The cost of health

a few days after i got out of makati med, i met berna, one of my former neighbors, on the street outside the sts. peter & paul church. she was one of the squatters along kalayaan ave, who were relocated 8 months ago to bulacan. she was back in makati because this was where she could earn a living for her mother, her nephews and nieces, and herself. she used to sell balut outside the nearby mini-stop store and earned about 50 centavos from each balut sold. she lost her job with the balut supplier because of their relocation. today, she's watching the cars of mass-goers or of those who eat in one of the restaurants nearby. she gets p2 - p10 per car; p20, if the car owner is the generous sort.

as cris and i got into the car, berna came over and asked about my condition. she said she had heard that i had an operation, and that her mother was in the charity ward of makati med at about the same time. someone told them i was on the 6th floor and she would have wanted to visit me, but she was too shy to dare (nahihiya siya). i guess when you're that poor, you figure you belong in the charity ward of the hospital, and you don't dare venture anywhere else, especially not in makati med.

i thought it was nice of them to spare me a thought when they had problems of their own. i wondered how the poor could afford their medical treatments. the makati government-issued yellow cards allowed them a free hospital bed and free consultations with the doctors or rather with the interns, but they still had to pay for medicines, medical tests, and procedures. i thought about the costs of my own ct and bone scans, and my operation. just the cost of my medicines alone would easily feed any neighbor of mine, with 5 or 6 family members, for 3 or 4 months. a ct scan of the abdomen with contrast worth about p32,000, would feed them comfortably for at least a month.

what would they do if they needed a ct scan, or an mri, or even a simple ultra-sound? what if they needed as much medication as i did? before my operation, i was able to keep the pain at bay with twice a day dosage of pain-killers. my intravenously administered antibiotics prevented infection. without them, i might not have made it to the operating table.

i suppose the poor just have to stand the pain the best they can. or take the cheaper drugs that don't have as much effect as the more expensive pain-killers. alaxan instead of dolcet? ponstan instead of morphine? how about a gram of shabu to just forget everything for half a day or so?

getting shabu isn't so far-fetched because these people live cheek-by-jowl with each other, including their friendly neighborhood drug dealers. if they need shabu or grass, they could probably get it on credit, as long as payment is forthcoming. it is a business after all.

it's bad enough to have to scrounge the garbage cans for a living, but to get sick without having the money to buy your medicines, must make you feel as if you were already in hell, suffering for sins you didn't know you committed, other than simply being born poor.

i remember jaime, one of my neighbors. he was a sepulturero, a gravedigger, in the nearby public cemetery. he made money only when someone had to be buried, or when nov 1 was nearing, and people would pay him to clean the tombs of their family members. no burial or cleaning job, no earnings. no earnings, no food.

jaime and his wife had 5 children, 2 of whom they raised on their own; 3 were effectively adopted by his in-laws. they all lived in a shanty on the sidewalk of our street, scarcely 2m x 3m, made of scavenged cardboard boxes, GI sheets, and tarpaulin. how did they fit in at night to sleep? well, definitely, not all at once. some would have to sleep outside, and the rest huddled together inside like sardines in a small can. on rainy nights, those outside would have to look for shelter elsewhere, and hope they would be able to get some sleep, for they had to work hard again the next day.

jaime's wife, about 15 years younger than he was, had suffered a stroke in her childhood that left her speech-impaired, and unable to completely control her limbs. yet, if you looked beyond her condition of poverty and ill health, you could see that she would have been pretty in her youth. her name is ellen, but because her head shakes from the effort of having to speak, she is called 'iling', a pilipino word that roughly translates to 'head shaker'.

iling augmented the family income by pushing a wooden cart and scrounging for paper, cardboard boxes, plastic bottles, and that prize find of scavengers, pieces of metal. she would start out every morning at about 3 or 4 in the morning, and be back home after 3 or 4 hours, usually travelling 15 – 20 blocks. when she got home, she and her children, starting when they were 4 years old; her husband, if he didn't have a job that day; and her mother and father (who was also a sepulturero), would sort out their loot, to be sold in various junk yards.

there are the used paper buyers, the iron and metal junk shops, and the plastic and soda pop bottle purchasers. their take would feed them for that day. if they got lucky enough to find enough iron pieces, they might even have some meat to go with their rice, instead of the usual vegetables, and bagoong, or tuyo.

one day, iling's husband suddenly fell ill. with his yellow card, he was admitted to ospital ng makati, which was then still situated along jupiter st. the first time i visited him. he was thin and he looked bedraggled, but then that was the way he always looked; 6 feet tall, dark, made darker from working under the sun, reed-thin, with lank, stringy, shoulder-length hair. he looked scary, like a drug addict desperately in need of a fix. if you saw him on the street, you'd stay well clear of him.

he smiled broadly when he saw me, pleased that i would deign visit him in the hospital. iling said that jaime had been suffering from severe stomach pains for the past few days. it wasn't hunger, he'd been eating well. appendicitis was ruled out by the interns or doctors, tho they really couldn't say what the problem was. the pain was getting worse, and jaime was getting weaker and noticeably thinner everyday. i tried speaking to the doctors, but they couldn't tell me anything other than what i heard from iling.

i visited a second time. this time, jaime's smile wasn't as broad nor as brave-looking as he would have wanted it to be. he was still in pain; the doctors still couldn't tell what was wrong with him. they couldn't seem to do anything other than give him ineffective pain-killers.

the last time i went to see jaime, i brought him a priest for the anointing with oil. he was basically unconscious. this time, even iling wasn't smiling her usual bright and ready smile. she was visibly subdued and sad. i myself could only manage a weak smile and a consoling hand on her shoulder. the next day, late in the afternoon, iling's mother told me jaime had passed away.

now, thinking back, i wonder if, having access to the proper tests and procedures – ultrasound, ct scan, mri, whatever – would the doctors have been able to identify what he was really sick of? if he had access to better educated, more experienced doctors, would he have lived awhile longer?

i would believe so, because knowing what you're sick of, opens venues to getting well. but these high-tech machine-dependent examinations are expensive, way beyond the reach of ordinary mortals.

beyond the cost of the examinations and consultations with medical specialists, are the costly treatments and medications. even if a person gets properly diagnosed, how would he be able to afford the treatments and the medications? would it be better after all if they remained ignorant of their health problems, and totally unaware that treatments exist, just beyond their reach?

i wonder what percentage of deaths among the marginalized members of our society is due to undiagnosed illnesses? 'marginalized' is truly an appropriate word for them. marginalized from safe shelter at birth. marginalized from proper nutrition in their infancy. marginalized from good education in their youth. marginalized from adequate-paying jobs as adults. marginalized from enjoying the benefits of modern society and technology because of sheer ignorance of their rights and privileges.

one would think there is a way we can all work together using God's benevolent gifts and resources, to lessen the marginalization of the poor especially in healthcare, without unduly reducing the good fortune of the rest.