Health inequality

Spotted in MI, originally blogged by Dr. Ang

Someone very famous said: “Off all the forms of inequality, justice in healthcare is the most shocking and inhumane.”

I am one young doctor who had just started the learning curve of treating the unwellness of another human. Coming from a humble background, my empathy for people who are disadvantaged in getting healthcare makes me sad. And this is even sadder when those who claimed to have been living in reality long enough laugh off the very discomfort I have for the injustice of healthcare. They say “This is how the world works” and “Welcome to the world”.

Is that so? I know you would have thought the same.

And any hope and ideals in having a just and equal world, is immature, unrealistics, and idealistic, or even utopian?

Let’s not digress into other inequalities, just stick to healthcare. Apparently it is acceptable and reasonable that the world works by the concept of the more money you have, the better care you would have, and this is at the expense of those who have less money than you.

Queue is different for everyone. Treatment is different from one person to another. Same disease, different persons, would have different course of treatment, despite having similar natural history and progress.

I can give plenty of examples.

Those who have money will go to top-class, most senior doctors, who get their years of experience by treating the poor. So when you have money, you don’t have to take part in providing a learning curve and avenue to young doctors.

Other examples like doctor placements. This has been going on and on for years. Same story different centuries. We can’t actually blame these doctors. Humans are born to be individuals, and no one would want to be away from the comfort of families, entertainment, connectivity, and good future. Meaning it is understandable why doctors are still packing up, overflowing the cities and big towns, leaving very few in the rural areas. We have 20 doctors seeing 20 patients a day, but at the same time there is one doctor seeing 200 patients in the rural areas. Is this an acceptable standard of care for the rural patients?

Other examples like hospital placement. The best of facilities are almost always at the biggest city in the state. If we go by having 200 doctors in the rural areas but no modern facilities, it is pointless. But at the same time, having all the expensive modern facilities in the rural area with 1 doctor is also not useful. So, we are stuck.

This brings me to the most important message that I want to convey in this piece.

We need holistic development. Building a world-class hospital needs to bring with it a world-class connectivity of roads and public transport. The education level of the society around the area needs to be improved. Schools, sanitation, transportation, healthcare, education, and so on need to be pulled together, not just one after another.

Those in power in the health ministry can slowly take sips of their hot coffee in the comfort of their air-conditioned offices looking at the many projects they have put in place; mobile clinics, flying doctors service, latest PET scan machine in Putrajaya, hundreds of new clinics and hospitals across the country; but if there is no simultaneous development of roads, public transportation, education and sanitation, the real problem of health inequality will still, depressively, be there.

How can we claim success when patients earning RM70 a week spend RM40 on transport to see us in the clinic for follow-up frequently?

The recent general election concluded with a razor-thin majority for the current government. As an impartial and concerned civil servant, this is very unfortunate. I would have hoped for a clearer majority to whichever side to form government. This is so that there will be less politicking, less populist decisions, and more difficult but necessary steps can be taken.

But there is still hope, I hope. – August 14, 2013.

Are you as optimistic as Dr. Ang about the future of healthcare in this country? Dr. Ang is young and idealistic. I hope the leaders of the country (now and in the future) won’t let his generation down.


Malaysian physician, haematologist, blogger, web and tech enthusiast