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Health Care and the profit motive

ETHICS Healthcare

Health Care and the profit motive

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NHIF Should Patients be thrown out of hospitals

The weather is extraordinarily cold this season, sending my way an unending list of very sick children; pneumonia, asthma, colds, ear infections et cetera. The children’s ward is crowded, holding at least triple its capacity. There are urgent cases needing review. I am at the far end of the ward working to relieve this young girl with a severe asthmatic attack. Suddenly, I hear some commotion at the entrance; someone’s shouting, calling for a doctor. I can’t leave this girl: Someone who can’t breathe is an emergency unlike any other. I stay on my task as the commotion escalates on the other end. Then I hear fast footsteps approaching. Someone pulls me by the coat.
“It’s serious, it’s serious. Hurry up.” It’s the nurse, an elderly lady who has worked in hospital wards longer than I have been alive. I have no choice.
“Then you have to take over here,” I say, yielding.
“Sure, sure!” She takes over.
I hasten towards the agitated crowd. The commotion settles as a path is made for me, leading to a sobering sight in their midst. On rickety stretchers lie a boy and a girl; fluids are running into their veins at a fast rate; poorly fitting oxygen masks struggle to deliver the life-saving gas. I assess the situation, check their vital signs, and adjust the flow rates of the normal saline and oxygen to coincide with the clinical condition. The heart rate for both is shockingly high; their pupils are fully dilated. It must be some form of poisoning, I deduce, and possibly…just possibly, a case of overenthusiastic antidote administration. The prospect of antidote poisoning in seven and five-year-olds sends chills down my spine.
“Is this just normal saline or was something added to it?” I ask, pointing at the drip.
“They added atropine.” Someone says. Someone who must know atropine. My jaw drops. I stop the drips immediately and ask that the children be transferred to the beds nearest the nursing station! I know I have a very serious problem to deal with.
This sad situation is only the visible tip of a multilayered narrative of untold human suffering, social isolation, and our unbelievably avaricious healthcare system.
This visible end started about 24 hours ago when a mother with severe depression decided to end her misery through that most permanent of ways. She wouldn’t leave the children suffering behind — the final maternal act to end the life of a child whose suffering you cannot resolve. The poison worked for her but succeeded only in worsening the situation of her children. The rescuers of the children rushed them to the nearest hospital, which happened to be a private hospital. Under such desperate circumstances, a hospital should be just a hospital, not private or public, and should be what a hospital is meant to be; an institution where lives are saved. Everyone would go by that assumption when faced with the risk of losing someone’s lives. That would seem even more justifiable when those lives on the line are children who had just been orphaned. Such an emergency would appeal to the hearts of anyone.
What an assumption they had made!
That hospital slapped them with a fee deposit precondition. That they were trying to save the lives of two orphaned children didn’t matter. There was a wall they would have to scale—an impossible one. They left, then hopped from one city hospital to another trying to find one that could save the children. All had one demand; pre-admission deposit. A lot of money. Without that nothing can be done—even for orphaned, dying children!
After a frustrating night, they learnt that an aunt of the children worked at a county hospital at least two hours away. They set off, hastily. They were forced to make several detours into health centers as conditions got worse. Where they were lucky to find a health worker, an antidote of some variety would be administered to the poor children before they were sent on their way, with the advice to get to the “aunt’s’ hospital” fast because it is a big one. The “aunt’s hospital” was where, at the time they arrived, I had some 45 children in the ward, several others waiting to be booked in, and the little girl with an asthmatic attack.
And there I was. A seven-year-old and his five-year-old sister lay in front of me, their bodies ravaged first by the poison (which had killed the only person who knew what it was), then by the mixture of unnecessary and dangerous antidotes. One particular antidote had been administered generously at every stop they made; atropine. You don’t overdose that. It is supposed to be administered in vanishingly small amounts, and its effect on the body monitored closely. Just a little over the correct amount could turn one’s physiology into a kinetic mess. I had to deal with a lot more of it. The initial poison no longer mattered. Our life-saving antidote was the poison I needed to deal with. I called every specialist I could find; pediatricians, pharmacists, anaesthesiologists—all of them: What should I do? Nothing, they all said. The antidote for this antidote is not even stocked in our hospitals because no one imagines we would be overdosing patients with a dangerous antidote that then needs a very potent, expensive, and highly regulated antidote. Only one thing remained, pump more fluids into them, dilute the problem and hope the kidneys are in good enough shape to flush it out!
These were children who would have been treated in the very first hospital, saving their lives and avoiding the mess that I was now dealing with. There is something about a child that calls out the best in us. Something about a dying human being and especially a child which compels us to action. That something, intangible and indescribable, is how you know you are human.
But avarice had trumped that. Perhaps I am just naive to expect that it shouldn’t.
Slowly, painfully slowly, their fragile systems returned to normal. It took days, of which the first involved checking their heart rate, breathing rate, pupils, and other vital signs several times an hour. It’s an involving task, but eventually, they pull out of it. They were extraordinarily lucky; to survive a poison that killed their mother, then the many hours hopping from hospital to hospital, and finally the deadly overdose. I couldn’t help wondering why they had had to go through all that. Why had their lives depended on luck? How many other children hadn’t been as lucky?
As their pupils contracted and the eyesight improved, they would come to my table, snatch my pen and start writing—the alphabet, the numerals, their names. I was amazed by their innocence. I could see myself in them, less than two decades earlier. They had potential, dreams, aspirations. Their lives were already shattered by the loss of a mother. I hoped they would overcome that loss as they grew. But I knew there was something they could never overcome. Something much more far-reaching. Something that may not let them grow to achieve their dreams and fulfill their aspirations.
Avarice.
When a society has something, anything, more important than the lives of its children; when it perceives them as an impediment to the profit motive, what else has it to lose? Does it even qualify to be called a society? Duty to our children is above everything else, even self-preservation. To lose that is to descend to a low from which we cannot lift ourselves. How shall we overcome this stranglehold of the profit motive in healthcare to pave the way for universal health coverage? How can we give up a culture so deeply entrenched; one that now defines us?
This is hard to overcome — those who fully inhabit that realm of profit cannot easily give it up. If the universal healthcare we are talking about is what it is meant to be, then it is a frontal assault on the profiteers’ turf; a threat to an avaricious tribe. The mention of universal health coverage must be ominous to them. It threatens to collapse a system they have carefully built and meticulously refined to get the most out of pain, suffering, desperation. The profiteers will fight back. They will fight long and hard. A system that can send away dying children because there’s no money isn’t one who cares much for the humanistic thrust of universal health coverage.
Who are these people? Who are they, so greedy that they don’t care a thing for our children, for human life?
They are us.

To many, disease brings misery and death. To others it is good business. It is the way to riches, power and influence. Who’d give that up?

The profiteers are you and me! You and I are the ones who have built a private healthcare system and a culture designed to benefit out of human misery. We collectively created the circumstances for its establishment. We all sustain it. We have all contributed to its astonishing success and predominance over everything healthcare is about; dominance even over logic and morality. It is unapologetic enough to demand pre-admission deposit for dying children. It has so overruled human sense that planeloads of suffering Kenyans fly to India because “it is more affordable there”! More affordable than home? By suggesting UHC, we are declaring a war of us against them.
The profit healthcare system is a broad system including hospitals, private insurance companies, the pharma, and the government that allows them to operate and smiles when taxes come in. It is such a complex maze of interests that getting through it will be an achievement in itself. Hospitals are just the most visible players. Without the high charges in private hospitals, insurance premiums would be lower. Without the exorbitant prices of drugs at these hospitals, the profits for the pharma would plummet. Without those exorbitant fees, the investors who every year wait for a better profit margin and dividends—wrung out of the misery of fellow man—would be unhappy. Doctors like it because, without the high fees set by the big private hospitals, it would be impossible to charge the high consultation fees in even the tiniest street corner clinic. It wouldn’t be necessary for doctors to abscond work in public hospitals to earn money in their private practice, leaving the poor taxpayer in the public hospitals unattended. The proliferation of private clinics, including quacks, wouldn’t exist. With this wide web of conspiracy against life, it is likely we are all in too deep.
The profit motive has driven this country to a profiteering frenzy that will be difficult to deal with. We all sustain this system by allowing deliberate destruction of the public healthcare system so that millions of Kenyans must choose between death in a dysfunctional public hospital or sell everything they own and call for fundraisers to be treated in a private hospital, or perhaps fly to India or wherever to save their lives. To most, to millions, there is no recourse; death comes fast, mercifully fast. It’s impossible, given the aforesaid, for us to overcome this profit addiction without very serious resistance. The resistance of remodeling ourselves. UHC is a promise that must fail. We shall kill it, just as we have no scruples about killing our children.

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