Tuesday, October 13, 2009

Priorities (Marin IJ)

September 30th, 2009

During the last several months of health reform debate, there has been a lot of scary talk. We’ve been cautioned about bankruptcy, denial of coverage, and pre-existing conditions. We’ve been subjected to speculation about delayed procedures and death panels with a mandate to pull the plug on grandma.

Surely, there are many inequities in our health system and with proposed change comes angst, but whether you are for, against or indifferent towards reform, please pause and remember how lucky we are. We live in a country that has a medical safety net; highly specialized emergency departments capable of treating anyone, anywhere, anytime. This safety net may be expensive, imperfect and severely strained – but it exists. Many around the world are not so fortunate.

Dr. Vicki Martinez, a colleague of mine in the Emergency Department, travels each year to Guatemala to provide free medical care. She works with an organization called Faith in Practice (http://www.faithinpractice.org/) that has been sending volunteer medical teams to Guatemala for the last 16 years. These teams travel to the most remote and poorest parts of the country, setting up makeshift clinics in rural villages and providing very basic treatment; antibiotics for parasitic infections caused by contaminated water, pain relief for debilitating arthritis, dental care, and simple surgical procedures. Extremely ill patients are evacuated to urban hospitals. In her journal, Dr. Martinez writes about the heartrending circumstances she encounters: “Today we treated a gravely-ill one-month-old infant with cleft lip and palate. Before we could transfer him, we found the baby mottled and dead in its mother’s arms, she unaware. Our horrified team did its best to console her and deal with the death. To us, the loss of a baby would be our greatest nightmare. In truth, the loss of this woman’s 10th baby with its severe birth defect was just an expected tragedy in a life of struggle.” And, from elsewhere in her journal: “It broke my heart to see young people that would certainly die because they were born in the wrong country. I was sure one 21-year-old mother of three had lymphoma by the multiple lymph node masses she had. Sadly enough, if you are poor with an expensive, chronic disease in Guatemala, you are out of luck for treatment. Another young man appeared to be dying of cancer. The most we could do was to help prepare the family for reality and give him pain medicine to ease his suffering.” Each year, I see Dr. Martinez return from Guatemala with a renewed sense of what it means to a physician and extreme gratitude for the health resources at her disposal here at home.

Dr. Scott Cohen, a pediatric colleague, was so horrified by the conditions that he saw during a three-month visit to the Guatemalan jungles that he founded a non-profit organization – the Global Pediatric Alliance (http://www.globalpediatricalliance.org/) – to address some of the health needs of the indigenous peoples of Latin America. Most pressing among these are clean water, de-hydration treatment, and child-birthing skills. This last need is particularly grave – approximately 85% of women in these jungles deliver their babies in huts without medical assistance. And consider that out of all female deaths between the ages of 16 and 40 in Latin America, one in five is due to complications during pregnancy or labor. In contrast, in the U.S., a total of 569 women died during childbirth in 2006 – less than half the number of young women who died from accidental drowning.

“I feel that as a physician,” Dr. Cohen told me “I have a responsibility to care about patients in other parts of the world whom I may never have a chance to meet.” He has accomplished this by helping to train midwives and give them the skills and equipment to recognize complications of childbirth, such as bleeding, early on, so that an expectant mother can make it to the hospital – rather then bleed to death in her hut.

When I reflect on the medical care available to Guatemalans and others in the third world, it is clear to me how fortunate we are in this country and what we take for granted. This is not an argument for or against change in our system; it’s just the way it is. But, I think that the experiences of my colleagues in Guatemala highlight what our health priorities can and should be; basic preventive care, in particular for societies’ most vulnerable populations. A good place to start would be improving out infant mortality rate – currently ranked 29th in the world – on par with Poland and Slovakia. Now, that is truly scary.