Sorry, I had responded earlier, type a big bad response, went to post and I was re-directed to the log in page. I was to irate from losing everything that I didn't come back to re-write... till now.
Well I think the best I can do to answer your question Bob is to tell my experience and impressions from being diagnosed. This all happened in Arequipa, Peru. While Lima, the capital of Peru, is quite modern and developed, Arequipa is considerably less so. I'd classify it as developing, although toward the higher end of the developing.
The first doctor I saw was a neuro at a private clinic. I was told that the nubness in my leg was due to an inflamed nerve. Not exactly incorrect, but not the whole story. She may have reached the conclusion of MS had I continued to go there... but..
I then took the advice of some local friends and went to the public clinic, where I got an x-ray and was told by the GM that my symptomes were due to the minor scholiosis that image was showing. I then saw a neuro there, who told me it was due to a viral infection and that it would soon clear up. Had I trusted him and waited, it may have made sense when my symptomes resided... but...
The symptoms persisted, so I went to the private clinic reccomended be Lonely Planet. After telling him my previous experiences, I think the neuro there suspected MS right off. I say this because he sent me in first for a cerebral MRI, not a spinal. When that came back positive, I did the spinal MRI, the spinal tap, and EKG, and he confirmed MS.
The question is, does the perception of autoimmune being rare in developing areas lead the doctors to search out other causes for symptomes and make different diagnosis? Which in turn leads to a lower diagnosis rate and feeds back into the theory that autoimmune is not a phenominan of the devoping world? In short, is it a self fulfilling cycle, or is there truth to the treory. I would say yes and no.
My personal impression is that in the public clinics (where the majority of the people go) is that MS or autoimmune may not be on thier radar. The answers that I got there didn't seem to be anywhere close to what was really going on with me. In this case, this cycle could very well be in effect.
On the other hand, the neuro in the second private clinic seem to intuitively suspect MS, and seemed quite familiar with it. However, I asked him how many cases of MS he had seen. I had been reading on MS after my first MRI came back, and had read that it was fairly rare in developing areas. He responded that he had seen only a handful of cases. Since he seemed good at making the diagnosis, and since he had indeed had a long carrer, I would expect him to have made more than a handful of diagnosis if MS really were more widespread in the developing parts of Peru.
My impression anyway