This I Believe

Philip - Galveston, Texas
Entered on September 6, 2006

This, I believe

Growing up in a highly populated country like India it was hard to understand how prolonging individuals’ lives by treatments like transplantation, cardiac surgery and cancer treatments could be of any use to society. In India less than 2% of the population have any kind of social security and for the most part medical care is funded by patients paying for it themselves out of their savings. It is not uncommon for a family to sell everything they possess to pay a medical bill for an aged parent, or a family member who may never return to economically productive life. It is easy in such a situation to be discouraged about the purpose of high-cost, hi-tech medical interventions. Ethical questions constantly hammer at the providors of curative medical treatments that seem to swallow up resources when the same amount of money that was spent on a single individual could be used to provide a low-cost preventive intervention (e.g. vaccination) that could potentially benefit thousands.

While working in this system for over 25 years, much of it as a transplant surgeon, I experienced the real power of medicine. A family would have to come together to save a patient’s life when he or she was diagnosed with end-stage organ failure. Several thousand rupees later, and after many sleepless nights for the family, the person would return home to a hero’s welcome. His successful battle with his illness, and the sacrificial support of various family members and friends would become the topic of conversation in the community. Families would huddle closer, differences would be forgotten, wasteful expenditure curtailed, and a citadel constructed for protection when hard times came. Thrift, loyalty, unity and deferred pleasure : these are the building blocks of economic strength. Heroes in the neighborhood, celebrating life; the shared experience of surviving danger and death; the knowledge that by coming together, and being energetic, resourceful, and by never giving up hope, people can save each other : these are the ingredients of high morale, adventure, entrepreneurship, and, finally…. wealth.

Physicians, nurses, emergency medical responders and the entire “establishment” of medicine have the opportunity to participate in this process, and catalyse it. It is a privilege and a rare opportunity to be an element in the process by which society rejuvenates itself and strengthens itself through victories in the never-ending battle with illness and injury. Strong societies recognize the importance of this activity, and the economic advantages, albeit circuitously obtained. Perhaps the first vivid example of how this works was provided by the recovery of Germany from the destruction of World War 1 during which the first nationally administered fund to pay for curative health care was developed, enabling every individual to access high quality medical care, irrespective of his ability to pay for the service. Soon after Word War 2 several countries put in place social security programs with portions of tax revenue dedicated to curative medical care provided via a network of public and private hospitals/providors. Countries which adopted socialist economic models chose to build and administer the hospitals where people could access “free” medical care, but time proved that the malaise of socialist inefficiency affected hospitals as much as other governmental agencies. Complete dependence on a government-run medical care system is now rare, and the privatization and corporatization of medical care is recognized as being compatible with good medicine.

Sadly in two of the most notable democracies in the world, the richest – America, and the most populous – India, large sections of the population are presently unable to access medical care. In America they are part of the “uninsured” minority. In India they are part of the majority known as the “poor socio-economic class”. These people are thought of as a problem, perhaps even an unsolveable problem. The opportunity they represent has been forgotten. The stories they have to tell are stories of neglect and rejection by an unfeeling society: negative stories that kill morale, and breed discontent, and failure. The stories that they can instead be telling – of victory in a battle of life and death – will never be told. I believe that both these democratic societies are poorer for this. I believe this unfortunate situation can be remedied through innovative and entrepreneurial approaches to the problem. Societies are a product of the stories they can tell.