A letter from Doug Orbaker in Nicaragua
August 2010
Health Care: Nicaraguan and U.S.
I’ve had three encounters recently with health care: two of them in Nicaragua and one in the United States.
The first was a young woman with one of the delegations who returned to Managua from the rural area where we were working with a seriously infected foot. I took her to the emergency room of the Baptist Hospital, one of the best private hospitals in Managua. She received excellent care both in the emergency room and after she was admitted, received IV antibiotics and antibiotic pills as she returned to Canada with her delegation. The Canadian doctors examined her foot, continued the same treatment and assured her that the quick action of the Nicaraguan doctors had saved her foot. The total cost (emergency room, overnight in hospital, lab tests, medicines, etc.) was just slightly over $400.
The second encounter was with a volunteer who had spent eight weeks in a community in the Matagalpa area. When I arrived in that community with another delegation she had been suffering from diarrhea and vomiting for a couple of days and was becoming quite dehydrated. Since my vehicle was the only one in the community I took her to the hospital in Matagalpa. I know that there must be private clinics in Matagalpa, but I don’t know where they are. The public hospital, however, is large and easy to find, so we went there. I usually don’t use the public health system because I don’t believe that U.S. people with money to pay for health care (at least at Nicaraguan prices) should use the scarce resources available to Nicaraguans. However, I didn’t know where else to take this young volunteer.
I have had a few other experiences of taking members of delegations to one of the best private hospitals with the same symptoms of diarrhea, vomiting and dehydration. The doctors at the public hospital did exactly the same things, took exactly the same tests and re-hydrated the young woman with the same kind of IV solution. There were no questions about whether or not she was a Nicaraguan citizen or the status of her visa. Of course the public hospital is more crowded and not as comfortable, but the surprise for her came when she left the hospital. The bill? Absolutely no charge! The public health care facilities of Nicaragua have no way to receive and account for money, even as a donation. In fact, it is against the law and a doctor could be fired for accepting such a donation. The same quality of care as at the best private hospitals, absolutely free!
Doug Orbaker recovering from hip surgery.
My third recent encounter with the health care system is here in the United States. In fact I am currently in the United States, recuperating from surgery for a total hip replacement. The care of the hospital here (in a separate Joint Replacement Unit) is amazing. My surgeon is part of a 10-doctor orthopedic practice, and he is the “hip specialist.” The relationship between the surgeon, the hospital and the physical therapists is completely coordinated. A week after the surgery I am almost completely pain-free and the physical therapist is pushing me harder every time I see him. I expect to be off the walker by next week and to be ready for the replacement of the other hip in early October in order to return to Nicaragua by the end of the year. I know that many people all over the United States and Nicaragua have been keeping me in their prayers and I thank all of you for that. Of course the cost of my hospitalization here in the United States will be somewhat different from even the most expensive private care in Nicaragua.
All of these experiences have made me think about the whole health care debate. If a country like Nicaragua (the second poorest country in our hemisphere) can afford to have a system that gives basic care to everyone at no cost, why can’t the richest country in the world afford it? If a poor country like Nicaragua can give free health care to a (relatively rich) college girl from the United States, why can’t a rich country like the United States give basic health care to everyone within our borders, without asking to check their documents?
Yes, I chose to come to the United States for hip replacement surgery. Not everything is available in Nicaragua, and especially not the level of specialization that I have enjoyed here. And yes, of course, the public health care system of Nicaragua is not perfect. Local health centers sometimes run out of the most needed medicines, specialized surgeries are not available, sometimes the waiting line is long and there are a host of other complaints. But the fact remains that basic-level health care is available free to everyone in Nicaragua, citizen or visitor, not just in hospital emergency rooms but also in tiny local health posts in little rural communities all over the country.
I hope that you will continue to keep me in your prayers as I work through the physical therapy and prepare for the second surgery. But please pray also for the people of Nicaragua as they struggle with huge issues of health care. As Christians we believe that God created this world with enough for everyone’s need, but not enough for everyone’s greed. As the health care debate continues, even after reforms have been passed, may we work for a system where everyone (in Nicaragua and in the United States) has access to basic health care, even if that system doesn’t include specialized care like my hip replacement.
Please continue to keep me in prayer, and I hope to be off of this walker by the time you read this.
Doug
The 2010 Mission Yearbook for Prayer & Study, p. 282