Medical care on the brink: the need for re-engineering healthcare services in sub-Saharan Africa.

The sub-Saharan region of Africa is home to more of the ills of mankind than any other region on earth. Nowhere is the aggregate of disease, political turmoil, inadequate resources and a crumbling infrastructure so completely packaged in a seemingly "escape proof" pod as in sub-Saharan Africa. This continent is a kaleidoscope of people and problems derived from artificial boundaries drawn by European colonial powers, resulting in a litany of problems that have flourished for many decades. In the immediate postcolonial era, there was some oversight by the departed powers, but this has changed recently with decreasing interest in African affairs and only episodic worldwide news coverage because of other world events that overshadow Africa and its problems. The end of the cold war also eliminated the attention Africa received when the superpowers were courting nations. The American Medical Team for Africa has conducted medical missionary work throughout Africa for over a decade and, through its observations, has developed recommendations that are germane to all of sub-Saharan Africa. The organization thinks that this might warrant the attention of governments, international pharmaceutical houses, foundations, the United Nations and all international aid agencies concerned about the plight of healthcare in Africa. These recommendations should enable these countries to re-establish an affordable, efficient and sustainable infrastructure for basic hospital services so that they can diagnosis, monitor, treat and manage disease populations. In some areas, Africa needs to be retrofitted with technology from the past, while in others it needs to be fast-forwarded into the future. The purpose of this manuscript is to try putting the various healthcare challenges into one of these two categories.