When I immigrated to the United States to pursue surgical training from Jamaica, I thought I was entering the center of advanced first-world healthcare. In many ways I was right: the U.S. has the most advanced technologies, the top doctors, and cutting edge researchers who are finding cures and fascinating discoveries for some the world's most menacing diseases. But in many other ways, I was naive.
Today, as I complete my fifth year, now as a Chief Surgical Resident at Harlem Hospital Center in Manhattan, I have learned that it's the extremes -- the huge disparities in the delivery of care -- that truly define the U.S. healthcare system. Just one day on my surgical ward paints the picture.
On its face, my day looks a lot like that of any other resident's. Starting at about 6:00 a.m., I conduct a round of the patients who stayed over night. I catch up with the night nurses, check X-rays and test results that came in during the night, and talk to colleagues and junior residents about the surgical case load ahead.
Then at about 7:30 a.m., I scrub in for the first of anywhere from three to ten scheduled surgeries. Trauma surgery, vascular surgeries including dialysis access, bariatric, breast, bowel, orthopedic, neurosurgery and thoracic surgeries are some of the most common at Harlem. On a good day, we'll receive no emergencies, no victims of car accidents or interpersonal violence.
And then at about 8:00 p.m. we're wrapping up, updating medical records, and finishing up other loose ends of a typical 14 hour day in the busy level I trauma center.
But there are key differences from the surgical wards at Harlem Hospital and those of any other private hospital across the nation. My patients are not the wealthiest, and many times, they aren't the healthiest when they get here. They represent the diverse ethnic groups of the city: African Americans who have lived in the neighborhood for generations, immigrants from the Caribbean, Central America, Mexico, and East and West Africa. But their diversity is overwhelmed by one common, determining factor: the majority are low-income minorities--the same group that is least likely to have access to primary healthcare and most likely to have the poorest health outcomes.
This means that for me, even with routine surgeries, I too often close the medical file knowing that the patient got to me too late. The cancer has spread too far, the diabetes has ravaged the body significantly, and the heart has become very weak. The opportunities to add meaningful years to my patients' lives seem to have been missed many years before. All I can do is make their last years a little more comfortable and of a better quality.
I can't tell you how frustrating this is from a medical perspective. It's not just that I know how many lives we could save if my patients had access to preventable care; it's also that I see the many millions of dollars that are wasted on expensive, emergency sick care.
It continues to baffle me that the richest nation in the world seems to be comfortable with being one of the sickest nations in the world. The statistics are clear: more than one in five African Americans are uninsured and they have the highest rates of death due to diabetes; heart disease; and breast, lung, and colon cancer than any other ethnic group. These numbers haven't improved since I've been here. If anything, they seem to be getting worse.
Recently, I have appreciated hearing the words "universal healthcare" thrown around by the 2008 Democratic presidential candidates, but I know better than to trust they will deliver if we don't take a strong stand. Since it's Black History Month, it seems as good a time as any to start taking responsibility for our healthcare failures. Let's start talking about it, lobbying members of Congress, and reminding everyone that we can build America's healthcare system into the ideal that I had dreamed it was and that I know it can be.
It's high time the wealthiest nation in the world become the healthiest nation in the world. And it's high time that patients like mine have the same opportunities to live healthy, full lives.