Watching the shutdown of the U.S. federal government over a healthcare law that will give people an opportunity to purchase insurance that will finally give them access to quality preventive healthcare has been just as painful for me abroad as it is for friends and family in the U.S. For years and years, I have been struggling with managing my costs being an under-employed or unemployed worker. I once paid up to $900 for medication when a cough worsened and eventually developed into bronchitis. And I paid that “little” because I went to my pediatrician with my financial woes and he was kind enough not to charge me for his consultation.
I’ve now lived in welfare states that offer “free” healthcare to its citizens for some time. Of course, these welfare states are not those of Nordic nations or Europe. These public health systems are failing miserably. Right wing conservatives seem to be using these examples from the developing world as to why we shouldn’t have a government sponsored healthcare system.But their failure is not due to the existence of free health care or a welfare state—but because of neglect and lack of money which is intimately linked to the degree of corruption within that country.
When I was living in rural Mozambique we had one hospital. And I was very surprised and generally impressed with the facility. It had an intake room that could fit about 3 people at a time, a dispensary, a maternal ward and a maternity intake space which was painfully small and always overcrowded. They were in the process of expanding the hospital when I was living there. But what was more discouraging was the patient care at the hands of the staff. I’ve seen government worker ennui in the U.S. and even in other developing nations. But I have to say Mozambique is the first place that I’ve lived abroad that I have a general fear of placing myself in their care beyond the most simple of procedures.
I became familiar with staff treatment because I volunteered as a birthing doula in our hospital. So first off, I have to say that the hospital in this area is doing remarkably well with the scarce resources they have. They have exactly one doctor to serve a far lying area—and she would have to participate in the mobile care unit for those individuals who could not walk themselves to the hospital (which is how most people get anywhere in the rural area). There was one registered nurse, and the other staff members were like me, basically trained in some aspect of medical service provision. Before the maternal ward was built, only 6 months before I got there, women were giving birth on the ground under the hot boiling sun---usually naked, in front of all other patients. When B told me this, my heart ached painfully and thus my motivation to volunteer there increased.
Once I did, I was disheartened as I could see that even though the facility was improving, the staff care would not change anytime soon unless there was some intense patient care training administered—preferably by people who wanted to be doctors and nurses and did not see their job as just a paycheck. During one of my births, a woman was screamed at, slapped to push and insulted repeatedly, as this patient was giving birth to her fifth child and it was deemed that she shouldn’t be taking so long to birth her baby. I was encouraging her to push and I put myself in the support position so she could push more easily as I could see that she was just tired. But the doctor and the midwife told me that I was being soft—this woman should know and do better. When I was alone with her, and she was lying down resting, I asked her in my most clear and deliberate Portuguese, as she only spoke her tribal language, “Do you want to have this baby?” She looked at me intently for a moment and then closed her eyes and turned her head.. But I know she understood me. Really, there was nothing physically that indicated that she couldn’t deliver her baby. I believed she had a mental block-that she in fact did not want another baby to feed, cloth, and generally care for. Unfortunately in rural areas in Africa, women are socially, culturally and economically forced to have babies at an early age and have many of them during their reproductive life cycles.
In the end, the woman I assisted in the hospital was in labor much too long and the life of the baby was truly in jeopardy. Unlike in the U.S., doctors here do not have the equipment or drugs to rush into conducting C-Sections—the doctor had to send her to Malawi, about a 15 minute drive to the nearest hospital.Her family, who was not permitted to enter during labor (thus most women labor alone as the limited staff attend other patients), and whose husband was somewhere drinking beer in celebration of birthing another child, were brought in to clean up the blood off of the patient, the bed and the floor. When you are admitted into hospitals here you have to bring your own sheets and provide your own food. I do not know what happened to this mother, I had to leave my town before I could find out, but I do know that her family had no money to pay a taxi to the hospital in Malawi—they mostly likely walked.
I would say there is a general contempt for anyone walking into a hospital door as it means more time and work for the attending provider. I saw this every day when I was not birthing women. My tasks were to divide the women who needed to get their ARVs and other HIV meds to prevent intrauterine transmission and those waiting for their prenatal care. After separating women I would measure women’s bellies and check for babies’ heartbeats. I was grateful for this training they gave me—as it went beyond my doula duties and into the realm of midwifery. But I was not appreciative of the derogatory remarks they would make about how the women looked, smelled and that they were uneducated.
The contempt that is felt does not necessarily disappear when you have money, it just dissipates and you are attended to in a more expeditious manner. I found this out when B had a health problem of his own and we went to a public health facility for care. We got the run around for a week but when we explained that we were leaving the country and that we really wanted to receive care before leaving, magically there was something called the “Special Consultation” where we paid six times what we would normally have paid, and again, magically, the doctor could see us that very day! Yet, all the other weeks we were told how extremely busy he is and that he could not receive walk-ins. As we waited for our doctor, an elderly couple was sitting waiting as well, and shortly thereafter, a nurse told them to come back in a month. She turned to me and started speaking in Changana on the verge of tears. B translated later to say that they had already been coming back 3 months in a row—being sung the same old song. They didn’t have any money, so no one was going to attend to them until the condition got to life threatening or her husband died.
Private care, of course, is even better. I have recently been diagnosed with a viral infection in my left eye that is causing an ulcer. At first I thought that I just had some really dry eyes, which happened to me in Botswana--it being a desert it is very dry and dusty. At the moment, it is very dry and dusty here in Maputo. I feel like I went to every drug store in the city to find the goopy eye drops I used in Bots, but only $20 contact lens eye drops could be sold to me. These drops did not work. So B told me to dip my head in a bucket of ice cold water and open my eyes. My brother asked me if that is a real traditional cure or if B wanted to watch me do that for his own entertainment. I think it may have been a little of both. I paid $80 in total for the visit and the medication. That’s awesome for us with dollars or a super high salary. But for most Mozambicans that is all they make in a month, if that much, so they are forced to use the public healthcare system where they have to wait months and months to be seen. We decided that eyes are important so we would spend the money rather than let my eyes be damaged or totally lost at the hands of an incompetent or----because hospital workers are on strike for an increase in salary--- an uninterested or disgruntled hospital worker.
The public health system would be better if the government did not allow for private hospitals---as those with money would be using the same services as everyone else and thus demand improved delivery of services. These private hospitals must get permission, and I’m sure pay something to the government, in order to be authorized to operate. But from where I’m standing, the money from allowing these private hospitals doesn’t seem to be injected into improving services within the public health care system.
So the best I, and all of us on tight budgets,can do is to continue to eat healthy foods, get my Zs, exercise, and laugh heartily and plentifully—my time in Africa has taught me, once again, how important my health is when your options for care are limited.
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