Thursday, July 30, 2009
Editorial: A chronic symptom of a sick system
Year after year, Wise County is host to a mega-health event admirable in its display of kindness, horrifying in its show of need.
From the RoundTable blog
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For the 10th year in a row, a small army of volunteers stepped up last weekend to transform the Wise County Fairgrounds into a free health care clinic for the uninsured and underinsured.
Every year, the numbers seeking treatment grow.
Organizers said most come from the surrounding coal-mining region, but the failure that draws them here once a year is not an Appalachian phenomenon. It's a national failure of the way America provides health care, a way that must change.
It leaves gaping holes in insurance coverage, encourages fragmented care and, as a result of both, must over-rely on intervention when prevention would get better results at less cost. Sometimes it leaves people to die long before their time.
The Remote Area Medical event in Wise is only a microcosm of the larger picture.
n RAM offers medical screenings as a sort of early warning system for patients. A local organizer estimated that 40 percent to 50 percent will need follow-up care, but that doesn't mean they will get it.
The organizer said she knew of a young woman of 19 or 20 who is dying of cervical cancer for lack of money to follow up on an abnormal result.
n RAM's dental clinic did extractions on a woman whose teeth had been smashed in almost two years ago, causing repeated infections that prompted repeated emergency room visits for antibiotics and painkillers -- but not removal of the teeth and, thus, the underlying problem.
n RAM attracted more people seeking dental work and eye examinations than screenings for early cancer detection or tests for diabetes or unhealthy cholesterol levels -- a common pattern, organizers say. Patients want immediate relief for immediate problems, but are less motivated to seek preventive help.
This reflects a distressing lack of personal responsibility for their health, yet maybe something else.
RAM patients aren't establishing an ongoing relationship with a doctor who can provide long-term treatment or help them keep chronic conditions under control. If patients need follow-up care they can't afford, perhaps they'd rather not know.
It's an all too human defensive mechanism that seems also to have infected the nation's health care reform debate. Yet denial does not obviate the need for treatment, and delay can wait too late.
