The way we treat our sick and the disadvantaged is a reflection of the civility of our society.

Satish Chand
Pacific communities have lost ground on this in recent years. The healthcare system in several of the islands states is sick and suffering severe malnutrition. This magazine earlier this year raised a number of concerns regarding the burgeoning crisis of lifestyle diseases within the region. While TB and Malaria are making a comeback, HIV/AIDS is already wreaking havoc in some of our communities. It is time we did something about our deteriorating healthcare system.

Changing times or changing priorities

It may simply be a sign of changing times, possibly my age too, that I have for the past twelve months seen several families evacuate close members to Australia for treatment.

Some of those evacuated were staring at death in a matter of weeks—months at best—without immediate overseas treatment.

One family brought their little daughter from Port Vila to Westmead Hospital in Sydney for emergency brain surgery. Another brought a young mother from Port Moresby to Canberra for treatment for breast cancer.

Breast cancer, I am advised, is most virulent in young women—those at the prime of their life and often with heavy responsibilities for the wellbeing of their families. Loss of a mother by anyone is bad enough, but by young kids is a tragedy. Those evacuated are the lucky ones, even though they will go back with a heavy financial burden from the costs of treatment.

LEVEL OF HEALTHCARE

Many more are left behind due to lack of funds, wrong diagnosis, and often without any access to medical facilities. In many cases, access to basic healthcare has retracted from the levels that were available at independence decades ago.

The human costs of premature deaths in the region are hard to fathom. It is high time for a more serious look at improving the health of our healthcare system. This will entail revamping the general hospitals in our urban centres to aid posts and health centres out in the rural and outer-island districts.

The state of many of our public hospitals is appalling. Shortages of staff, funds, equipment, transport and housing plague nearly every major hospital in the region. Drop into your local health centre, aid post, and if possible the general hospital, and see for yourself.

My recent forays into Port Moresby General Hospital, Majuro Public Hospital, and the Colonial War Memorial Hospital in Suva show that their capacity to service their communities leaves much to be desired.

The ordinary folk visit a hospital only to visit a sick relative, if not carried there sick in the first place. Even the best of the hospitals are not pretty places to visit.

Having spent a day in neck brace at Canberra Hospital following a car prang recently, I can assure you that being wheeled around on a bed with needles punctured into your veins and with all the electronic gadgetry around to keep an ever-watchful eye on you is not much fun.

One extremely kind staff member at the hospital joked to me that the probes on my chest were there to keep a watch on me, just in case I tried to take off in a hurry—the thought did cross my mind, I must admit! What was even more shocking was the A$1400 plus bill that rolled into the mailbox a few days later. In my case, the insurance (hopefully) will take care of the latter, but this privilege is not available to patients from abroad.

For someone sick, getting to Australia is no mean feat. Securing the funds, the visa, and the time away from the normal chores of life is a luxury that only a few can afford. The rest, reality demands, would have to be content with what is available locally.

We thus have little choice but to improve our healthcare system as a matter of priority. Country and district level scrutiny of the delivery (supply) of and accountability (demand) for healthcare is long overdue.

On the supply-side, improvements in the delivery of basic preventative and primary care by the aid posts and health centres, the frontline with the widest reach, deserves revamping. In some cases, the churches managed to provide far better services with much more meagre resources in the early days of colonisation then what is being made available now.

User-pays as taxation with accountability

Given that most governments are strapped for cash, we may have little choice but to introduce some form of ‘user-pays’. Such a scheme, however, would need to have exemptions for children, the elderly and the handicapped.

User-pays, in being (partial) payment for services rendered, create the demand for greater accountability on the part of the service provider. This could also form the basis for greater community participation in health delivery.

The local Health Centre Board, for example, could raise funds and assist in community education on health issues within their localities. They could be an invaluable resource for combating the outbreak of an epidemic, with community-wide immunisations, and in raising funds for public purposes.

Schools provide another medium through which preventative healthcare education could be extended.

It is high time the health and physical education curriculum in our schools is reviewed with a view to making it more relevant to the contemporary challenges of drugs, alcohol and sexually transmitted diseases in our communities.

Improving preventative care, particularly in-patient/palliative care, is resource intensive. While ‘user-pays’ could also be used in the above, governments may have to reconsider the levels of budgetary allocations to health as a whole.

Treatment for the most life threatening illnesses, cancer as an example, is unlikely to be available within the regional hospitals soon. Patients facing such ailments would, at least for a while, need to be taken to the most receptive of the industrial country neighbours for assistance.

Of what I can see, families struck with such misfortunes were simply unlucky in being dealt a blow by nature. Risk-pooling, such as via insurance, is the preferred answer to such eventualities. Such insurance, however, is not available to the majority of our people.

There is a case for some public subsidy to induce greater private sector participation in filling this market void. Donors could help with such an initiative too.

New Zealand currently has a ‘Medical Treatment Scheme’ that is accessible to nationals of seven states; namely, Fiji, Kiribati, Samoa, Solomon Islands, Tonga, and Tuvalu.

Those eligible for treatment in New Zealand get their costs and living expenses paid for by the New Zealand taxpayers.

This scheme, despite its minimal publicity, has been strained as demand for places have exceeded supply. It, nonetheless, is a start and could be used as a starting point for a regional initiative on extending such services to the region more broadly.

Unless we reverse the deteriorating state of our healthcare systems, we might as well stop pretending to be the caring and loving society that we often boast of. Yes, let’s treat our sick healthcare system, and now!