Care at any Cost

Although health care reform has been pushed off the front pages by BP’s oil spill in the Gulf, the subject is on my mind. I don’t have health insurance. It was an intentional decision. But it puts me in a category that is a little like being gay: Nobody talks about it in polite society. And certainly if you are, you shouldn’t admit it!

I am more than happy to be an example of why reform is necessary. Look, our business’s policy was up for renewal at the end of November, which was around the same time that Arthur and I decided to dissolve the agency. I already knew that I was leaving the country to live in Senegal starting in the spring. There just didn’t seem to be any point in taking out a policy for four months, especially as I knew it would have no value once I left the country.

Further assurance (if not insurance) was that I would be living with an M.D. and that health care in Senegal is completely affordable. As Nathalie has explained to me, an emergency room visit costs on average about $15 but there is a fee for virtually every medical item that is used in a diagnosis and treatment, i.e., every syringe, every gauze pad, every alcohol wipe, every test, every single item. OK, paying for everything that's used is not so different from the US system, here, .the price is undoubtedly lower because there's no insurance covering multiple mark-ups as supplies work their way through the distribution channel.

A marked difference in care in Senegal is that before a physician undertakes a procedure, the patient or a patient’s family member may be dispatched to the pharmacy to purchase all the supplies that are required for diagnosis and treatment.

I naively asked: “And what if the patient has no family member or is too sick to go get supplies or has no money?"

In her matter-of-fact Swiss fashion, Dr. Cretin replied, "They just might die.”

This brief and enlightening discussion opened my eyes to just how challenging it is for Coumba's mother and grandmother to care for her (See post from 5/14.). Daily, the work that we’re undertaking at the Hospital of Hope—to provide comprehensive, affordable, accessible care—becomes more relevant, more real, more urgent.