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Specialist shortage in developing countries: comprehending delays in care
  1. Khalid Javeed Khan and
  2. Vishal Farid Raza
  1. General Surgery, Fatima Jinnah Medical University, Lahore, Pakistan
  1. Correspondence to Professor Khalid Javeed Khan; drkjkhan2{at}


We describe a case of a middle-aged woman who presented with progressive jaundice and was suspected to have rebound choledocholithiasis, which was initially managed with balloon extraction through endoscopic retrograde cholangiopancreatography at her first presentation. Healthcare in Pakistan, like many other developing countries, is divided into public and private sectors. The public sector is not always completely free of cost. Patients seeking specialised care in the public sector may find lengthy waiting times for an urgent procedure due to a struggling system and a lack of specialists and technical expertise. Families of many patients find themselves facing ‘catastrophic healthcare expenditure’, an economic global health quandary much ignored.

  • biliary intervention
  • global health
  • health economics
  • healthcare improvement and patient safety
  • general surgery

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  • Contributors KJK was involved with conception, report writing and editing, planning and overseeing the discussion pertaining to the case, and final analysis of the work. VFR was involved with acquisition of data, writing and editing the case report, conception and idea evolution, and discussions pertaining to the work and its development.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Next of kin consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.