"Health is wealth," the popular saying goes. But I think the more appropriate saying would have been "wealth is health."
It is a fact well known to every clinician, especially one practising in the 3rd world, that wealth is an important indicator of good health, as it gives one the "privilege" of having access to optimal nutrition, and good health services when the need arises. I was rudely reminded of this again yesterday.
When WHO included poverty as one of the vicious triad [the other two being ignorance and infection] that constitute a health Waterloo to the average African, they weren't high on some cheap weed; they were merely stating hard cold facts.
9. 30 am
As I leave her room, I know she won't last another 24 hours. All her organs are failing one after the other, like a pack of cards, in a game of domino.
First the lungs. Then the liver. The heart. The the brain. And now the kidneys are shutting down.
Disseminated TB. The acid-fast bacillus had spread spread from her lungs and infiltrated her whole system, wrecking havoc in its wake.
If she had come earlier, she would have lived; we could have done something. But poverty had kept her; they were scared they won't be able to afford the treatment. If only she knew that treatment for TB is free!
10.30 am
Not long after I settle down in my consulting room at the OPD, they drag her in, a 30 year old woman looking twice her age, having been dried up, like a stockfish, from excessive passage of urine leading to serve dehydration.
She is a diabetic. I had discharged her about a week ago after saving her from the clutches of death. When they brought her, the hangman -- diabetes, was standing over her with the noose of severe dehydration 'round her neck, in the gallows of hyperglycemic coma.
With normal saline infusion, I had cut her lose from the noose, and used my double-edged sword-- insulin, to fight off the "hangman," and bring her out of the "gallows."
Now, she's on her way back again to the gallows, and the hangman is waiting, noose in hand. The reason? She had been off her thrice-daily insulin regimen for 4 days now! Something about not having enough money to get a new vial of insulin.
Hubby has been running around, but it had all been futile. Unfortunately, diabetes is a life-long illness, and you need money-- lots of it, for effective diabetic care.
You need money to buy insulin, or oral hypoglycemic agents as the case may be. You need money to buy glucometer strips to monitor blood sugar levels. And you need money to be able to keep up with the special type of diet required of diabetics.
I want to admit her again, and stabilize her. But! They are saying no. They can't even afford the admission deposit; the last admission took all they had. If I let them go, she will definitely be dead within the next 72 hours. What do I do? My hands are tied; there's only so much people you can help at the same time ...
3.30 pm
I finish from the clinic and head to the neonatal ward. There lies a 5-month old sick neonate, sleeping calmly on the bed, looking quite like a sight for sore eyes.
I carry her and marvel at how much weight she had gained! Just about a week and some few days ago, she was an inconsolable, crying bag of bones, abandoned for the Granny by the HIV-positive mother, who was been fed with plain pap alone.
With plain pap as her only source of nutrition, and with HIV battering her defences, she had developed severe malnutrition [Marasmus] with accompanying sepsis, severe dehydration, and was almost in shock at presentation.
We had offered Granny the option of admission, but she had vehemently refused. Because, money; she didn't want to incur a debt she may never be able to pay.
Knowing that her going home with child would mean death within 24 to 48 hours, we volunteered to foot the bills, and Granny had agreed with tearful eyes. "Msuu gbim; thank you very much," she had said.
Now carrying her in my arms, some 10 days later, I can only marvel at the wonder she has become, and the fact that save for our intervention, poverty would have dragged her to the gallows.
She stirs, as the voice of the granny tells me that the formula we bought just 2 days ago had been exhausted. And I begin to wonder for how long I will be able to sustain steady supply of her infant formula, before switching to fortified pap. As long as I can; I'm not letting poverty have its full course on this beauty....
Meanwhile, Universal healthcare for all may be a solution, the axe that will chop off the 3rd leg of the tripod [of infection, ignorance, and poverty], which is the mitigating effect of poverty on the lofty dream of giving the below-average African access to standard healthcare.
Question is, how feasible is it?
As usual i exceeded the word count: 470
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