This year, FemInEM launched FemInEM Forward; our initiative to support individuals and organizations who are making the world better. The FemInEM community at large has the power and privilege to expand our reach and voice, and to highlight those voices who are moving us forward. The FIX19 International Attendee Scholarship is one our our FemInEM Forward initiatives. The FIX19 International Attendee Scholarship was created to support women from low and middle income countries to attend FIX19. We were overwhelmed to receive over 70 applications, with applicants representing almost 20 different countries: India, Myanmar, Uganda, Kenya, Tanzania, Pakistan, Ghana, Egypt, Rwanda, Ethiopia, Sri Lanka, Nigeria, Mozambique, Honduras, Zambia, Liberia, Bangladesh, Brazil, and Nepal. Women from all over the world submitted their written experiences with gender inequity. And what we were reminded is that gender inequity in medicine is pervasive. It is essential that we understand the experiences of all women in order to expand the solutions and build a global community. With FemInEM Forward, we hope to highlight stories from women everywhere. 

Over the next several weeks, we will be highlighting blog posts from some of theses incredible applicants.

The blog post below is by the amazing Dr. Prithsvishree Ravindra. She received the FIX19 International Travel Award and will be attending #FIX20. Dr. Ravindra was supported by EMJ and RCEM to attend FIX20. Thank you to EM:RAP GO, Abbott Fund, and RCEM/EMJ for their support and partnership in supporting gender equity around the world.

Why do emergency medicine? You ask

Making sense of ED chaos seems a Herculean task

Sleepless nights, crashing patients, unforgiving mistakes

Responsibilities on shoulder, with lives at stake

Fighting the ‘system’ which doesn’t like to evolve

People resisting change with great resolve

We are the face of the hospital

First face the sick and their families see

And to some, the last too

As much as we hope that wouldn’t be

We put our heart and soul

To get a stopped heart beating

And when spontaneous circulation returns

To keep the heart ticking

The challenges, the puzzles, the wins

Keeps our adrenaline pumping

In pursuit of resuscitation

We often have tales that are touching

Balancing the emotions

With knowledge and bravery

Persevering to make the patient better

Life saving skills in our armoury

We are the patients’ advocate

We know what is best for our patient

We get in our colleagues to intervene

Trusting them with and sharing our patient

We try to save lives

Each and every day

We work as a team

We learn, we teach, we pray

Why do emergency medicine? You ask

It let’s the hero within you unmask

This is a part of a poem I had written during residency. Emergency medical care is a right of every person and responsibility of the country’s government to provide. The importance of Equity in Emergency Medicine cannot be overemphasized. On what could be one of the worst days of their lives, a patient and their family come to us with the hope for improvement. As an advocate for patients, we, the emergency physicians, always strive to do our best and treat everyone with equity.

Irrespective of socio-economic status, gender, religion, caste, everyone deserves standard emergency care.

Having said this, the reality in India is a stark contrast.

Access to healthcare, especially emergency care and advanced treatment options, are limited to urban areas. The rural population does not have access to well equipped hospitals or trauma centres. Around 1 year ago, I received a 42 year old patient to the ED. While playing cricket in a village, around 1.5 hours from our centre, he developed chest pain and collapsed. He was transferred to our hospital in an ambulance. He suffered a cardiac arrest on the way and came in cardiac arrest to our hospital. Despite our best resuscitative efforts, he could not be revived. I felt pained and exasperated that there was no bystander CPR/ CPR in ambulance/ early defibrillation done, which likely could have changed the outcome. He had a young wife and a child. If only they had access to nearby health centre. If only, there was a trained paramedic in the ambulance.

Among the patients who do reach a tertiary care hospital with the hope of getting standard treatment- one of the biggest obstacles is COST. Most of our population does not have medical insurance. When giving treatment, we need to keep the cost at the back of our mind. Many poor patients cannot get admitted in private hospitals due to cost. Even if they get admitted, the expensive treatment drains them of their resources and the whole family is driven more into poverty, many times mid-way during the treatment, they discontinue and take the patient against medical advice. Ideally, the government run hospitals should provide a good alternative. But the government hospitals don’t have adequate resources to cater to emergencies.  We feel quite helpless when we need to shift the sick patients who require emergency and critical care away, knowing that they will not get adequate care elsewhere. We pray that patient doesn’t deteriorate during the transfer, and that an ICU bed in the government hospital is available as the waiting list in government run tertiary care ICU’s is usually 1-5 days.

What is the solution? How do we go forward from here?

Until last year, India spent 1.15% GDP on healthcare. This is abysmal compared to countries such as the USA, which spends 17.8% of GDP on healthcare. Measures have been introduced to increase the expenditure on healthcare. Insurance schemes are being introduced to cover emergency care. Implementation of such large scale insurance for 1.4 billion Indians is a daunting task. But a collective will, public-private partnerships, commitment from government, and health care stakeholders, and involvement of the public in taking responsibility for their health will help transform healthcare in the coming years in our country.

Healthcare for all. Equity in health care. These are the goals we need to strive to achieve.