A Tale of Two Health Systems

It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, but that’s always how things are in Nigeria. Striking juxtapositions of polar opposites – wealth and abject poverty; intellectual brilliance and illiteracy; exemplary honesty and guiltless corruption – are part of everyday life and few feel the need to do anything about it. Folake is one of the few. Since she started medical school in 2008, she has focused on understanding health disparities and thinking about ways to eliminate them. She has plans for Nigeria and certainly has the drive to see them through. In June 2011 however, she broke up with her fiancé and temporarily lost much of her motivation to do well in school. After four months of depression and one suicide attempt, her parents decided to seek medical assistance and got her admitted to a private hospital in Ikeja, Lagos – one of the best private hospitals in the state.

At the hospital, Folake’s parents were informed that they had to pay a portion of the fees before they could receive any care. Luckily they are well off, having both had successful careers in the business industry. They paid with few complaints. Unfortunately, the hospital was not quite as ready to fulfill its part of the bargain. The family soon realized that when tests were ordered, they had to personally walk over to the laboratory to ensure that the appropriate studies were being performed. Worse still was the minimal patient monitoring that was provided at the hospital. The parents took turns watching their daughter because no one at the hospital had time to do it. One lapse in their surveillance efforts allowed another suicide attempt that left Folake with a broken arm. Disappointed with the private health sector, Folake’s family decided they would seek orthopedic care in the public sector, electing to pursue care at one of the National Orthopedic Hospitals. Through a friend of a friend, they were able to get their daughter admitted to the facility. Folake did not see a doctor until the third day of her admission. The family was then informed that the hospital’s x-ray machines were broken so any imaging studies would have to be done at a private facility, an hour away. At that point, Folake’s parents were so frustrated with Nigerian health care that they flew her out of the country. This option was only available because they could afford it.

A few thousand miles away in Chicago, Illinois, Stephanie was starting to have mood issues of her own. A week after losing her husband in a car accident, she visited her doctor who promptly committed her to the psychiatric ward of a nearby hospital. Somewhere in their discussion she admitted that at one point during the past week she had thought about hurting herself. A week, two MRIs and multiple lab studies later, the attending psychiatrist deemed her fit to leave, discharging her with prescriptions for anti-depressant medications. Fast-forward two months and things aren’t going well for our young widow. Without her husband, she is barely able to make ends meet. Then she gets the bills in the mail for her stay in the hospital. The responsibility for paying $7,600 in hospital fees is too much for her. She too decides to make an attempt to end her life…

That the structure of the health system (or lack thereof) played a part in the health outcomes of these two women is unquestionable. On the one hand, Nigeria’s total lack of healthcare regulation exposed Folake to the devices of incompetent health care providers whose efforts were directed at extorting money from the patient. On the other hand, the practice of defensive medicine that is now common place in the United States Health Sector led to bankruptcy and the sense of financial helpless that left Stephanie stranded. Perfection in the design of healthcare systems still eludes mankind, but some places do it better than others. Sick Around the World is an hour-long documentary that explores the features of different health care systems around the world. It’s a must see for anyone interested in working through the challenge of delivering healthcare at the national level. Policy makers and health care providers in Nigeria and in the United states can benefit from the insight provided in the video as we seek improve the way we take care of our citizens.

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