Notes from underground

يارب يسوع المسيح ابن اللّه الحيّ إرحمني أنا الخاطئ

Archive for the tag “healthcare”

Life Esidemeni — the elephant in the room

For the past few months a lot of news coverage has been given to the deaths of mental patients removed from Life Esidemini facilities to those of unlicensed ?NGOs. Questions have been asked about why they were moved without adequate preparation, and who decided that they should be moved, and who selected the places they should be moved to. I have no comments top make on that, and I’m sure answers will eventually emerge from the current investigations.

What concerns me now are the questions that are apparently not being asked. Such as:

  1. What is Life Esidemeni?
  2. Who decided that they should be in Life Esidemeni in the first place?
  3. What policies lay behind that?

I suspect that the policies that lay behind it were related to neoliberal principles of privatisation and outsourcing.

The Department of Health outsourced the care of mental patients to Life Esidemeni, which was under contract. This proved too expensive, so they decided to look for cheaper alternatives.

The trouble with outsourcing such things is that providing such facilities costs a great deal of money, and people who tender for such a contract are not likely to do so if it is likely to be put out for tender again in a few years. To make life secure for mental patients, the Department of Health should provide its own facilities, or should at least own the land and building on which the facilities are locates, so that if they put it out to tender again they can at least disturb the life of patients as little as possible. If the contract proves too expensive, then there would be no need to move the patients.

It’s not enough to investigate this particular incident, but the policies that lie behind it also need to be scrutinised.

Flu vacccines and snake oil

Almost every year my medical aid sends out a circular to its members, urging them to get vaccinated against influenzs, and saying that they will pay for it. And the letter they send usually warns of the dire consequences of not being vaccinated, and the complications that can ensue from influenza.

flu-shotAnd every year I ignore their advice, because I believe it is unnecessary. Yes, I know that they will pay for it, and so it will cost me nothing but the effort of going to the doctor or the chemist to get vaccinated. But I believe that the main purpose of medical aids is to help with medical expenses in the case of serious illness or injury, and that wasting money on things that I regard as trivial, like flu vaccines, mean that contributions will have to go up, or benefits will go down. So I ignore it.

Influenza is something that comes around every year, and I suspect that one of the reasons for that is that the virus that causes it mutates, so any immunity you have from last year isn’t much good for nezt year’s variety. And in my experience, most times it can be sorted out by two days of bed rest and a couple of boxes of tissues. An aspririn to two can help with headaches, and Vitamin C seems to help, if only as a placebo.

influenzaOf course two days in bed usually means two days off work, and that means lost productivity, and as employers provide substantial funding for most medical aid schemes, it is in their interest to urge people to get vaccinated to avoid the time lost. But if immunity to last year’s flu doesn’t count this year, then vaccines made for last year’s flu won’t count for much this year either. And my experience has been that if I have flu once this season, I’m unlikely to have it again. So the most effective vaccine for flu is flu. Unless, of course, you suffer from something like Aids, which weakens the immune system; in that case it is probably safer to be vaccinated against everything.

I’ve had no scientific basis for ignoring the blandishments to be vaccinated against flu, just my own experience and reasonings. But now there comes this article, which seems to support wehat I’ve long thought: Johns Hopkins Scientist Reveals Shocking Report on Flu Vaccines

A Johns Hopkins scientist has issued a blistering report on influenza vaccines in the British Medical Journal (BMJ). Peter Doshi, Ph.D., charges that although the vaccines are being pushed on the public in unprecedented numbers, they are less effective and cause more side effects than alleged by the Centers for Disease Control and Prevention (CDC). Further, says Doshi, the studies that underlie the CDC’s policy of encouraging most people to get a yearly flu shot are often low quality studies that do not substantiate the official claims.

So it seems that my reluctance to support big pharma is not so crazy after all. Of course influenza can lead to complications like bronchitis or pneumonia, but I also suspect that it is most likely to do so if you skip the two days of bed rest and try to carry on with n0rmal activities. So by all means have the vaccination if you can’t afford to take the two days off work, or if you are planning to travel to America, where they might mistake the symptoms for Ebola.

But generally I think medical aid schemes can find better things to spend their money on.

They can also find worse things to spend their money on.

The medical aid I belong to, Bestmed, retains some vestiges of its socialist origins, and therefore tends to consult its members about some things (we are memberts, not customers, you see). One thing they consulted us on was whether we wanted to participate in one of those “loyalty” programmes, which give you points to save up for this or that benefit, or discounts at various shops you never frequent and on products you would never dream of buying. I gather most members said that they’d rather pay lower subscriptions or get more medical benefits than such frippery, because no more was heard of it. But capitalist medical schemes, which have “customers” rather than members, and are accountable to their shareholders rather than to their customers, embark on such things without asking the people who ultimately have to pay for them.

So there are definitely things worse than flu vaccines, but I still don’t want one.

Pro-choice and pro-life

At first sight, the use of the terms “pro-choice” and “pro-life” to represent opposing ethical viewpoints seems a little strange. Are “choice” and “life” necessarily opposed to each other?

When they first came into general use I assumed (on no evidence) that people settled on those terms in order to avoid negative stereotyping in debate. Saying someone is “anti-” something sounds so negative, and it is generally better to say what one was for rather than what one was against.

The illogicality of the implication that “choice” and “life” were antithetical was regarded as the price one had to pay to avoid negative stereotyping.

Or at least so I assumed thirty years ago when “pro-choice” and “pro-life” first began to be bandied about in public debate.

But now I am not so sure.

It seems from recent debates that they really are antithetical. There’s this US Senator Ron Paul. I know nothing about him except that American libertarians (or at least those American libertarians whose blogs I sometimes read) seem to like him.

Now if there is one thing that seems to characterise American libertarians, it is that they are pro-choice. They seem to elevate choice to a supreme value. The essential freedom is the freedom to make choices (provided, of course, that you are rich — but that is an unspoken condition).

And in a recent TV debate, it seems that “pro-choice” and “pro-life” are indeed antithetical. GOP Tea Party Debate: Audience Cheers, Says Society Should Let Uninsured Patient Die:

“What do you tell a guy who is sick, goes into a coma and doesn’t have health insurance? Who pays for his coverage? Are you saying society should just let him die?” Wolf Blitzer asked.

“Yeah!” several members of the crowd yelled out.

Paul interjected to offer an explanation for how this was, more-or-less, the root choice of a free society. He added that communities and non-government institutions can fill the void that the public sector is currently playing.

This has led to an interesting discussion in the Progressive Orthodox Christianity forum on Facebook, where I first learnt about the incident.

And in that discussion I suggested that if Christians were to adopt the “let them die” attitude, then the story that Jesus told about the rich man and Lazarus (Luke 16:19-31) would have to be modified to the effect that the rich man, in Abraham’s bosom, seeing Lazarus burning in hell, would say to him “it’s all your fault — you didn’t have health insurance.”

I’ve written about that aspect of it in more detail in other blog posts, so I won’t repeat all that here.

But what I have discovered from this recent incident is that pro-choice and pro-life are indeed antithetical, and that “pro-choice” is mainly about the inalienable right of the rich and powerful to choose when those poorer and weaker than they are should die.

Rob Bell go to hell

It sounds like the kind of chant that could be used by street demonstrators and protesters, like “Turkish troops: out of Cyprus” — “Rob Bell: go to hell”. Lots of my Protestant blogging friends have been writing about the tizwoz in the blogosphere that has greeted the publication of a book on hell by a fellow called Rob Bell. Julie Clawson, it seems, was one of the few who had actually read the book before writing about it at Love Wins – A Review | onehandclapping:

Whether it was a brilliant marketing strategy or just a sad reflection of the charged atmosphere of Christian dialogue these days, one cannot deny that Rob Bell’s latest book Love Wins has stirred up a load of controversy before it has even hit the shelves. As a book claiming the daunting task of being “A Book about Heaven, Hell, and the Fate of Every Person Who Ever Lived,” the uproar was understandable although disappointingly cruel at times. For some reason many Christians hold to the notion that where we go when we die is the most important aspect of our faith and thus get rather up in arms when people even dare to open that topic up for conversation. Bell deftly addresses the need to re-prioritize what is central to our faith, but more on that in a moment. Let me first get the controversial stuff out of the way.

Tall Skinny Kiwi: Who has the skinny on hell? notes that “‘Farewell Rob Bell’ has probably become the most famous Christian tweet of all time”. Then there’s Stoking The Religious Fires With Rob Bell by Jonathan Brink. And so it goes.

I’m not going to add to the blog posts about the book because I haven’t read it, and on the subject of Hell I have little to say other that what I have already said in two other blog posts at Hell became afraid and Go to Hell! | Khanya.

So why am I writing this?

It is mainly because I went back to read those two previous posts as a result the flurry of posts about this book, and was struck by some of the comments on the second of them.

I had noted that in the New Testament when Jesus talks about going to hell he does so mainly in the context of wealth accumulation and redistribution. Specifically, he teaches that those who accumulate wealth and fail to redistribute it are going to hell (in the parables of the sheep and the goats at the last judgment, and the rich man and Lazarus). Yet this emphasis seems to be lacking in the blog posts of those who seem to be most upset by Rob Bell’s alleged threat to the doctrine of hell.

And a lot of the commenters on the post at Go to Hell! | Khanya seemed to be obssessed with a point that seem (to me at least) quite peripheral to the parables. For them the question of whether or not Lazarus got health care was unimportant. And whether he got it or didn’t get from the rich man or from the dogs was unimportant. The really important point was that it should not come from the government. This, it seems, is the first and greatest commandment, which supersedes the law, the prophets, the Fathers of the Church, and indeed the gospel itself.

They seemed to regard any use by “the government” of tax-funded resources to relieve suffering as the worst possible form of theft.

And that led me to thinking about the recent earthquakes in Japan and New Zealand. Various governments of various countries offered to send help, and many of the “search and rescue” teams looking for survivors were government funded. US president Barack Obama even offered the services of a US government-funded aircraft carrier that happened to be in the vicinity of Japan.

Some of those who have offered and provided help are NGOs, and therefore, one hopes, not stigmatised with the “theft” accusations in their effort to rescue and help survivors. Such, for example are Rescue SA to search for survivors – Times LIVE:

The South African search and rescue team that left for Japan last night will have the grim task of helping to search for survivors in the devastated town of Ishinomaki.

Half of the town, with a population of about 16500, was engulfed by the tsunami triggered by Friday’s earthquake. The town is 60km north of Sendai and 100km west of the quake’s epicentre.

I just hope they don’t use government funded helicopters in their work!

And then there is International Orthodox Christian Charities:

International Orthodox Christian Charities (IOCC) has been in contact with the Holy Autonomous Orthodox Church in Japan and our ACT Alliance partners to assess the emerging needs following the massive earthquake and tsunami which devastated north eastern Japan on March 11. IOCC is also reaching out to the Metropolis of Korea which is also the Exarchate for Japan under the Ecumenical Patriarchate. As the Orthodox Church in Japan works to assess the needs of survivors, it reports that one priest in Tohoku, Japan is missing.

‘Most of the church buildings in Tohoku parish along the Pacific coast are severely damaged and one priest is missing,’ reports Fr. Demitrios Tanaka of the Holy Autonomous Orthodox Church in Japan. ‘However, we confirmed that the clergy of Sendai Orthodox Church, including Bishop Seraphim, are safe.’

Universal health care tends to cut the abortion rate

Apparently some people in the USA are opposed to universal healthcare on the grounds that it will increase the abortion rate. It seems that they are operating on a faulty premiss.

T.R. Reid – Universal health care tends to cut the abortion rate – washingtonpost.com:

Increasing health-care coverage is one of the most powerful tools for reducing the number of abortions — a fact proved by years of experience in other industrialized nations. All the other advanced, free-market democracies provide health-care coverage for everybody. And all of them have lower rates of abortion than does the United States.

This is not a coincidence. There’s a direct connection between greater health coverage and lower abortion rates. To oppose expanded coverage in the name of restricting abortion gets things exactly backward. It’s like saying you won’t fix the broken furnace in a schoolhouse because you’re against pneumonia. Nonsense! Fixing the furnace will reduce the rate of pneumonia. In the same way, expanding health-care coverage will reduce the rate of abortion.

At least, that’s the lesson from every other rich democracy.

How healthy is your healthcare?

Healthcare seems to be a big issue in the American blogosphere at the moment. Normally I try to keep out of such debates, for the simple reason that I don’t know enough about the issues at stake. When the debate intruded into a newsgroup discussion on another topic, I had to ask what “single payer” meant — a term bandied about by Americans on the assumption that everyone knows what it means, but one which I had never heard of before. Don’t worry, someone has explained it to me now, but I’m not really interested. The manner in which healthcare is provided in the USA is something for the citizens of that country to decide. I’m not so much a disinterested spectator of the debate as an uninterested one.

Two things happened to weaken my resolution to stay out of the debate.

The first is that the debate seems to be largely ideological, and some proponents of ideologies have been propunding slogans based on ideological principles that they regard as universally applicable. One of these was the statement that “universal healthcare is theft”, which seems to me diametrically opposed to the basics of the Christian faith, and to have huge theological implications. Those who find theology too boring and abstruse will be glad to know that I’m not talking about that now, since I’ve blogged about that already at Health, disease, theology and politics: Khanya.

The second thing that made me think that this wasn’t a purely domestic matter for the USA was a rather vicious campaign among some in the USA about the British National Health Service (NHS), full of lies and innuendo. It certainly caused a reaction in the UK Twittersphere, with lots of tweets tagged #IlovetheNHS. Bishop Alan has responded at Bishop Alan’s Blog: How healthy is your healthcare?:

Stephanie’s birth as an undiagnosed extended breach in a strange hospital (she arrived early and unexpected on Christmas night) was supervised by one of the finest obstetricians in the world, who gave Lucy the choice, then delivered her faultlessly without a C-Section, using an old midwives’ routine called the Burns-Marshall technique. Both these ace bits of effective medical care were delivered with nary a credit card or insurance policy between them, and I would take a lot of persuading that the kind of medical system we use for Max the Cat would have served us any better.

We had a similar experience with the birth of our daughter. She was born in the provincial hospital in Utrecht, Natal. Shortly before she was born the cat had kittens, and because she had previously had obstetrical problems we took her to the vet. The kittens cost us four times what our daughter’s birth did.

But such anecdotes prove little or nothing. One can collect anecdotes of both good and bad treatment in any kind of hospital, whether private or public, commercial or non-profit. A lot depends on the ethics, skill and dedication of the staff, and that is often very much a matter of the luck of the draw.

I think healthcare in South Africa is something of a disaster. First because the apartheid policies of the previous government, which nationalised the non-profit church hospitals in the 1970s for ideological reasons, and there was an immediate very rapid decline in the standard of healthcare in the rural areas that had been served by those hospitals. The reasons are not hard to find. When the hospitals were run by Christian churches, they were able to recruit staff who saw healing as part of their Christian ministry. Young Christian doctors, newly qualified, saw this as an opportunity of Christian service. Highly qualified and experienced surgeons when they retired did the same. Well qualified nurses would go to serve in such hospitals with a similar motive, and try to pass on their dedication and enthusiasm to a new generation of student nurses.

When the government nationalised them, the former church hospitals were immediately taken out of the recruiting network of the international Christian conspiracy, and very often the only people the government could get to work there were medical students who had been conscripted for military service, and were sent to do their national service in rural hospitals.

Of course dedicated Christian healthcare professionals did not have to work in church hospitals, but church hospitals did have a better recruiting network for such people. Some years ago I visited the Orthodox seminary in Nairobi, Kenya, and there were two other people in the guest house. One was a young Ukrainian doctor who had come with a United Nations relief group to work in Rwanda after the genocide there. The other was a top Greek heart surgeon who had become a priest, and was spending a few weeks providing healthcare to the clergy in Kenya and their families, and helping out at clinics run by the church. The young Ukrainian had to pass exams to be licensed to practise in Kenya, and so was going through the stuff he had to learn with the priest, which shared his knowledge, and I heard the more experienced one catechising the younger one after dinner in the evenings.

But whether in Kenya or South Africa, very few commercial healthcare providers are going to establish a practice in the poorest rural areas. Anyone who puts the commercial model forward as the ideal and universal one might be following the best free-market economic principles, but for Christians that comes up against the parable of the rich man and Lazarus.

Update
There is now a stnchroblog on this topic, with various Christians writing on it: Square No More: Synchroblog on a Christian Response to Healthcare

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