Poor Health Care: A Reflection

By Mezie Okolo

Who cares about the poor? In many human societies known to us, health care has become ostentatious, available to and affordable only by the upper class. Growing up, we were taught that universal primary health care is a fundamental human right...you are right. First and foremost, is there anything universal about health or health care? If indeed there is anything universal about health, then there is no care associated with it. Health care for the poor seems to always be poor health care. But why can’t health care be universal and universally accessible to those who need it? Why should the poor be poorly diagnosed and poorly cared for? Diseases that affect the poor or the world’s poorest populations especially the third world countries are called ‘neglected tropical diseases’ and everybody is ok with that title. Isn’t that an indictment on the rest of us?

I have lived and worked in three countries (three continents) so I will be looking briefly at those systems to make my points. In Nigeria, the health system at the rural communities is anything but systematic. In fact, it is chaotic. There is high level of self-medication because most people cannot afford the cost, luxury and/or the inconvenience of going to a doctor’s clinic. Also, regulatory frameworks are poorly structured and poorly executed. Lack of trust in the quality and usefulness of available services and products undermine the clinical training of the providers. If you manage to show up at a doctor's clinic, you must buy medical card before anybody would talk to you. Certain persons have died because the family was not able to gather enough money in time to deposit before the doctor would do his thing.

It is not entirely the doctors’ faults either, because people don’t go to the doctor until they are already convinced they are dying. Many people that show up at a doctor's private clinic are emergency department cases, but lack of emergency department services and lack of adequate systematic referral coupled with logistic irregularities mean that even ill-trained nurses stand in for a doctor who is rarely on duty. The result is that more people die of poverty and of no health care than of poor health care. The rich have a way of making the system work for them if they don’t want to hop into the next available flight and head out to England, India, or America. However, COVID-9 changed all those dynamics. Nigeria is long overdue for laws against medical tourism by government officials and politicians.

The last time I checked, I saw my NHS card and it reminded me about my years as Clinical Audit and Clinical Effectiveness Facilitator. For the benefit of those who are not familiar, the NHS is designed to provide health care to everybody in the UK with an arrangement that assigns everyone a GP within a reasonable distance from his postal code. The idea is to make sure that primary health care is as close to the people as possible. When you do need care, you could see your GP soon and it has nothing to do with ability to pay. Although the NHS has its own numerous challenges, at the primary care level it serves those who would otherwise not be able to pay for care. Even wellness checks for a newborn was part of the package those days. What is more noteworthy was prescription copay...no outrageous charges at point of care as could be the case in the US; even though I had to wait in line for a year to see a dermatologist.

Here in the United States, it is pretty much survival of the fittest so to speak. Although there is Medicaid and Medicare, most people either have private insurance or no insurance at all. The average hardworking middle-income family would not qualify for Medicaid and may not be able to afford private insurance. They just fall through the cracks of society. Even Obamacare seems to have made it harder for certain categories of people to procure coverage. What then happens is that the hardworking poor suffer and live with more than proportionate deal of unmet health needs. Over this period of COVID-19 pandemic, the situation was unusually escalated to the point that people refused to refill their prescriptions because they had to buy food. Some people had nothing or almost nothing else left in the house but toilet papers. I still don’t understand the rational behind stockpiling of toilet papers. But the poor still suffer more from ‘COVID’ than everybody else. The people that catch and those that die of the "virus" are predominantly, (you guessed right) middle or lower class. One could blame that on low immune system probably from not eating healthy. But eating healthy is costly. We all want to eat healthy but we all cannot afford to eat healthy, and we all don’t know how to eat healthy. That’s why we subscribed to “Start Healthy Magazine” to help people understand that you are what you eat.

Many people don’t know that the best form of health care is daily routine care which includes what you eat. Time and space will not permit us to talk about the effects of chemical additives in food and on our body. We must quickly say that if you don’t check what you eat you will soon be checked for what you eat. Many people eat themselves to obesity, others drink themselves to cirrhosis and yet others smoke themselves to bronchitis. Who suffers more from these diseases? The poor of course.

So back to our question, ‘who cares for the health of the poor?’ Ironically not even the poor themselves care for the health of the poor. When the poor suffer ill health from poor choices, that is triple jeopardy. If we could hardly survive one, how would we deal with three? That explains the decline in quality and quantity of life in contemporary society. Total reorientation, personal responsibility and leadership are needed to change this ugly trajectory. At the intersection of health, health care and leadership, blessed is he that considers the poor...he lends to the Lord. May he be handsomely rewarded on the day of reckoning.

Mezie Okolo, PhD is an Independent Leadership Consultant @The Rite Place and can he reached at www.mezieokolo.com