Tuesday, August 27, 2013

Reflections on Access to Health Care

Memory: November 2012

I wake up in the middle of the night with stomach cramps and nausea. I stand up and walk from my sister’s room to one of the bathrooms in my family’s home in Canada.

As I walk I feel faint and call for my Mother. I then loose all control of my body, collapsing onto the soft carpet floor.

I come to as my mother drags me to the bathroom and helps me sit upright. In minutes, two paramedics are hovering over me. They wait while my Mother cleans me (sorry about that Mom) and then I’m on a stretcher being hoisted into an ambulance. The ambulance ride is less than 5 minutes.

I’m wheeled through the emergency room and immediately get a bed in the emergency ward. I’m seen quickly by a doctor and hooked up to state of the art machinery. They take samples of everything you can imagine, conduct X-rays, give me an ultrasound and monitor me constantly.

Within hours, my father is on a plane home from Florida and my Mom takes the day off work to be with me. I was discharged late the next day.

As I lay on that hospital bed I felt angry for competing reasons. At first I was angry to be in the hospital, to be sick, to feel helpless and confused because I didn’t know what was happening. I wanted to go home.  

Then I thought about what would have happened if the same thing had occurred a month before when I as living in Malawi…

... and THEN I thought what would have happened if I was a ‘typical’ Malawian women.

In Malawi, the GDP per capita is $900 USD per year and 80% of the country lives in rural areas. Thus, the ‘average’ Malawian woman is living in poverty in a rural area. At the age of 27, I would most likely be married with a few children and have significant family responsibilities to attend to. I would likely have collapsed onto the mud or cement floor of a small makeshift brick or thatch house without electricity or running water in the home.

Just months previous, we had been delivering bicycle ambulances in a rural area. While thanking us, one of the carers who would be using the bike to transport sick people to the hospital told us that someone he knew had died the previous week because they couldn’t get him to the clinic.
Even if the person who passed away HAD been able to get to the clinic, they certainly wouldn’t have had anything close to the quality of treatment Oakville Trafalgar Hospital in Canada had.

Alinafe Hospital in Salima District
Reflecting one what would have happened to me if I had been born into a different body on a different piece of land, I felt simultaneously angry, lucky and sad.

In addition to being able to access a quality hospital, Mom had a good job that allowed her to take the day off work at no cost. Dad was able to buy an emergency plane ticket from another country to be with me.

The cost of my day in a state of the art hospital in a country where private care does not exist?


How did I get so lucky?


Memory: July 2013

My friend calls me one Saturday morning, telling me that she is sick with Malaria after a trip to Mozambique. She asks if I wouldn’t mind taking her to the clinic – she isn’t responding well to the medication she was prescribed. We go to one of Cape Town’s clinics where her international student medical insurance is accepted.

While at the clinic, her condition deteriorates quickly. When the doctor sees that her, her temperature is over 41 degrees. We are told that she must go to the emergency room immediately and then gets asked if her medicare covers private hospitals? (A note on South Africa’s health care system: there are essentially two of them – a private one which the richest approximately 20% of the country accesses and a public one used by rest who don’t have medical coverage or the ability to pay out of pocket.) My friend isn’t sure what is covered so we get referred to the closest public hospital.

By the time we get to the hospital, she is unable to walk. A porter comes with a wheelchair to take her to the emergency room.

I park and make my way inside to find her slumped alone on a chair, waiting in the crowded room to be triaged. After pushing my way to the triage station and insisting they see her immediately, they triage her ‘red’ (high priority) and she is finally taken to be seen by a doctor in the emergency ward.

We wait for hours while they take a blood test and eventually give her medication. They say if she can hold the pills down without vomiting, they will discharge her – they don’t have enough space to keep her there.

I’m asked me to leave the area – visitors aren’t allowed. In response, I search my bag, find an orange and smile at the security guard while passing it to him.  
Just before they discharge her, I give her juice and tell her to chug it – I’m hoping she will vomit because I’m terrified that they will kick her out of the hospital.

Just before discharging her, the doctor looks down again her file. His expression changes - her kidneys aren’t functioning properly.

I’m on her phone frantically trying to communicate with her family in America and at the same time, talk to her South African medical insurance. I call them on repeat, but it is the weekend and I keep getting passed to different places. No one can tell me if her plan covers a private hospital. Choking back tears, I tell the woman on the phone that my friend is very sick and that its pretty shitty that she can’t tell me if I can get her private care. She tells me there is nothing she can do and hangs up the phone.

Next I’m on the phone with my friend’s sister, trying to figure out if the situation needs, if they would like to transfer her to a private hospital at their own expense.

In the corridor outside the emergency room, I stand stunned. I have a million questions running through my head but the main one is ‘Should I try to get her to a private hospital?’ and ‘Can I afford it if it comes to that?’.

Never in my life have I had to ask myself these questions.
Never have I had to consider the cost of healthcare when making a decision. 
Never have I had to do a cost-benefit analysis with regards to a human life.

Rarely have I felt so lucky to be Canadian.

(Note: my friend is alive and after 3 weeks in the hospital has gone back to the States. We later found out the severity of the Malaria – she is lucky to be alive. She has lost most kidney function and is now in need of a transplant.)


Memory: June 2013

I’m sitting chatting with a friend in a small restaurant a few hours outside of Cape Town.
She is more educated than I am and has access to well paying work as a journalist.

She casually mentions that before leaving for Cape Town she had to decide between getting a polyp removed from her cervix or getting a mammogram. She is pleased that she chose the cervix operation because her periods are much less painful now.

My fork freezes mid-way towards my face. My eyes well up as she looks at me questioningly.


I had minor surgery on my cervix a few years ago and I’ve known for years that I will start getting mammograms when I turn 40.

It never crossed my mind that I would have to PAY for either.

It never occurred to me that I would have to pick and choose health services based on what was in the piggy bank.

Hell, my piggy-bank and health services don’t even fit in the same category in my mind.  

Despite hearing about health care debates in the States and hear-say on Americans making the trek North in hopes of accessing Canadian health services, the reality of the country less than 100km away from my home neverfaithdp3 really hit me.

Not to say our health care system is perfect. Not everything is covered and access to health services for marginalized peoples isn’t near as good as what I’ve had the privilege of accessing. I’ve had to wait months to get an appointment for an annual physical.

The concept of having to choose between cervical surgery and a mammogram completely floors me. 


Memory: November 2011

I’m sitting reading the newspaper in Malawi. The fuel crisis continues to rage and neither diesel or petrol are available at the pump.

Black market prices are skyrocketing (around $3 USD equivalent per litre if my memory serves me correctly). It is next to impossible to get a taxi cab, and if you can, it is close to prohibitively expensive.

I’m used to hearing about the crisis and seeing huge lines at the pumps on the odd day when a shipment comes in. I’m used to hearing about cars damaged from black market fuel which has been mixed with cooking oil or water.

I’m also used to the frequent (oftentimes daily) power outages.

Despite having become used to the fuel and energy shortages, this newspaper article put things in a completely different perspective. It was a story about 3 lives lost in the city in which I was living.

One woman died at home because the ambulance didn’t have the fuel necessary to pick her up.

The other woman was at the hospital giving birth and developed a complication. She was in emergency surgery when the power went out. Since there wasn’t any fuel, the backup generator didn’t go on and both her and the baby died.

The relationship between infrastructure, economics and access to hospital services had never crossed my mind. To have a power outage in a hospital was obscure enough – loosing two lives on one operating table because there isn’t fuel for the back up generator?


Coming from a country with one of the best health care systems in the world, these past 2 years have been a huge eye-opener for me. Access to health services is immensely important, and very few people are as lucky as I in this regards. Despite firmly believing that health care is a right, the daily realty for many people across the world is much different for many economic, social, ideological and political reasons. 

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