The moment the text message lit up my watch, I knew my life had irrevocably changed. I looked down at the miniature screen and found that I could not look away from the gray bubble and the three words that shattered my world: My aunt had passed away. An all-consuming grief overtook me as I processed a reality where my aunt’s boisterous laugh no longer echoed off the walls, along with a future that did not include her warmth and kindness. This loss not only affected me personally but also made me reflect on broader issues in health care, especially considering that, for the third time in eight years, I had lost an aunt to complications of type 2 diabetes mellitus.
When I immigrated to the U.S. 10 years ago, my home country, Guyana, had little semblance of primary care. Preventive health was limited to vaccinations, and that was the extent of it. If I had resided in Guyana when my aunts passed away, I would have viewed their deaths as inevitable, a mere fact of life. However, my experience with the health system in the U.S. complicated my grief, filling me with feelings of helplessness and frustration. Had my aunts had access to the yearly hemoglobin A1c screenings, education on their diet and foot care, and the routine ophthalmology visits available for patients with type 2 diabetes mellitus in the U.S., perhaps their stories would have been different.
The limitations of targeted aid
While I cannot lay the burden of my aunts’ deaths solely at the feet of any one individual, organization, or government, there were opportunities for preventative health and primary care to expand beyond just vaccinations and sick visits to general practitioners. These opportunities took the form of financial support from both external governmental and non-governmental organizations. Despite these opportunities still existing today, as they did then, funding for health care is almost always accompanied by stipulations. It is typically targeted specifically at disease eradication efforts. While I do not want to minimize the importance of such efforts, I believe that U.S. health care funding to other countries should be provided without restrictions and should not be limited to addressing specific diseases. Recipients of such funding should be empowered to direct resources toward multiple causes, including preventative health programs alongside disease eradication.
A case study in mortality
Guyana is one of many countries that receive the targeted aid discussed previously. One example of this is through the U.S. organization, USAID, which is focused on antimalarial efforts in Guyana. However, according to the Pan American Health Organization, in 2019, Guyana’s rate of preventable causes of premature mortality was 326.9 per 100,000 population, which was 138.4 percent higher than the regional average. Given the funding that Guyana received and continues to receive from organizations such as USAID, how many more lives could have been saved from premature mortality if such funding had been directed more broadly instead of to a specific cause?
Local expertise matters
Many other countries receive generous health care aid in the same way that Guyana does. However, the insistence that this funding be spent solely on disease eradication, and the belief that external organizations should control both the provision and allocation of aid, can be infantilizing. This approach often disregards recipient countries’ autonomy to decide how best to improve their health care systems. While an argument can be made that failure to direct such funding could lead to misuse and corruption, I am advocating against oversight. I am instead advocating for limited control over the funds once they are distributed. Donor organizations can oversee how funds are used to ensure fairness; however, controlling where and how funds are used is beyond oversight.
There are numerous experts within these countries who witness the health challenges their communities face every day. These local experts should be given the power to determine where aid is most needed. Their intimate knowledge of their health care system enables them to prioritize areas that need the most support, whether in disease-specific interventions or broader initiatives such as preventive care. They can champion causes that address both specific diseases and overall health needs, rather than being restricted to a single, externally imposed focus.
To address these issues and avoid tragedies like those my family experienced, we must advocate for flexible health care funding from both government and non-governmental organizations. This funding should empower recipients to decide how best to use resources. Therefore, it is imperative that these organizations grant recipient countries’ governments control over funding and its allocation, ensuring that each country’s needs are equitably addressed by those most knowledgeable about the local health care landscape.
Selena Kattick is a medical student.
