better coverage of health problems.” Likewise the dermatology specialist pointed out that there is a centralisation of specialists, and this produces a shortage in small towns.
“After the coronavirus crisis, the way health professionals are trained academically can be changed, and investment in technology emphasised, as in the long run it will be the way we can ensure that people have good medical care around the world and in places where specialists cannot reach,” added De Anda.
Medicine: a humanitarian vocation
In order to have more specialists, as well as good general practitioners, a balance is required between a good income – that ensures that the health professional can live adequately on their salary – and vocation.
Juan Carlos Vazquez said that on many occasions young people preparing to become doctors tend to choose specialise due to the quality of life that this offers, as well as income.
In Mexico one of the biggest problems is family and general medicine. “For decades we have trained doctors to be specialists, not to be general practitioners. And if you’re not a specialist, you cannot be considered a good doctor; that is the general perception,” said Vazquez. However today it’s much clearer that primary medicine is needed in the country.
Juan Ramon Fabregat added that if an acceptable income can be guaranteed that ensures a good standard of living for the doctor, the other aspect that must be considered is vocation. “We choose our vocation when we are young, when we are idealists, and we want as doctors to help people,” he added.
For new generations, it will be important to remember the value of the patient and not just look at income. Likewise Fabregat stressed that young people are more optimistic, so it’s easier to plant in them the need to help others and have a more humanistic approach to the planet.
He added that, without the vocation and heroic spirit, there would be no organisation like MSF, with health professionals determined to care for and help patients in complicated situations such as war zones or isolated areas.
Dallatomassina stressed the importance of collaboration, creating networks of professionals such as general practitioners who can share their experience internationally is a push, because they can share scientific updates in addition to human experience. This is possible thanks to new technologies allowing a doctor to attend and collaborate remotely.