Published October 20, 2009
A woman was being carried down the road in a bed.
I have encountered some strange things in South Sudan—seen malnourished children; nearly stepped on a large opalescent snake—but nothing more compelling than this.
What impressed me as I struggled to catch up was the speed at which the four men carrying the women were moving, each supporting a leg of a bed constructed of rough-cut wood and a lattice of rope.
The little procession walked with fierce determination, despite the sweltering heat and the mud. The rains had turned the red clay into a sea of braided puddles.
Finally I did catch up, but only because they stopped at what turned out to be their destination. Adang Ater lived in an outlying village, I learned. Her husband and members of her extended family had carried her like that for two hours to get to a clinic here in Akon, a county seat in this impoverished region, that consisted of a large shade tree and a meager stash of medicines.
Ater was gaunt and feverish, suffering from abdominal pains. She told her story in Dinka and someone translated. She'd gone into labor, and after two days of contractions the traditional midwife had determined the birth canal was too narrow and had cut the baby up and withdrawn the pieces.
They looked to me hopefully. Lacking any medical training, I felt helpless. But I sent for my Dinka colleague, Chris Koor Garang, a "Lost Boy" who had become a U.S. citizen and a certified nurse. He'd brought medicines with him and gave Ater an oral antibiotic and instructions for taking the remaining doses.
This was her seventh pregnancy; all but one had ended badly. The anti-diarrheal medications and routine vaccinations that save infant lives, along with birth control options that we take for granted, were not available to her.
South Sudan, torn by decades of colonialism and decades of war, has one of the highest infant mortality rates in the world. No reliable data exists, but Sudan's Minister of Health, whom I interviewed later, estimated infant mortality at somewhere between 40 and 70 percent. Sudan's maternal mortality rate is also among the world's highest.
Miraculously, Ater lived.
Across an ocean, another failed system
Now fast-forward two years, to March of this year. I was visiting my son in Vermont—which was fortunate, because when I experienced stomach pain and nausea, I could get to a local emergency room and then be taken by ambulance to one of New England's top-notch hospitals. There I underwent emergency removal of eighteen inches of small intestine that had become twisted and gangrenous.
I was lucky. Had I been traveling in South Sudan, we might have assumed I had some parasite. I never would have made it to an airport for transport to Nairobi in time for surgery. I wouldn't be alive to write these words.
As I lay in an intensive care unit in southern New Hampshire—emerging from a five-day medically induced coma and attended by a bevy of surgeons, anesthesiologists, pulmonologists, radiologists, and nurses—I experienced a string of hallucinations. When my mind was finally clear, one image kept surfacing.
It was Adang Ater being carried down the road in the bed.
We were fortunate, each in our own way. She had become for me an emblem of survival.
My point in recounting these two stories is not to contrast a failed or non-existent healthcare delivery system with a successful one. On the contrary, that woman and I both represent failed systems. They've simply failed in different ways—one from poverty, the other from profits.
My own treatment was commodified, under the dictates of U.S. hyper-capitalism, to an extent that comparable treatment under socialized medicine is not. The total price for my surgery and related expenses came to $144,000, or $8,000 dollars per inch of intestine removed.
Fortunately my expenses were covered under Medicare, and supplemented by the excellent private healthcare insurance my wife gets as a retired professor. Our private plan is almost as good as that enjoyed by members of Congress. I was out hardly a dime.
My son in Vermont, in contrast, has no such coverage. He works as a chef in a small restaurant and is one of the estimated 47 million currently uninsured Americans. Like most, he's in debt. Too young for Medicare, and struggling to make ends meet, he lost his private healthcare coverage last June by failing to make a monthly payment on time.
In search of a collective conscience
Other Americans are denied coverage by private insurers because they are sick. Still others have coverage tied to their employment, marital status, parents or tuition payments. And finally, others are too poor to do more than put food on the table.
In other words, it's a completely insane system that makes sense only to those who reap profits from it. Is this any less bizarre than that woman being carried down the road to a clinic that barely exists?
In short, it seems that we in the U.S. have shaped our technology, or allowed it to shape us, into a system that is less humane than one ravaged by colonialism and war.
This is why a "public option" is the linchpin in any real healthcare reform. It offers an alternative for the uninsured, while serving as a yardstick to measure the performance of a private healthcare industry notorious for its greed and runaway costs.
Of course it's the public option that Republicans and conservative Democrats want to strip from any reform package. Senator Charles Grassley (R-Iowa) argues that a government-run plan "will ultimately force private insurers out of business," and that its supporters are "trying to open a back door toward a fully government-run, or single-payer, health system like those in Canada or England."
Even as polls indicate that most Americans favor a public option, the Senate shows itself a rich man's club whose members are all too indebted to the healthcare industry.
Two statistics are often quoted by President Obama to make the case for healthcare reform. One is that Americans pay one and a half times as much as citizens of other industrial nations, and have a lower life expectancy. The other is that our spending on healthcare accounts for one sixth of the U.S. economy.
However, neither statistic adequately reflects what we do not spend individually because we can't afford it – the inequity that translates into life or death for millions of Americans who, like my son, might not feel they had the luxury of going to the hospital.
The image of Ater being carried down the road in such a determined fashion, despite the mud and heat, has taken on special meaning for me in the context of the present healthcare reform debate. It was the urgency that surrounded her.
We could learn from that. We who may thoughtlessly assume that our own system is somehow more "civilized"—simply because our resources are more abundant and our technology more sophisticated—need to rediscover our collective conscience and understand that access to healthcare is a human right.