Hospital Ships: What exactly are they for?
So, as I may have mentioned one or two times, I am no big fan of hospital ships.
Hospital ships have a long and storied history. The US Navy has been providing care from its ships for almost as long as they have been visiting ports. The US military is proud of these humanitarian efforts. They are still using hospital ships now, which sail specific humanitarian trips. The Navy crews the ship, while US-based non-profits such as Project HOPE generally provide the medical staff.
These kinds of hospital trips are excellent public diplomacy. They are seen as evidence of American caring and generosity. People remember the visits for years. The visual of a ship sailing up just to help people is extraordinary. And the volunteer doctors and nurses who provide the medical care have genuine and altruistic motives. Almost everyone involved with hospital ships has the very best of intentions.
The problem is that you just can't provide very good care from a hospital ships. The volunteers who have staffed the ships will be the first to tell you that. There are very few cases in which good medical care can be provided by a single visit to a doctor. Good medical care needs follow-up, and hospital ships don't stay in one place long enough to provide follow-up.
Good medical care also requires doctors deeply familiar with the diseases they are treating. This can rarely be provided by volunteer doctors. A pediatrician from Palo Alto, however well-trained, probably hasn't seen a lot of cases of severe malnutrition or schistosomiasis. Volunteer doctors also won't know what medicines are easily available locally, or what are inexpensive enough that people can afford them. I met a volunteer doctor in Uzbekistan once who was recommending that mother use flat Sprite to rehydrate children sick with diarrhea. It's decent medical advice, but beyond the financial means of most Uzbeks and sugar water would work just as well.
Awareness of a hospital ship visit may distort health care decision-making. People often travel a long, costly, way to get to port for hospital ship care. In many cases, this money could be spent getting care from a local provider. They may delay care until the ship arrives, making their health problems worse. They may delay care, spend money for travel, and then discover that the hospital ship can't help with their diabetes or tumor.
Hospital ships are popular with patients primarily because they provide free care, and secondarily because they do so in an exciting setting that makes people feel like they are getting world-class American health care. That's why people go to them; it's free and it's glamorous. The glamour makes them assume it is better care. Hospital trips demoralize local health care providers, and reduce people's faith in their skills. They are a flashing sign that says "Care here in Liberia/Mexico/Guatemala/Malaysia is so very bad that the Americans send ships to protect us from having to go to local doctors."
The US military provides care a gesture to demonstrate that it cares about developing countries. The health care providers who volunteer rarely know much about the context of their health care. They just want to help, and go somewhere unusual and exciting to do their helping. No one in this equation has any incentive to actually improve the quality of health care available in people's day-to-day lives.
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