Tuesday, March 30, 2010

Signs of the Times

Time and time again, I am reminded of the futility of my profession and how, despite my efforts at self-improvement and compassion, I and all of my peers in Medicine are just skimming the surface, smoothing out little dents in the giant, deeply rooted evil of inequity and poverty.

Yesterday's Hemodynamics Conference brought to mind certain painful truths, how vain all our efforts are, how superficial our state of existence is, and yet, the possibility of being able to do something, even just an iota of a good thing, is so promising and so enthralling, that it erases whatever cynicism and fear of disappointment there is.

While most of us can afford to visit the classiest of hospitals and the most expensive of specialists at the smallest bodily ache, and even splurge on unnecessary cosmetic surgery or food and vitamin supplements, more than 75% of our population is still wallowing in the mire of neglect and poverty, with half of them dying without having seen a real doctor during their entire lives. Some of them will even suffer the most unimaginable of illnesses quietly and stoically, simply because they have nothing to spend for themselves.

Take this case, for example.

YS is a 28 year old male who used to work as a water delivery boy. He has a wife and a child, but he lives with his mother, being the eldest of 6 siblings. His mother is a laundrywoman, his two other brothers drive rented tricycles for a living. At the end of the day, they pool their income and somehow end up with P500 to spend for 8 people in the family. He smokes occasionally and drinks during special occasions, just like an ordinary 28 year old. He wasn't dirt-poor, but he was barely surviving.

One day, his legs suddenly became painful after his usual walk to his workplace. Gradually, he can no longer tolerate walking due to the pain. He also developed an ulcer on his left leg that slowly festered and grew in size.

Because the pain was so severe, bad enough to keep him from working, he consulted the country's biggest government hospital. The doctors were smart and kind. They treated him well, and studied his case carefully. He was seen by the best specialists from the country's premiere medical institution. Extensive work-up was planned: P2000 for an ultrasound of his legs, P750 for an ultrasound of his heart, P3000 for various lab tests that would screen for a possible autoimmune problem, P8500 for a kidney biopsy. He could not afford any of them.

His mom and his siblings begged from PCSO and politicians from all over Manila. His doctors were kind enough to sponsor some of his tests from their own charitable foundations, some even shelled out their own dough to help him. Because of their generosity, a logical, though still indefinite, working impression was obtained. YS underwent a vascular surgery which removed blood clots from his legs, spending only about P6000 for OR fees, anesthesia, and medications - an amount he and his family had to borrow from neighbors and the local money lender.

After a few days in the hospital, YS was walking again. He was well enough to be sent home. Due to the complexity of his illness, he had to be placed on a number of medications: blood thinners (P50/day), heart medicines (P60/day), steroids (P30/day) and he was advised close follow-up with his doctors. The medical residents managing him were even kind enough to give some of their drug samples so he can have a week's supply of medicines for free.

YS was back with his family, and he was walking again. He took his medicines religiously. But when the drug samples ran out, he had no more money to spend for his prescriptions. He also had no money for his commute to the hospital for his follow-up consults.

Two weeks later, the pains came back. His legs were again blue and cold. The pain was so severe he can no longer sleep and he was very weak. He could not eat even if he forced himself. He was begging his mother to take him to the hospital but his mom could not find people who would lend them money for the fare.

Few days later, his left leg again developed an ulcer. This time, it rapidly grew in size. His toes started to turn black and eventually dried out. The foot started to ooze a grimy, foul-smelling fluid that looks like garbage juice. In a week's time, the smell of the foot was so terrible and unbearable it was enough to make YS himself nauseous. One morning, he noticed that maggots have started to breed and feed on the necrotic debris of what used to be his foot.

But he had no money to go to the hospital. And he knew that even if he sees the best doctors, he has no money to spend for his medicines.

He was already prepared to die. And so he covered his dead leg with rags, to hide the ugliness and to reduce the stench. Lying on his bed, he wished that every day would be his last. But Fate played a wicked, absurd and painful trick on him. He was bestowed a slow and smoldering death - despite his festering leg, he continued to exist, all lucid and bitter, suffering his hideously pathetic and despicable state.

Three months later, he was still alive. A carcass breathing, a corpse still in pain, gradually and inevitably wasting away. After 3 months of scraping the barrel, his mother was able to save enough cash to take him back to the hospital and salvage whatever can be saved.

When we received him, his left leg looked like this...

How can any human being endure this? How can suffering and disease be tolerated this long? What type of person can have a single shred of respect for himself after going through all this pain and ugliness?

How can anyone with a single molecule of soul and compassion not be moved?

But what can a doctor do? When you and your teachers, who do not lack the knowledge nor the compassion, are faced with the certainty of the futility of your efforts because you know that the disease is more deeply rooted than what appears on the surface? You cut the leg. Fine. What about the entire body beyond that leg? What about the person with the body? You barrage him with all the free medications you can scavenge now, but what about next month? How could you send him back to a wretched existence, to a home that reeks of abject poverty, to a country that neglects the basic needs of its constituents?

P100,000 - a trip to Europe. P40,000 - the latest iPhone. P20,000 - a tour around Thailand. P5000 - new running shoes. P3000 - front seat tickets to a concert. P500 - dinner in a mall restaurant. P150 - a cup of coffee. But for some people, it could be a leg, a heart, a life.

Tell me, what can I do? What can you do?

What will you do?

(This is not a fictional character. The pictures are real and unedited. Special thanks to Dr. Kristine Tumabiene and Dr. Neil Bacaltos for the photos.)


Lawstude said...

honestly, do you want to weigh the problems of the world on single shoulders? we might as well go crazy.

individually, our efforts might not be enough but collectively, we might make a difference.

Walking on Water said...

Hi Lawstude.
I still believe we can make a difference. We save the world one patient at a time. In your case, one client at a time. =)

pinoydok said...

I think its time for most of us to open our minds and hearts to what is happening around us. The solution to our problems lies within each of us and work as a collective and not blaming those at the top they comprise <1% of the population. We should blame ourselves for not acting, for not caring, for not seeing, for not feeling for not doing anything about it. Dinandaya na tayo sa harap natin "wala pa rin tayong pakiaalam." Its time to take action. Tackle the problem at its roots. Delay and we are no different from a living corps eating away a part of us slowly.