Health care

Dr. Mary Kemen

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As we gather during this Thanksgiving holiday weekend, we may be asked to recite the blessings in our lives. Some may express gratitude at the good fortune of being born in America. I recently completed two months of service in the new nation of South Sudan. As always when I return from medical duty in Africa, people marvel at the deprivation and poverty I witnessed abroad.

What is most striking to me this Thanksgiving is the increasing deprivation and poverty I see here at home.

The people of South Sudan are proud of their status as a newly independent nation and have an abiding optimism about their future. We remain proud to be Americans but find the fabric of our children's futures weakened by the blight of unemployment, foreclosures and financial ruin.

The U.S. Census Bureau has released new data that redefines poverty rates, describing a category termed the “near poor.” This analysis revealed that one-third of our countrymen - 100 million people - live below the federal poverty line ($24,343 for a family of four) or in this tenuous stratum of the near poor. When fixed expenses (taxes, child care and transportation) and benefits (food stamps, earned income credit) were factored into effective income, more people sank into poverty than rose financially. Medical expenses remain the leading cause of bankruptcy in this country.

In South Sudan, there is one referral hospital that serves the entire Bahr el Ghazal state, an area of 36,255 square miles. There are an estimated 200 doctors in all of South Sudan, population 8 million. By comparison, in Eastern Iowa we have three major hospitals staffed by more than 2,000 doctors within a 30-mile radius, which serve a population of approximately 300,000.

There is no health insurance in all of South Sudan. Patients must buy all necessary hospital supplies, such as syringes, gauze, suture, or medications, in order to receive treatment. Many of my patients walked miles or traveled for hours to reach the hospital, even for emergency care. The health status of women and children has declined significantly since my tour there one year ago, with more critical illness, more abscesses and severe burns, too many deaths.

In the United States, we now have 50 million uninsured patients. The Census Bureau report showed almost a doubling of elderly people living in poverty, largely due to medical expenses.

Locally, the Community Health Free Clinic provided 55,000 medical services, in the form of direct care or medication, over the past year. Increasingly, patients covered by Medicare or insurance seek assistance to procure medication they cannot afford. The IowaCare program in Iowa City, which is intended to provide specialty and surgical care to the uninsured, is overwhelmed. Many patients have no car and struggle to pay for transportation to Iowa City for care. The health status of patients in Eastern Iowa, by every measure, has declined dramatically each year.

So this Thanksgiving I am grateful to have health insurance and live near 2,000 doctors. But I am concerned about the fate of my fellow Americans who remain uninsured or underinsured. Their health care has more in common with that of the South Sudanese, though like me, they live in the wealthiest nation in the world.

The question is why we allow so many Americans to receive South Sudan-style medical care. The answer lies in the actions behind our expressions of goodwill toward man around that Thanksgiving turkey.

Dr. Mary Kemen of Cedar Rapids serves with Doctors Without Borders. Comments: bcr1792@aol.com.