Healthcare reform: Back to the basics

What if there was no healthcare system?

No doctor’s assistant to fight with to get an appointment on time. No insurance company to argue with over coverage. No bureaucracy. No bad attitudes from hospital workers for being overworked and underpaid.

What if we went back (if only in thought) to the basics? Strip away everything that has labeled the industry for so long and return to what medicine was intended to be.

I think you would get something like this:

I spent a few weeks of my summer each year growing up in the rural mountains of Nicaragua. About a 4 hour bus ride from the capital city of Managua, La Finca (the farm) operated just outside a town called Matagalpa. A group of healthcare professionals and some others interested in making a difference set up a clinic in a small barn-like building on La Finca.

Sheets were hung from the ceiling to separate exam “rooms”. There were four “rooms” in total. Each equipped with a physician or nurse practitioner (of various specialties) and a translator. There was one nurse. She ran the triage station which consisted of about 20 chairs in a circle and some overflow outside the building. The pharmacy was a room off the triage area where surplus medications from the States were brought in and arranged by function.

Word of mouth: “American doctors are here!” Locals traveled miles on foot through the mountains, sometimes with 5 or 6 children.

Hundreds of people lined up outside the gate to the farm on the first day. Even more in the days to come. 300 people came through the 4 small exam rooms that morning. 8am-1pm. A break for lunch. Another 250 came through in the afternoon 1:30pm-5pm. We did not stop working until the last person was seen. They were triaged (BP, temp, pulse, chief complaint) without a translator, seen by the physicians, prescribed medications including anti fungals, anti parasitics, and life saving antibiotics. Each person left with a hygiene kit (toothbrush, soap, washcloth).

Each doctor worked quickly and accurately knowing there was so much need. Every person in the pharmacy worked diligently to put together a bag with the medications and instructions (in Spanish)—all meds were triple checked.

How did all of this get accomplished?

Through compassion. Hard work.

Year after year we would go back to that small town outside Matagalpa. We began to recognize the people as we would see them each year. Eventually, we built a freestanding clinic there—staffed by Nicaraguans which functioned year round. There was a significant decrease in the number of infections and parasites seen come through the clinic. Reason? Medical care that actually reached the entire community.

Can this very stripped down model of healthcare be applied to our situation today? Can we as healthcare workers work diligently and effectively knowing that there is so much need? Can we as professionals and patients not be greedy having the understanding there is much work to be done in this world?

Can we end the conflict between ourselves in the healthcare system so that we can get back to working together to change the communities around us and effectively change the world?

That would be true healthcare reform.

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