No assault weapons means a good day at the office

None of my patients showed up at the office today with an assault rifle, and none showed up dead. Unless I missed something none of them had any body parts blown off, and none carried a virulent, infectious pestilence dangerous to all around. For some doctors around the world that would qualify as a great day. Once in a while those of us who love to whine about health care in the United States need to remember just how much it can suck (that’s a medical term meaning to really stink) to be a patient or a health care professional in most of the rest of the world.

Three medical colleagues returning from tours of duty in Afghanistan and Iraq reminded me of this fact recently, by their stories and by the looks of changed men.

One spoke of practicing in a clinic in Afghanistan where the main entrance (actually, that’s too grand – the entrance was just a wooden door) had a sign forbidding assault weapons inside the premises. Another spoke of the piece of shrapnel in his neck, blown there by a suicide bomb in Iraq that killed 20 of his comrades. The third said nothing of his experience, but his eyes spoke of a man who was still trying to figure out all he had seen in his work on an evac helicopter for wounded American soldiers.

By comparison, if you had asked me about my day in the office today I would have spoken about the frustrations of the piles of paper awaiting me after two weeks on vacation. By comparison, some of the world of health care outside my pristine office, and outside this wealth nation, is a world of want and medical mayhem most of us cannot imagine; a day in it would have most of us reaching for our Prozac, a luxury itself in a world where the only medicine for depression might be tomorrow.

Health care in Iraq, for example, is not simply an issue of too much violence, but also one of a health care system completely unable to keep up with the demand for care of the violently injured or even the routinely ill. News reports speak of patients dying for lack of blood, lack of medication, and sometimes for the simple lack of electricity to keep the surgical lights and equipment running. They speak of doctors being shot for accepting medical supplies from America soldiers. By comparison some of my patients lack for insurance, but none are dying in front of me while I search for bleeding arteries in the dark. By comparison Maine Medicaid harps at me for prescribing a drug it does not want to cover, but as yet has not threatened me with anything but a bureaucratic headache.

Africa is another version of Dante’s medical inferno, a place where starvation and AIDS are consuming souls at a rate we in a country that mourns the deaths of a single child cannot imagine. On the front page of the New York Times recently was the photograph of a young mother handing her dead child to a relief worker. She had found help too late to save the child from the starvation currently ravaging several areas of Africa. I cannot imagine living and practicing in a place where such events are common enough to seem the stuff of normal days.

In some African villages almost half of children are orphaned by AIDS, and in some countries 25 percent of the adult population is infected with HIV. Millions of Africans will die of AIDS in the next 10 years, millions. If you stood on a hill and looked at the dying your eyes would be filled with people reaching to the horizon in all directions. Imagine New York City dead in 10 years; that is the scale of impending AIDS deaths in Africa. Most will die without effective treatment, treatment which is available to almost all of the one million Americans infected with HIV. I am not certain I could work as a physician if Africa was my office.

Much of what kills around the world is not as esoteric as AIDS or dramatic as bombs, and would seem mundane to us. Measles kills almost a million children around the globe each year; in America a measles outbreak is national news. Cholera – the gut-wrenching product of contaminated water – wrings fluids and life out of another million children a year. I have never seen a case.

Once in a while all of us need to step outside the American bubble of unreality and see how much of the rest of the world lives and dies. We need to give thanks that the evening news and the daily newspaper give us windows on the real world. If we did so we might not only whine less about our own circumstances, but do more to help others out of theirs.

Erik Steele, D.O., a physician in Bangor, is chief medical officer of Eastern Maine Healthcare Systems and is on the staff of several hospital emergency rooms in the region.