MediCARE

Here on my Philippine island, I live in a solid, cinder block house in an outlying barangay of a nearby port town. On either side of my house stand houses made from more traditional materials - a wood-plank house on one side, raised on rotting wood posts a meter or so off the ground, and a grass, or "nipa," shack on the other. Inside each of these houses, an old person lies, slowly dying - a family matriarch in her eighties in the wooden house, and her sixty-ish son-in-law in the grass shack. The son-in-law was taken ill about a year ago, in the middle of the night. He was rushed to the hospital, where the staff did what they could to stabilize him.(1) Because his diagnosis was a probable stroke, his family was advised to take him to Tacloban, the nearest sizeable city, where a catscan could help doctors give him a proper diagnosis. With no money to pay for such a costly procedure, the family brought the old man home. I saw him walking around the next day, physically unchanged except for the absence of the white ballcap he always wore. He had another attack of the same symptoms (incontinence and disorientation) that day, and the family decided to confine him to a room in the grass shack where he continues, I'm told, to steadily decline into dementia.

His wife, the matriarch's daughter, cares for him the best she can. She has become expert at caring for the dying by caring for her invalid mother in the wooden house. The woman, who has been dying for three years, sustained a powerful electric shock that, I was told, knocked her twenty yards through the air. She developed a kind of palsy after that, evident in an uncontrollable trembling of her head, and fell into a slow decline. For more than a year, the only sign of her presence in the old house is her cries of pain, which have grown perceptibly weaker as the months have gone by.

The cries can happen at any time, in the middle of a quiet night or during the day, and they can be heard as much as fifty yards away. Her cries have become so commonplace that they are almost unnoticeable, like the crows of roosters or the barks of dogs. But when children file past the house on their way to school and they hear her cries, sometimes they imitate them, and laugh. I've even seen grown men mock the sound, smiling stupidly. Her family is poor, but surely they have enough money that they can afford to buy generic painkillers for their matriarch.

I saw the recent film 12 Years a Slave a few weeks ago. There is a powerful scene in the film in which the protagonist Solomon Northrup is on the verge of being lynched by three men when they are stopped by a caretaker who works for the owner of the plantation. The three men leave, but instead of untying Solomon's hands and taking the noose from around his neck, he is left dangling precariously, just close enough to the ground to stand on his tiptoes. And he is left there for several minutes while someone fetches the master. Dangling there, half choking, while he struggles to keep his toes on the ground, other slaves emerge from their cabins and begin to go about their work. After a dissolve, children are shown playing. The scene attests to the amount of cruelty that the slaves must have witnessed all their lives, that they can go on with their lives as if it were commonplace for there to be a man close by, slowly strangling at the end of a rope. The scene ends when the master arrives by horse and immediately cuts Solomon down.

I think of that scene every time I hear the old woman next door crying out in pain, and witness the members of her family stroll by her house without paying the slightest attention to her. What suffering and cruelty must these people have known, and grown callous to, during the course of their lives that the cries of an old woman in pain would not inspire them to do something - anything - to make them stop?


(1) I feel compelled to say something about the disastrous healthcare system in the Philippines. By law, as in the U.S., a hospital cannot refuse treatment of a patient if they don't have the money to pay for it. But I've heard of cases, and seen surveillance camera footage, in which security guards have thrown patients and their families out of emergency rooms when their inability to pay becomes evident. In a country where a third of the population lives on $2 a day, a tiny minority have health insurance. The rest have to pay in cash, which they manage to do only by pooling the resources of the entire family. When a patient has to be "confined" (admitted) to a hospital ward, a family member has to stay with them in order to fetch food if and when they need to eat (hospitals don't serve meals), and to accept "receipts" from the nurse for the many charges that the patient's treatment incurs. Meanwhile, the rest of the family scrambles to raise enough money to pay the hospital bill. If, when the patient is ready to be discharged, the family cannot pay the bill in full, the hospital's rules oblige them to keep the patient until they are paid. If the patient dies and the family cannot pay, the patient's corpse is held in the hospital morgue.