I have to start this out with my conclusion: I am incredibly fortunate to have round the clock access to medical care. As a public health worker, I have had plenty of lessons and experiences in the US on the importance of easy, culturally competent access to medical care for having a society that is overall healthy and happy. But in my recent trip to rural Indonesia, these lessons became immensely real and extremely frightening.
Lombok is a rather small island quite close to the Eat, Pray, Love setting of Bali. Like it’s famous neighbor, it is blessed with rich mountains, warm waters and kind smiles. In the southern region, it attracts mainly surfers because of its near perfect barrels. According to our local friend, not 30 years ago villagers would travel solely by walking across the 70km island from village to village. Nowadays, motorbikes are the main form of transportation and the main roads are surfaced, allowing an insane dance between giant SUVs and tiny motorbikes, gliding through mountain roads. Through American eyes, it’s like a continuous game of chicken.
While some roads are now surfaced, many are still dirt roads (think mud and boulders) that require equal amounts of skill and assumption of one’s immortality. As I have neither, I hired a local teen surfer (nick-named Hendrik, after Jimi Hendrix) to help get me to the waves. Having lived abroad some years back, I was used to hopping on the back of a bike and whizzing through the cities. The countryside? Not so much. As we sped away from the small village, my neck was already getting sore from whipping back and forth between the sapphire blue ocean and the emerald green mountains, and the occasional water buffalo. At the same time, I became more aware that the road was getting worse and worse, the rain heavier and heavier.
Hendrik weaves through mud, between boulders and dodges SUVs like a pro. I breathe deeply and think of the waves at the end of this road. As we round a bend, the road opens into a flat stretch and I sigh for a moment of relief. Looking ahead hoping for more relief, we see the bike ahead of us waver, and then spin out, throwing a man to the road. Within moments, we are with him as he screams in pain holding his head. His head hit a rock and is bleeding on the road. He is German and not speaking English at the moment. Another German is with him and talks to him as I try to find someone with a cell phone to call for help. No one. More motorcyclists arrive as they are traversing the island. All of them stop, maybe 20 people, and no one has a cell phone. Finally, a woman in a mini-van comes across us and agrees to take him to the hospital. By this time he is not talking anymore. He is just silent. Staring at the sky. We move him into her van, she does a U turn and disappears around the bend.
I have no idea what happened to the man. Standing there in the rain, Hendrik and I got back on the motorbike and drove slowly to the next town. He asked if I was ok (“not really”). I asked if he was ok (“sure”). Almost every day since then I have thought about this. Thinking about how much closer to death we are in different settings. In the US, many of us can successfully avoid thinking about our own deaths until we are quite old. The fact is that this closeness to death has so much to do with things that aren’t usually tied to “health” like having a way to call for help and having an ambulance system.
This “infrastructural barrier”, while vivid in rural Indonesia, is no less troubling here in the US and its territories. Journalist and author T.R. Reid starts out his eye-opening book, “The Healing of America,” with a story of a woman living with lupus (a serious, but manageable condition) who died at 32 after not having timely access to medical care, due to lack of insurance to help pay for the high costs of the services she needed. Time Magazine ran a piece by Steven Brill about a year ago on the outrageous costs of healthcare that received huge attention and concern from across the country. In our staff’s work and time in Puerto Rico, we have witnessed countless barriers in getting needed health care, particularly for stigmatized groups like drug users.
Back to the conclusion I started with: I am incredibly fortunate to have round the clock access to medical care. I live in New York City. I have insurance, a phone, a citywide emergency system that I am familiar with, and doctors that speak my language. But this is not the case across the city and country.
This is the definition of inequity.
It is unjust that some have this access and others do not.