Garth Rattray | Must you be wealthy to be healthy?

It’s bad enough that it takes a lot of money to eat healthy. Because vegetables, lean protein, and fruits are exorbitantly priced, most Jamaicans subsist on a starchy and oily diet. To make things worse when they become ill, the public hospitals can be hellish.

A patient of mine had a stroke and went to our public hospital in Kingston. He was among several very ill patients who were sitting on chairs for days, suffering while hoping and praying that a patient would be discharged. However, he jumped at the opportunity to occupy a bed from which a corpse was JUST removed. This is the state of affairs in the 21st century … in a country that is rated by the World Bank as an upper middle-class economy, where certain [ruling] politicians claim that we are experiencing prosperity.

Then there is the situation of another citizen of meagre means who attended that same hospital. His elective surgery was postponed because doctors detected a potentially serious heart condition. On April 28, he was [provisionally] diagnosed with atrial fibrillation (which is known to cause devastating strokes). He must have confirmation before treatment can be administered. However, the echocardiogram is scheduled for September 9, and the Holter is for September 18. What will his fate be by then?

A colleague and friend of mine took her ailing family member to the hospital that is associated with higher medical learning. The emergency area was so busy and congested that conversing with the overstretched medical staff was barely possible. The obligatory wait in uncomfortable circumstances caused her to wonder why ‘the government’ has not allocated more funds to providing better healthcare for a wider cross section of our society.

She, like the rest of us, appreciates the need to rehabilitate the premier public hospital in western Jamaica. We also see the very obvious need for a paediatric hospital in the west. But what about the serious problems with the existing healthcare facilities? They need rehabilitation too.

SUFFERING

The narrative and optics surrounding the work on those hospitals in the west are all well and good. Our citizens are suffering, and our visitors have provided feedback that Jamaica has extremely poor public health facilities; so much so that the problem is listed as a warning in the travel advisory for potential visitors to the island. Consequently, billions of dollars are being poured into those hospitals.

But visiting many other healthcare facilities can be so nightmarish that some patients prefer to stay home and die rather than punish on chairs and hope for a bed in hospital. Our politicians do not realise that, despite the hype and reh-reh, Jamaicans see the anomalies between those who are able to access private healthcare and those who cannot.

Jamaica’s upper middle-class World Bank rating and much vaunted prosperity are not being appreciated by the regular citizen. There is extreme incongruence between the spiel from politicians and what they are experiencing in their daily lives. That impressive World Bank rating is being skewed by a select subset in Jamaica, and the rest of us don’t know what prosperity is. As a consumerist society, we contribute to their prosperity but do not experience it ourselves.

Whenever ministers and dignitaries tour healthcare facilities, they are shown the best things. It would be good if the minister of health dropped in unannounced to see seriously ill patients suffering in chairs for days, and the necessary intermediate ward to hold the sick until beds become available. The minister needs to see the disappointment and deep concern etched on the faces of those postponed for ‘elective’ procedures and investigations. I wish that he could speak with them and feel their pain.

CLINIC FEES

Before April 2008, only about 10 per cent of Jamaicans paid their public hospital and clinic fees. Nonetheless, that income was nothing to be scoffed at, it was $1.7 billion and [at that time] it contributed 10.2 per cent towards the revenue of regional health authorities. Our healthcare system was already understaffed, underequipped, inefficient and under extreme strain. Announcing the no user fee policy caused a veritable run on the ailing public health system.

The extra burden resulted in greater suffering for the poor, who showed a 10 per cent increase in hospital/clinic visits. Here is where the schism between the haves and the have-nots widened; the better-offs abandoned the horrible public health system and visited private facilities more than ever before. That went from 71 per cent in 2007 to 83 per cent in 2009. In fact, there is an overall increase in use of our private healthcare facilities (a 2012 PAHO report corroborated this). Not only did the no user fee policy drive the better-offs to utilise private facilities, but it also even forced some poor people to utilise them. It wasn’t simply for the convenience; it was in a bid to save their own lives.

And still, nobody is asked to contribute whatever they can at public health facilities. The political decision to provide ‘no user fee’ healthcare remains even though The Report on the World Social Situation 2010 clearly stated, “… removing fees will entail additional resource requirements. It is, therefore, important to ensure that additional funding is available for countries that want to remove fees.” Jamaica never had and does not have those additional financial resources. Perhaps when the suffering public stops whimpering and begins screaming, they will listen.

Garth A. Rattray is a medical doctor with a family practice. Send feedback to columns@gleanerjm.com and garthrattray@gmail.com