Where are the doctors?

Source : Google photo of rural doctor serving remote villages

Synopsis : The shortage of doctors, high cost of hospital care and medicines plus long wait to get the required treatment in a good hospital hurts poor people more than the rich. The universal healthcare system in some countries show the way to cover everyone in need through taxation and strict control of prices of medicine but it goes against the healthcare industry that is based on greed and quick profit in some countries. The system of family doctors has also vanished leaving the poor people in trouble. The blog looks at these issues and the reasons behind the soaring healthcare costs.

When I was young , there used to be doctors who were called the family doctors meaning almost all the families had a doctor who knew them well, knew their medical history and often visited the family on social occasions like wedding or festivals. No one needed to make an appointment to see him and he could visit the patient in his house in case of emergency. He charged very little for his medicines and professional help so even the most poor could afford him and got well.

Sadly such family doctors have all but disappeared in India and have been replaced by greedy and very expensive doctors who want you to have an appointment days in advance but do not have the diagnostic experience the old family doctors had and demand all sorts of expensive laboratory tests and x rays before he can decide what is wrong with the patient. If he agrees to a home visit in case of an emergency, he would charge a big fee but mostly he refuses to see a patient outside his clinic. This is particularly true in the Philippines.

The doctors now spend their day by keeping their offices in several hospitals where they sit on alternate days or once a week where a long line of patients are kept waiting for hours to see him because he shows up late and never apologizes to the patients. He is haughty and says his time is more important and valuable than of the patients so they have to wait to see him.

Then there are hospitals where they will refuse to admit you in the emergency ward by saying that you should have come immediately when you had a problem but by going there a day or two later means it is not an emergency so you have no choice but to see a doctor who sits there only once a week and may not see you at all due to the crowd of people waiting.

A young girl had an accident and was bleeding steadily but she was kept waiting in the emergency ward for 6 hours before a doctor could see her and died bleeding . Her frantic mother could not get the help the child needed because they said that the doctors were busy . It is a true story and it happened in the USA.

There are horrendous stories of careless doctors who gave the wrong medicine based on wrong diagnosis so the patient died or the doctor removed the perfectly healthy organ and realized that a mistake had been made after the surgery on a patient who had a problem. There are incredible stories of a doctor who drugged his patients and secretly removed a kidney that he sold at a high price to someone who needed it badly.

In Haiti a doctor was found to be very neglectful in his duty so a patient died . The relatives did not accept it and tried to kill the doctor so he fled the town in the middle of the night never to be found again. There are many such cases that are frequently reported in the media but nothing really changes.

In India people always ask if they know someone influential who can get them admitted to a hospital for a surgery or specialized treatment because without knowing some one it is quite impossible for a patient to find a bed in a hospital. They always say that there are too many people and not enough beds so they have to be put in a waiting list for several months or until a bed becomes available.

So those who can afford go to nursing homes to get well where the cost is high but you do not have to wait like others. This has given rise to thousands of nursing homes everywhere because the business of getting well has never been so lucrative as it is now. That leaves the poor people on their own who have no recourse to medical help when they need it. It is said that there is only one doctor for one thousand people in India so there are not enough doctors in the country and those who drive fancy cars and charge hefty fees for the consultation prefer not to go to rural areas where most people live.

It is so much easier for these greedy doctors to sit in the air conditioned offices and make people wait for hours than for them to practice in rural areas where the health care centers are primitive and lack the basics. I have lived in Burundi where a sick person is carried in a make shift hammock by people over a great distance on dirt and very difficult roads to bring him to a hospital so the patient suffers and often dies on the way . It also happens in many countries where ambulance service is not available in remote areas.

Here in the Philippines an ambulance may arrive quickly enough to carry the patient to a hospital but if he is too poor to pay for the hospital charges then he is in big trouble.The hospitals keep guards 24 hours a day who check if the patient has paid his full fees and want to see the receipts before the patient is allowed to leave. Some poor people do try to run away without paying so the guards are kept by the hospitals. When my wife needed a surgery, the doctor refused to get paid by the hospital and wanted cash from me. When I protested by saying my wife had a medical insurance to cover some of the expenses, the doctor replied that she did not trust the hospital to pay her so she wanted the cash right away. Just before checking out of the hospital, the anesthesiologist, the lab technician and even the janitors and the guards all lined up to get paid from me in cash.

Over the years I have seen a steady deterioration of the health care services in many countries and the cost rising sky high so everybody has to buy insurance that often fails to cover all the costs. They will not insure a person with pre existing condition so they want to insure only a healthy person and take his money but the poor and sick people are the ones who need medical care and not a healthy person.

The universal health insurance scheme in the United States called Obama care was very popular because for the first time the patients with pre- existing conditions were insured but the new administration has tried very hard to replace the Obamacare with something that favors the rich insurance companies,the pharmaceutical companies and hospitals but so far they have failed to replace it.

The plight of the poor people is quite universal that includes even the so called rich countries. A group of poor Americans who were sick and could not afford the costly medical treatments in their own country went to the Guantanamo American base in Cuba to seek the help of the base doctors but were chased off by the gun toting guards.

So they went to Havana seeking medical help from the Cuban government and asked people on the street where to go. They were guided by the sympathetic crowd so they soon found themselves in a modern hospital where the doctors promptly attended to their needs , diagnosed their problems and did all that was necessary without charge.The Americans were overwhelmed with gratitude and shed tears when they were given all the medicines they needed at a very nominal cost and were given gifts by the hospital staff as well. Michael Moore made a documentary about it showing the appalling conditions of healthcare in his country for which he is vilified by the media and the politicians.

Watch the video below on Cuban health care system

Source : U tube video on Cuban health care system

The health care system varies from country to country. In some countries like Cuba ,Sweden ,Denmark and Norway they have universal healthcare system where anyone in need gets the maximum care at practically no cost because it is subsidized by their government. They fund the healthcare system through taxation so people nationwide share the cost this way. In other countries like in India ,the government now has started a nationwide program to cover all poor people who need medical help for free or at a very low cost. The rich people or the middle class people have insurance that covers them but the shortage of qualified doctors there is a serious issue that needs solving.

When we were in Mexico City, our son had an accident and fractured his left arm but soon a social worker appeared and quickly called the ambulance. When we reached the hospital, we were promptly interviewed by the doctors and our son was taken to the operating room soon where the skilled surgeons fixed his broken bones and put his arm in a cast. He stayed in the hospital for two days after which we took him back to our hotel. The modern and very well equipped hospital did not charge anything for this extraordinary service but we donated some money just the same. Naturally we were very impressed by the quality of their health care system.

There was a stop gap measure introduced long time ago in India called the Licensed medical practitioners ( LMP ) who were not full fledged doctors but had some medical knowledge and training so these LMP doctors worked in rural areas but they were not specialized to handle serious cases. The rural India still lacks good roads , modern hospitals and well trained staff so I have seen these LMP doctors riding their horse to visit patients in remote villages.

There are traditional herbal doctors or people with knowledge in herbal medicines who helped rural folks for a nominal fee but they are slowly vanishing as no one takes their place now. Please read my blog here called Gabar Buri that I wrote quite some time ago. In Africa there are still the herbal medicine men and women who help people in remote areas but those with serious conditions who need surgery or hospitalization under expert care need to go to cities at a great cost that they can't afford.

The healthcare is a serious issue that affects everyone everywhere but it concerns the poor people more than others. The shortage of doctors who are needed in remote rural areas is a serious problem that has no solution because the good doctors stay where they can make a lot of money quickly. The system of family doctors has almost disappeared in many countries where the doctors used to have close relationship with their patients.

I think the root of the problem of not having enough doctors lies in the high cost of medical education in most countries, difficulties in getting admission to the good medical colleges, shortage of medical colleges and shortage of training hospitals where doctors train for some time under a senior doctor. The students in medical colleges in the United States chalk up huge debts because they borrow money to pay for their education. This discourages others to become a doctor because they know that they have to struggle for many years to pay off their massive debts before they start earning a decent salary.

All over the world there is a need for doctors , medical technicians, laboratory workers, nurses, paramedics, people who operate complicated medical equipment, radiologists, anesthesiologists and specialists in every field. There are doctors who only work in research to develop new medicines and treatments so they are of no help to people who need help although research is needed to develop new cure and medicines.

The soaring cost of medicines and hospital care is one stumbling block for many plus the shortage of doctors and hospital beds all complicate the matter. I remember going to many drug stores everyday to look for pain killers that my father needed but always came back empty handed because they said they had run out of medicine. I was never told why there was this chronic shortage of urgently needed medicines.

I get nostalgic about the old days when there were family doctors who took care of you at low cost. Sadly they are a vanishing tribe in the new world of greed and self centered lifestyle of care givers. Please also read my earlier blog called Where are the hakims that is related to this blog.

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