Access to Healthcare: A Global Perspective

American film director Michael Moore’s documentary “Sicko” on health care in the United States – 50 million people without insurance or access to proper treatment – may have engaged in a bit of hyperbole to make its case. But the film was convincing on one point. You don’t want to be sick in America if you have no money. The fact that two billion other people, mainly in the developing world, also have no adequate health care should shame Americans. Edward Girardet draws on the recent death of his brother showing how lucky many Europeans are to have such access…even if we do complain about the inadequacies of National Health in the United Kingdom, the high premiums of Switzerland’s health insurance cartels, and overstretched facilities in French hospitals.

Just over a month ago, my older brother Cliff, a sturdy man in his late fifties, collapsed with what appeared to be a heart attack. Cliff, who suffered from severe but manageable schizophrenia, lived with my 89-year-old mother overlooking the Swiss Lake Geneva town of Morges. He took care of most things such as shopping and ensuring that our fit but frail mother took her medicine. I just happened to be visiting for dinner with my two children, when the incident happened. I was able to act immediately. While trying to help him breathe, I called the ambulance which came within six minutes.

The paramedics immediately took my brother to nearby Morges hospital. There, the emergency team established that he had suffered from a dissected or ruptured aorta. Normally, most such victims are dead on arrival. The emergency doctor pulled me aside. “He is in extremely serious condition. It doesn’t look good. We’re amazed that he is alive.”

Aware of Cliff’s schizophrenia, the doctor quietly asked me about his quality of life. I explained that as with many schizophrenics, Cliff, who had once aspired to become a surgeon and had gone to first year medical school, had his ups and downs. He was a loner. He was also paranoid about being tracked by the CIA and believed that mysterious people were spiking his food with heroin. At the same time, apart from helping my mother, he worked several times a week at a local market selling vegetables. Basically, he still had a good life ahead of him.

This seemed sufficient to the doctor. He immediately dispatched Cliff, who was in a coma, by helicopter to Lausanne’s CHUV, one of Europe’s leading university hospitals, and less than 15 kilometres further up the lake. That night, a lead surgical team undertook two major interventions in an effort to save his life. The next morning, a tired doctor called me on my cell phone to say that they had taken care of the aorta but that Cliff had suffered major internal bleeding. Some of his organs, notably his kidneys and liver, were in bad shape. There was also a strong possibility that he might be paraplegic – if he survived.

For the next three weeks, Cliff remained in CHUV’s intensive care unit 5. He was hooked up to dialysis for his failed kidneys, a breathing apparatus, and various other support mechanisms. We visited him at least once a day, sometimes twice. The doctors and nurses, a team representing different nationalities – Swiss, French, Irish, Iranian…- were always helpful and ready to answer questions. They also phoned with updates. At all times, they remained candidly clear that Cliff’s chances remained slim. All we could do was wait and see.

Nevertheless, their insistence to involve the family in what they were doing did much to assuage our own concerns. Not once was there any talk about medical cost or insurance. In Switzerland, everyone is obliged to have health coverage and if one cannot afford it, the state is there to help. No one is left out in the cold. My wife’s father, a heart and lung specialist in the United States, who remained in close touch about Cliff’s condition, repeatedly asked about how we were going to pay for this clearly high quality intensive care. He was stunned when we told him this was not one of worries.

It is precisely this aspect of working toward universal health care that brought some 1,200 inter national experts to Geneva in late May 2008 for the second Geneva Health Forum (www.genevahealthforum.org) . Speaking to a special journalism workshop organized by Media21 Global Journalism Network (www.media21geneva.org ) at the Forum, Uganda vice-president Gilbert Balibaseka Bukenya, himself a doctor, explained that this was the goal for his own country. What is needed, he stressed, is to ensure that all Ugandans earn incomes thus providing a tax base that could eventually sustain a national healthcare system available to all.

Turning to me, he said: “If someone in your family was sick in Switzerland, you’d have the best health care for them, wouldn’t you? This is what we want to have in Uganda, too.” I could only nod in agreement.

My brother continued to suffer from various complications. At one point, he suffered from sceptic shock, but pulled through. He eventually woke up and was able to talk a little, albeit sometimes no more than mouthing a few words. We even began to have some hope. But he was weak and could only move his face. His arms and legs lay motionless. We wondered about the future. How would live as a paraplegic, even a quadriplegic, on full-time dialysis? For my mother, too, there were problems. Possibly as a result of the stress, she was hospitalised for four days with a lung infection.

Shortly before the end of May,more than three weeks after his collapse, I stopped by CHUV to visit Cliff. He did not look good. As I talked with him, I was shudderingly reminded of all those faces of dying war or famine victims I had seen as a journalist covering conflicts or humanitarian crises in Somalia, Afghanistan, Ethiopia or Angola. Cliff had that same expression. Desperately pale with sunken face.

As I sat there reflecting on his life but also our lives together as boys brought up in different countries around the world, I glanced over to the partly-curtained off area next to him. A young African girl, perhaps no more than 12-years-old, also lay in intensive care. The father was sitting by her side, his face buried in his arms, silently weeping. A woman, possibly the girl’s mother, sat motionless next to him. On coming in, I had noticed a whole group of friends and family sitting or standing in vigil in the waiting room down the hall. I wondered whether the girl would survive.

I also thought how lucky she was to be in a Swiss hospital. It was doubtful that she would have such care in Africa, except in South Africa or the more sophisticated hospitals of Nairobi or Lagos perhaps. Yet another reason for societies to try to provide at least basic of health care for all no matter whether Africa, Asia or the United States.

As I prepared to leave, one of the doctors, a Swiss-German, took me aside. “We have done all we can,” he said. “His body can’t take much more.” He paused. “We have to see how far we should go to keep him alive.” It was the conversation that I had been dreading. The doctor noted that even if Cliff managed to pull through, we would have to be prepared for the fact that he might not have a life anymore.

At the same time, he also made it clear that they were prepared to go as far as possible. This was not a conversation about cost or available resources, or that the intensive care unit had already spent almost a month providing him round-the-clock support. Nor was this a matter of forcing us into a thumbs up or down situation determining whether one’s loved one lived or died. Rather it was rather matter of being realistic – and compassionate, to decide what was best for the patient.

The next day, the same doctor called me at two in the morning. There was another complication, he explained. They suspected air leaking into his intestines. It was a relatively simple exploratory procedure. However, there was also a slight chance that they would discover other complications. If they encountered an impossible situation, he warned me, they would close him up again.

Later that morning, my wife called the hospital. They had not done the operation yet as they were waiting for one of their top specialists to come in. The intervention was scheduled for two in the afternoon. At five o’clock, a nurse called me. They had operated, she explained, only to find that his intestinal cells, which had been denied critical oxygen during the immediate stages of Cliff’s aeortic rupture, were dead or dying. There was nothing more they could do. Without a functioning intestine, he could not live. We should come in as soon as possible.

That evening, my wife and I drove to the hospital from Geneva. Cliff was sedated but looked surprisingly serene and even healthy, as if just taking a nap. We sat down with the medical team. Cliff only had a few more hours to live, a day at best, they explained. It was time to stop the procedures as these would only be prolonging his misery. They had not switched back on the dialysis following the exploratory intervention. We should say our goodbyes.

We returned to the hospital that night with my mother and our two children. Our 14-year-old daughter wept and my son – just eight years old – alternated between brief sobbing and being fascinated by the whole surgical setup with its flashing lights, computers, and motorized humming. As for my mother, she sat there quietly, looking at her son, not quite understanding how all this could go so quickly, from a physically healthy human being to a dying one. Finally, my wife and I brought them home before returning to stay by Cliff’s side until the end as they switched off his final support. Bizarrely, I found myself thinking that this is what happens to prisoners on death row with lethal injections. One is waiting for them to expire.

Cliff finally passed away at 0155 the next morning, peacefully, and without pain. A death with dignity.

The purpose of this story is to show that while Europe – but also select other countries around the world, such as Australia and New Zealand, – have made it their responsibility to provide quality health care, it is a crucial component of any society that should be made available to every human being, no matter who. This is what caring human beings do.

For those who rant and rave about the need for health care to pay for itself, and to hell with those who can’t afford it, they should understand that we’re also looking at a matter of economic common sense. A healthy society is a productive society. Preventive medicine, too, including dental care, which most insurance companies still do not embrace, is far cheaper than reactive medicine. The provision of basic healthcare for all would probably save most governments – and businesses – tens of billions of dollars a year.

As Michael Moore points out in his film, the United States provides a state-supported postal service and schooling, so why not health care? So I find it very hard to understand why short-sighted politicians and lobbying groups cannot grasp the simple importance of basic health care. My mother, for example, has a nurse stop by the house every day to check on her and to ensure that she takes her medicine. This is all covered by basic health insurance. They also offer meals on wheels, which she refuses adamantly maintaining that she can cook perfectly well for herself. But, as one of the nurses pointed out, it is a lot cheaper to help people at home rather than have them go to hospital. Most people are also happier at home.

Most of all, however, is that those societies that provide basic health care for all show that they care about their citizens, regardless whether young or old, and regardless whether they live in Somalia, India or the United States. They’re all human beings. And they deserve dignity. One is not simply discarding them because they are no longer considered useful. This is what civilized society does.

Edward Girardet, a former foreign correspondent, is a writer and journalist based in the Lake Geneva region. He is also journalist advisor to the Media21 Global Journalism Network. This is taken from Girardet’s blog: A Coward in Kabul.