Tuesday, July 6, 2010

Health for all?

I was pretty annoyed recently when I read of a statement by the Minister of Health that alcoholics should be denied treatment by the public health sector. That sanctimonious ... um... person...!!! Who is he to decide who gets treated and who gets denied? And then my second thoughts kicked in. I have been guilty of thinking the very same thing, not once but a hundred times, not just about alcoholics, but also of smokers and several others too.

It's hard to think charitable thoughts when an alcoholic is wheeled in as a "stat" admission, usually semi-conscious, vomiting blood, delirious and uncooperative. I confess I usually suppress a groan of despair at the sight of them... and with good reason. Almost invariably it results in a lot of running around, organising blood, plasma etc. etc. Especially at night where there is only one doctor and two nurses in a ward, this usually means that other patients might get neglected. Drugs and injections are not given on time, and other admissions are not seen to, because everyone is hovering around the alcoholic dude.

You see, the chronic alcoholics are LOUD. They are dramatic - swollen bellies, hallucinations, screams, blood and guts. They are critical - they may go into cardiac arrest at any time. And when (not if) they do, they are so obese, that it is near impossible for me to clamber on to their beds to deliver effective CPR. An additional thing I've noticed is that somehow, the relatives are the most demanding I've come across, the ones who are quick to make a fuss if things aren't done NOW.

And in the melee it is easy to miss the young dengue patient whose blood pressure has dropped, or the guy with the heart attack who has developed a rhythm disturbance of the heart, or the guy with leptospirosis whose urine output has dropped. When we do find out, it's because they too have progressed to a critical stage, when it could have been nipped in the bud. And that's not fair.

Then there is the expense. It's ironic that the patients with chronic lung disease due to smoking and chronic liver disease due to boozing cost the state more that the innocent johnny on the next bed who has done nothing to deserve his illness. Spiral CT scans, high resolution CT scans, ultra-sound scans, endoscopy, radiographically guided biopsies, inhalers, drugs, blood and blood products. Factor in the cost of hospital stay, meals, linen etc., which are also borne by the state. And then the health care sector runs through its allocated budget, and it is the other poor patients that bear the brunt of it. That's not fair.

You have to admit that the diseases are distressing, painful and associated with the hopelessness of knowing there is no cure. Yet because of the whole psychology behind short term rewards vs. long time penalties, very few cut down on their consumption, despite begging and pleading by the mothers, wives and children, and despite dark predictions by their doctors. I strongly believe that addicts must take responsibility for their actions, but there's always that niggling knowledge that for a person who is physically/psychologically addicted to something, the choice to stop is that much harder.

And this is where I blame the people in charge - officials who issue liquor licenses, politicians who extol the revenue brought in by taxing alcohol and tobacco but who are too short sighted to see the costs of a diseased society. I blame policemen who consort with brewers of moonshine in exchange for bribes, and officials who exploit legal loopholes. It has been scientifically proven that increase in taxation and ban of advertising and ban of public consumption are effective measures in controlling tobacco and alcohol. And yet we have this. No perfumes or jewelery; no watches, electronic gadgets or chocolates. Just tobacco and alcohol, sold duty free... thithata matha.

I am no saint. Even though I have never spoken it out for a patient or relative to hear, I have often thought viciously to myself "yes, go ahead, drink all you want, just die at home instead of landing in the small hours of the morning and ruining my sleep" (remember in SL, we don't get the following day off after a rough night on-call). To deny those thoughts is to be dishonest and blind to my own failings.

In spite of all that, we should never lose sight of the fact that we are dealing with human beings. That denying healthcare to anyone - whatever their failings may be - is unethical, unacceptable and a betrayal of the compassion we all need to cultivate within ourselves.


PseudoRandom said...

Brilliant post, Angel!

I find myself thinking the same things whenever I see someone smoking, or see someone wandering around in a drunken stupor. Regarding the extra cost of treating addiction-related conditions, there is an argument that the taxes on alcohol and tobacco do go into the treasury, which in turn provides the funds for the health service...but with regards to your other points, there's no argument whatsoever.

Over here, it's a similar problem. Especially considering that this is a student town. With binge drinking being the norm amongst the under 25s, a lot of young people get injured in fights or falls, or pass out. The ambulance crews have got so fed up of being called out 'cos someone's puked on the side of the road that now they refuse to come to town on club nights. The crews that do go out, often get assaulted by the very people they're trying to treat!

I don't think the people in charge can do much tbh. Everything's strict here, but the problem is huge. They've tried taxation, education, punishment...nothing seems to work. In my opinion, these people will continue to be a liability for the health service and the state until the drinking/smoking culture is changed. I can't say much about the patients you treat, but speaking about the people I've encountered...I think if binge drinking and smoking became less fashionable, we'd all be better off. But hey what do I know, I'm just a goody-two-shoes who doesn't drink or smoke ;-)

Chavie said...

Letting them drink and fall sick and then telling them that the journey is over is not the opinion, as you've pointed out. Our anti-alcohol measures are very weak and this looks like one of those ill thought-out quick fixes to reduce healthcare expenditure, and not a proper plan to defeat alcoholism.

Good post Angel.

Sach said...

Angel, I think no amount of taxation, advertising prohibition is going to fix the problem. At least no in Sri Lanka.

You see, it is the attitude that needs a change I believe. People in many other countries have their drinks socially, just one shot or two. We, on the other hand, just need to see the bottle off in a session if we sit down to drink. We drink just for the sake of it. That is where the problem is.

Dee said...

I think we need to pinch the bud. Its safe to say EVERY Sri Lankan family should have a alcoholic in it. The black sheep. The guy (sexist no?) who is a 'heavy drinker' 'party animal' 'the one who brawls at the family wedding'...

I'm not saying only a close relative, but someone somewhere in the perimeter.

We have no alcoholics anonymous, no self-help methods...people don't take anything seriously or as a medical condition. Imagine the number with OCD, bipolar...you name it. Those people are just 'funny'..or 'eccentric'...not 'treatable' ..because treatable sounds like angoda.

cj said...

I too shuddered when the Minister made that statement but then i think he is an idiot and no one really cares about what he is saying. I personally thought that being addicted to alcohol was a disease quite similar to food addiction and the disease we get as a result of it. I feel the government needs to take a positive stand either they should make tobacco and booze illegal just like heroin or pot or they should not tax it as much. Of course I could be biased because I drink and smoke in moderation I might add. I must also say that some of the stuff you mentioned in your post gave me a completely new outlook to the way I see this situation. Thank you for an insightful article.

Azrael said...

A thoughtful post.

As Sach pointed out, our people have this notion that if you open a bottle, it has to be finished. it's like they failed if they don't finish it off.

The best is to promote organizations like AA and get people help.

Increasing the price of the product is not the solution. The only ones who will reduce the consumption are the social drinkers. Addicts will find away to get their fix no matter what the price of it. This is one reason for the increase in the crime rate.

Me-shak said...

Great post. It is definitely not the solution, and he is a ass to speak like that in parliament. Thanks for sharing.


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Knatolee said...

This debate comes up here (Canada) every so often, since we have publicly-funded healthcare. I share some of your frustrations and I am sure I would be even MORE frustrated were I doctor serving these people!

That said, both my parents manage to smoke themselves to death, but I was glad that they received healthcare that prolonged their lives. Despite their numerous flaws, I loved them both (and I have never smoked!) So maybe you can feel a bit better about it if you think of the people who love these self-destructive patients, and how it comforts them that you are helping. :)

It does become a slippery slope as to where you draw the line. If people eat junk food, for example, and have health consequences as a result, do you not treat them? I think you are right to blame the people in charge! Tobacco and alcohol are heavily taxed here, but they are legal of course and the government is making lots of money off those taxes.

Another great post, Angel!!

Angel said...

I understand the angst of the EMTs when facing drunk students! it's not a pretty picture at all. the argument that funds from taxes help fatten the treasurery is kinda void because the cost to treat serious medical conditions far exceeds the income!

Chavie : thanks... I think that's part of the problem.. looking for "quick fixes"

Sach : where do we start changing attitudes? This whole "drink and be merry for tomorrow we die" concept is the pits!

Dee, Azreal : I'm sure you're right... we have so many heavy and problem drinkers here... and as you pointed out, very minimal social support for them to fall back on. What we need is measures that are tailor made for SL. Can you imagine someone saying "my name is Kandeappu, and I'm an alcoholic"? :)

Me-shak, Joven: thanks

Knatolee : thanks so much for giving insight to the perspectives of the loved ones. it's a slippery slope indeed! On bad days i feel like including people with diabetes, high BP, kidney disease, obesity, heat disease etc. etc. whose irresponsible lifestyl;es have caused all the suffering!

Jack Point said...

banning alcohol never works. Just think of Chicago under prohibition - it gave rise to Al Capone amongst other things.

Alcoholism is, (I think) a disease. I don't know if alcohol is addictive, like nicotine.

Angel said...

JP : alcohol is addictive both physically and psychologically. Nicotine is almost exclusively a psychological addiction.