Global health is a term that has several different meanings and implications. To many, it signifies providing health care in underserved areas faced with a scarcity of resources. However, the term also incorporates many present and future socioeconomic implications, as I have witnessed first hand. At Bangkok's Siriraj Hospital, a 2600-bed tertiary care center, physicians have available to them many of the technologies that are commonplace in the developed world. However, there are daily reminders that despite the technological advances, the demand far outweighs the supply.

I have seen several cases over the last 6 weeks that have personified global healthcare and resource allocation. However, one case in particular demonstrates not only the immediate consequences but also the long-term/lifelong effects.

A 20-yr old Thais man presented to his local village physician with acute ankle pain. As the patient performs many laborious tasks working, it was unclear as to the traumatic nature of the injury. Initial evaluation did not demonstrate any significant abnormalities and given the lack of an available Xray, radiographs were deferred and the young man was instructed to RICE his injury. Over the next 2 days, the ankle became more swollen, red and painful, and the patient presented again to his local medical clinic. There were several other patients to be seen before him and he did not feel the need to wait, thus, he went to the local pharmacy, purchased different NSAIDs and returned home. The next morning, the patient woke up with fevers and right-eye blindness. He was taken to the ED by his family. Evaluation at that time revealed signs of possible endophthalmitis and oligoarthritis. He was started on appropriate therapy and transferred to Siriraj Hospital where further investigation would reveal septic arthritis, bilateral endophthalmitis, meningitis, and blood cultures eventually grew S. agalactiae. After receiving appropriate therapy, the majority of symptoms improved with the exception of the blindness.

As a young Thais man, he provides approximately one-third of his family's income and thus bears significant responsibility. Now, his visual impairment drastically affects his ability to work and provide for his family. Due to limited resources and staffing at his local healthcare facility, there was a delay in diagnosis and thus appropriate management. This delay not only resulted in immediate increases in health care cost, but also the opportunity cost for what this man would have done with unimpaired vision.

I have no doubt that I will continue to learn firsthand the implications of providing health care in such underserved areas, and these life lessons will undoubtedly change the way I practice medicine. Thanks for this opportunity!

Sharif Halim is a Senior Resident in the Department of Medicine. He is currently completing a three month global health rotation at Siriraj Hospital in Thailand