Medicine in Zambia

Excerpt

To the editors: I believe that Welch's conclusions regarding health care in Zambia and the United States are mistaken. It is not clear that financial hardship, analagous to that in Zambia, can produce efficiency in American health-care delivery. It is certainly not obvious that such efficiency is desirable.

Last summer I returned to Zambia to work for 10 weeks at Mwami Adventist Hospital, a 169-bed acute care hospital and leprosarium. I participated in the efficient health-care delivery described by Welch. There are deceptive aspects to that efficiency. Even at $5 a day, hospital care costs more than 2 days' wages