Tag : healthcare

July 27, 2020 by

We’re Going to Witness a Surge in the Current Health Inequality

MARION DANIS is a physician and bioethicist who directs the Bioethics Consultation Service at the National Institutes of Health. The views she expresses here are her own and not necessarily a reflection of the policies of the N.I.H. or the U.S. Department of Health and Human Services.

The coronavirus pandemic feels like a throwback to an era when human capacity to overcome diseases was minimal. We revert to ageold techniques—isolation, hand-washing, masks. The novelist Orhan Pamuk, who knows a lot about how it feels to live through plagues (he’s read many of the great novels about past plagues as he has been writing a new one), tells us our experience is similar in some ways but different in others. We fear the unknown, we start rumors and blame others for bringing the plague. But unlike the experience of past plagues, we aren’t in the dark; we can know what’s going on everywhere in great detail, and we avoid the full impact of isolation by connecting virtually. We are relying on the biological sciences to eventually find more modern solutions.

In the U.S., the healthcare system will be in a sad state after we have made our way through the pandemic. This will not be solely due to the outbreak but also due to policy decisions made before the pandemic, and during it.

Millions of people will have lost their jobs and will lose their employment-based health insurance as a result. Many people who worked in the gig economy without an economic safety net will be unable to afford the basic elements needed for health, particularly safe housing and adequate nutrition, and will not be able to afford healthcare without incurring debt. Many medical practices will have faced economic hardship and even closed, and healthcare practitioners will have lost jobs because all routine, non-emergency medical care will have gone on hold. We will witness an exaggeration of health inequality because death rates from Covid-19 have been higher among minority communities. We will recognize how important maintenance of public health infrastructure is and what a mistake it was to allow a lapse in preparedness for pandemics.

It will take remarkable optimism to see much good coming out of this pandemic. But perhaps the consequences will be so dire and the urge to fix the problem will be so great that we will urge or even insist that Congress pass legislation to create guaranteed income and expand health insurance, and demand that the executive branch plan better next time. 

 

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July 27, 2020 by

Abortion for Anyone Who Needs It

STEPH BLACK is a writer, activist and clinic escort in D.C. who is passionate about the intersections of Judaism and feminism. 

Post-Corona, I want to imagine that abortion will be accessible in the ways I’ve always dreamed: The option to seek care in a clinic or self-administer abortion medication wherever a person feels comfortable. The abortion, whether by medications taken at home or by a procedural abortion done in a clinic, will be free. Information around abortion care will be holistic, demedicalized, and demystified.

At this moment, we are at a crossroads. Telemedicine options for many kinds of healthcare have spiked. Yet this has not been true for abortion: the FDA’s stonewalling on accessible abortion medication is baseless. Its refusal to relax medically unnecessary restrictions on the accessibility of these medications is life-threatening to those who need it. As an educator trained on how to self-manage abortion with pills, I know that access to these medications, and information on how to take them, is vital and urgent. Being able to manage an abortion yourself at home during Covid-19 is lifesaving.

Even as more people seeking abortion care turn to this option, I’m hoping others will understand how safe and necessary it is. I envision a time when these medications are available in pharmacies, for free, for anyone who needs it—no questions asked.

Right now, abortion is essential. In a post-Corona world, it must be freedom.

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January 10, 2019 by

In Med School Before Roe v. Wade

We chatted as the dialysis shift began. She was a young nursing student whose name and face I still remember five decades later, but I will just call her “Jane Roe.” She was from the Virgin Islands and had come to New York for nursing school. She was nearly done—justifiably proud, since she had funded it herself. I was a fourth-year medical student doing an elective rotation on what was called the “Renal-Metabolic Ward.” The dialysis machine was working well, so we continued to talk when we could as the hours went by. It was 1968, and dialysis would not be funded in the United States for another half-decade, which meant that any patient undergoing long-term dialysis had to have the means to pay for the treatments, one way or another, or the consequence was obvious—death, since kidney transplantation was in its infancy.

Dialysis shifts were long, and we changed the dialysate fluid (then called the “bath”) halfway through the treatment. We exchanged stories, as students do, about how school was going, what we’d seen on the floors, and what plans we had. Jane said she hoped to go back to St. Croix to serve people in her rural community. She liked it there better than the cold Northeast United States, anyway, she said.

Toward the end of the shift, some alarms on the machine went off, and we all did our part to stabilize the blood flow and the dialysate flow. Nothing so exact as modern hemodialysis, which delivers nearly automatic and precise dialysis care in comparison. But that treatment ended well.

There is another part to this story: Jane, the nursing student, was, in fact, the dialysis patient, and her odyssey had included far more than nursing school. Four months before I met her, Jane realized she was three months pregnant, despite always using contraceptives. She had a fiancé but was not yet married, and neither of them had the means to provide for a baby, so they reluctantly decided that terminating the pregnancy was the only choice. They planned to have children later, when they were both ready and could truly provide what they felt was right for a child. That way, Jane would also be able to continue her training and become a nurse.

So Jane did what thousands of young women were forced to do in the 1960s—she underwent a back-alley abortion. Though she had worried about going through with it, other young women she knew had used the same abortion doctor and had been fine. She went for the procedure with fear but also determination. Unfortunately, afterward Jane was not fine at all: she developed sepsis and multiorgan failure. She survived after weeks of hospitalization and near-death episodes, along the way enduring a hysterectomy and severe acute kidney failure, with bilateral cortical necrosis. Acute dialysis saved her life. However, Jane’s kidney function thereafter was essentially nil, and she continued on thrice-weekly dialysis, donated as compassionate care by the hospital. Jane and her fiancé married while she was in the hospital, hoping that she would gradually improve, receive a transplant, and resume her studies. She told me she was sad that she would never have a biologic child, but she was full of plans for the future.

A few weeks later, another complication developed—acute bleeding, with a hemothorax. I was the medical student on that dialysis shift, too. Jane was too ill to speak, though she was conscious and nodded hello, offering a weak smile. I chatted with her at the start of the dialysis run, but her status deteriorated, rapidly. There was a code. Though the team tried everything they could to resuscitate and stabilize her, she did not make it. We all cried.

Five years later, Jane would not have died—abortion had become legal in the United States. Over the ensuing decades, safe and legal abortion became standard. Thus, Jane would have, like me, become a grandmother, and would probably still be working and serving others.

Why am I telling Jane’s story now? The lack of legal and safe abortion before the Roe v. Wade decision of 1973 killed and maimed thousands of young women. Should that decision be overturned and abortion again become illegal, there will be countless more young women like Jane.

From New England Journal of Medicine, August 23, 2018. Used with permission.

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