Posts Tagged ‘healthcare’

20 March, 2010

Healthcare in America as it is in Sri Lanka

starry-nightI was born in a country usually described by those subscribing to the dominant paradigm of development as being poor and developing. Year after year, beginning from first grade, in our classrooms both public and private (we have a national curriculum), we learned mathematics, reading and writing, but also world history. We studied world civilizations, cultures, economic foundations, imports, exports and religions. We learned of most things as facts, only questioning choices – within political systems, for instance – when we reached the senior classes. There was, however, one thing that it would never have occurred to a Sri Lankan student to ask: Do American have the same access to health care that we do here?

In order to ask such a question, Sri Lankans would have to be suffering the same deprivations that Americans suffer today. They would also have to take it as a given that health care is something that is not commonly provided to all but, rather, reserved for a few. In the absence of those realities, no Sri Lankan child could conceive of a society where people are routinely denied medical care, where children remain un-vaccinated, and where the elderly perish because they cannot afford to visit a doctor. They would have to imagine a milieu where parents must decide between food and medicines, between dead-end employment with health care v. fulfilling work without health insurance, and between taking care of a sick parent and going into debt, or setting those parents adrift and saving for their children’s future. Indeed, they would have to conjure up a way of living that was routinely, relentlessly, psychotically preoccupied with the dread scepter of sickness rather than the much more joyful activity of the conduct of life.

Sri Lankans cannot do that. While I have joined this American life where all of the above have become my reality, every single one of my countrymen in Sri Lanka continues to enjoy first-class medical treatment in hospitals which provide it to them entirely free. Should a Sri Lankan not wish to avail themselves of free medical care, they have the option to visit a multitude of private hospitals. The same caliber of physicians serves at both. After a free education, Sri Lankan doctors are required to serve in public hospitals. They are also free to engage in private practice so long as that fundamental requirement – giving back to the country what it has given to you – is met. The decision of a patient to go to one or the other depends upon the patient’s idiosyncrasies; I have wealthy friends who have preferred to give birth in a shared dorm in a public hospital rather than in a private room at a fee-charging medical facility, my father vacillates between one or the other.

Yes, it is not perfect. Last time I checked, they do not have the capacity in Sri Lanka to separate twins sharing hearts or lungs. They do not have the Childrens’ Hospital of Philadelphia (CHOP), they do not have Memorial Sloan-Kettering. What they do have are the kinds of services, including advanced care services, which are pertinent and ought to be accessible to 99.9% of human beings. And what they do have is a society where should a particularly specialized form of medical care unavailable in the country be required by one of its members, citizens will routinely donate the funds necessary to send that patient overseas. It’s a lot cheaper to chip in the equivalent of about $5 to help a fellow-citizen about once a year than to live as we live (and die), now, here in America.

We are here today on the brink of a vote on making health care substantially more compassionate than it is currently is in America. It is a day that dawns with one of the last independent hold-outs from the left, Dennis Kucinich, deciding to make possible what is possible rather than wait for what will forever be denied. It is a day that alters the fate of three close neighbors, all of whom are professionals with doctorates and halves of two-income families in one of the wealthiest suburbs in America, who are trying to make ends meet without health insurance. They aren’t poor people, they have jobs; nonetheless, they cannot afford health care in this country. What then of the millions of others struggling with neither wealth nor employment? Which reminds me of a few words spoken on January 20th, 2009, in Washington DC by a new President:

“For as much as government can do and must do, it is ultimately the faith and determination of the American people upon which this nation relies. It is the kindness to take in a stranger when the levees break; the selflessness of workers who would rather cut their hours than see a friend lose their job which sees us through our darkest hours.”

This will, hopefully, be the end of that darkest hour for Americans. It is an hour that has lasted for more than five decades. Surely it is time for the leaders of this country to recognize their obligation to their fellow citizens. Surely one of the wealthiest nations in the world can finally do for its people what one of its poorest has done throughout its history.

10 May, 2009

For a Mother I Once Knew

In my purse, I carry a note which describes the clinical condition of a woman I knew. Tracy was not a good friend of mine in any real sense of the word; I did not share my life with her, not ask her for any help. For one, we moved in different circles, for another, Tracy was in not in a position to help me except by example. She was the mother of a little girl named Tessa, whom it had taken her seven years to conceive. She was diagnosed with cancer when Tess was very young, and by the time her daughter turned five, Tracy’s cancer was terminal, and all of her will was bent toward staying alive for one more day.

I assumed that I could help by getting Tracy more information because I have always found that knowledge is my best defense. Furious at the fact that her treatment had been delayed, and certain medications not administered to her because she did not have health insurance, I sat down with her and wrote those symptoms down. But instead of calling him, I waited two weeks until that Thanksgiving when I ran into my brother-in-law at the time, an oncologist, to ask him what he thought about Tracy’s situation. He looked at the drugs she was on, explained to me that they were usually given when there was nothing else that could be done, but that in some very rare cases, patients responded positively to them.

I didn’t tell Tracy that. I told her instead about the experimental drugs that she might be able to access were she willing to try them, by driving from Fairfield, Maine, where she lived, to Dartmouth, New Hampshire. She wanted to give it a go but, by then, her body was too far gone. Not long after, I stopped to talk to her as she sat in her car, waiting for her husband to pick up their daughter from school. She was so weak she could hardly speak. Thinner than it seemed humanly possible to be, and the fragrance of medicinal marijuana clinging to her, she had shown up, as she always did, to pick up Tessa, even if she could not herself get down from the car and walk to the door.

I saw Tracy one last time just before she passed away. She was lying in a bed that had been set up in her living room, with her husband and mother there to help. By this time she was simply receiving morphine so she could be comfortable while she waited to die. As someone who believes in the power of books, I brought one for Tessa that day, The Next Place, by Warren Hansen. I asked if Tessa would like to go home with me for a play date and it was incredibly poignant to me to watch Tessa climb up onto her mother’s bed to ask if she could go. It didn’t seem to strike her that her movements might be painful to her mother who was so wracked with frailty. Perhaps she knew that nothing she did could hurt the mother who had fought so hard to stay with her.

When she was told that I was going to leave, Tracy asked her mother to lift her up. She wanted to give me a hug, she said. I don’t know where she found the strength, nor what might have motivated her to try to do this for a woman she barely knew. Except that there was Tessa. I remember that I stood there saying, don’t worry, we will look after Tessa. I remember that whatever I said had the weight of a promise and though it wasn’t a request that Tracy had the capacity to make out loud, it was still one she articulated. That grateful farewell was all she could do for her daughter.

I meant well. But I moved from Maine. Tracy’s note stayed in my purse when I bought a new one. And Tessa stayed on my mind. One mother’s day came and went in the throes of selling and buying and moving and settling and bemoaning the mundane difficulties of a life lived with the blessing of good health. But this mother’s day, as I went through a series of medical tests of my own, I recalled once more my promise to Tracy. I called up the school she still attends, its tuition paid by her grandmother, to see if she was still there. I remembered that more than anything else, Tracy wanted her daughter to stay at the Kennebec Montessori School, within the inclusive, familial embrace of a high quality education transmitted by teachers gifted in the art of recognizing the unique nature of each child. Apparently, despite the loss of an elderly care-giver who had taken care of Tessa before and after school, her father is committed to her staying there for one more year. I am not sure what she will do this summer, but I hope I can find a way to help.

As a start, today, on mother’s day, I thought I’d honor both a mother of incredible courage and love, and keep a promise. I went out and bought a few of my favorite books, and a couple I had never heard of, for Tessa: The Great Nursery Rhyme Disaster (David Conway), A Child’s Garden of Verses (Robert Louis Stevenson), When Papa Comes Home Tonight (Eileen Spinelli), Incredible You: 10 Ways to let your Greatness Shine Through (Dr. Wayne W. Dyer), It’s Okay to be Different (Todd Parr), You Read to Me, I’ll Read to You (Mary Ann Hoberman) and You are my I love You (Maryanna K. Cusimano & Satomi Ichikawa). They are the kinds of books I imagine Tracy might have liked her daughter to have.

Tomorrow I will put them in the mail along with a note to Tessa. What I will say to her, I do not know. I know that she had read the first book I gave her many times, and I hope that these new books will help her navigate the parts of the world that are navigable. I cannot be like a mother to her, but it is not too late for me to be her mother’s friend.

The Books:

The Books:

On Sal Mal Lane

In the tradition of In the Time of the Butterflies and The Kite Runner, a tender, evocative novel about the years leading up to the Sri Lankan civil war.

A Disobedient Girl

A Disobedient Girl is a compelling map of womanhood, its desires and loyalties, set against the backdrop of beautiful, politically turbulent, Sri Lanka.


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