SPECIALS
ex
007 in Africa
Health System Break-Down
Quickroute Paddy
in buenos aires
GOLDEN SHOWER
beatroot Polish health service needs
the kiss of life
ex
007 in Africa
One Issue Voter
southron
Health insurance? What’s that?
Ms
Carnivorous.
My
dentist
June 24, 2008
ex
007 in Africa
Health System Break-Down
I'm looking for a counselor. Because even with a good job, interesting
friends, a nice apartment that I share with easy roommates, and excellent
health… well, I still sometimes wake up with a feeling of emptiness in my
throat.
It's hard to make the initial decision to see a counselor. It's not a stigma
issue - I'm not embarrassed to ask for help. This issue instead is: do my
measly problems really justify wasting a professional's time? I don't have
post-traumatic stress disorder, I'm not recovering from abuse, and I'm not
going through a unbearable divorce. I'm just a 30 year-old girl who works
too hard, tries to have meaningful relationships, and is looking for
guidance in making the right choices.
I called a counselor recommended by a friend of a friend. The receptionist
was very calm and soothing, but immediately told me that the initial visit
was $400 and subsequent visits would be $220…oh, and the doctor doesn't
honor health insurance.
I looked for a few other providers listed on my health insurance's website,
but:
1-a lot of them were male, and I would prefer to talk with a female;
2-the few that work in my area are HIV counselors, combined with a specialty
in social work. That comes with the territory I suppose. If you live in a
depressed area, counselors cater to the neighborhood's audience. I'm not
really looking for someone who can help me come to terms with the fact that
my no-good boyfriend left me homeless with three kids, and stole my stash. I
hope you'll forgive the oversimplification, but I volunteer in a shelter,
and that's where social workers can really help. My life is infinitely more
boring and banal than that;
3-some of them don't take new patients. This fact alone makes me loose
confidence in their abilities. I mean, isn't the whole point of therapy to
help patients with their issues? In that case, why is the office so busy
with old patients that it can't accept new patients? Are their patients not
getting better at all?
It's all pretty discouraging. No wonder people don't seek help when they
need it most.
Quickroute Paddy in buenos aires
GOLDEN SHOWER
In homes,
apartments, and shanties throughout Buenos Aires,
thousands of graying women joyfully pee into plastic
containers at all hours of the day.
It isn’t exactly the picture postcard image that
Argentina’s Secretariat of Tourism wants spread around the globe.
Gauchos, mountain peaks, tango, Patagonia, steak – now that’s the stuff of
travel brochures.
Yet at any given moment, there are thousands more 65-year-old matrons
holding a piece of Tupperware between sagging thighs – silently praying that
their hand is steady and aim direct – than tight-assed 20-year-olds twirling
the Tango.
Properly aged piss, it turns out, is one of Argentina’s least-known but
most-valued exports.
The liquid gold from the ripe bladders of post menopausal women has been
helping “float” the Argentine economy by tens of millions of dollars a year
for the last decade. Somewhere deep within the pungent molecules of
senescent whiz – we’re clearly running out of original ways to say pee – is
a high-value hormone used to combat infertility in younger women with ripe,
but unwilling eggs.
“At first I said no,” explains a donor. “Now they bring me a little gift
every month but I don’t donate it for that, but because it’s for a good
cause, and if I’m going to flush it away anyway.”
For every 200,000 litres of post menopausal urine, one gram of the
Gonadotropin-Releasing Hormone 1 (GNRH1) can be extracted. This is a bit
like evaporating a lake to get a glass of water.
It may take only an hour for three beers to pass through the bladder, but
getting GNRH1 out of the pee is a four-month process. However, that one
single, solitary gram can create around 2,000 doses of fertility promoting
medication. It is in demand across the globe.
A study presented to the European Congress of Human Reproduction and
Embryology found that more than five out of every 100 women with fertility
difficulties treated with this hormone would successfully become pregnant,
“which is clinically very significant,” affirms Anders Nyboe, the principal
investigator of the study.
The drug works by the application of a “massive doses of follicles that
stimulate the ovary to produce a great quantity of ovum,” explains Claudio
Chillik, director of the Centre of Studies in Gynaecology and Reproduction.
With a greater quantity of ovum (or egg cells) successful fertilisation is
more likely to occur. A Swiss researcher figured this out in 1962. And we
thought they only made chocolate.
Oh, and it also can work on men. About 1% to 2% of infertile men have a
gonadotropin insufficiency. GnRH is an effective treatment for them too,
helping turn recalcitrant sperm into Olympic champions. Get grandmother
another beer!
It’s still dark in Buenos Aires, but the smell of morning is in the air.
Birds are beginning to sing, delivery trucks are starting to roll, and men
are picking up bottles of fresh piss from front stoops. Morning never
smelled so profitable.
The urine collectors are from a company called Biomás.
On any given day they will gather unknown quantities of plastic
yellow-filled containers. The truck you pass on the way to work may be
hauling hundreds of litres of tepid urine.
If trucks filled with urine left a trail they would lead you to the
Instituto Massone. This is the collection point. The refinery. The place
where urine goes in and hormones come out. Instituto Massone is the only
Argentine laboratory to engage in the “dark art” of pee to hormone
transformation.
It must be very profitable. Europe and the US form the principal market for
the hormone of which Argentina is the world’s greatest exporter, satisfying
more than 80% of the global market. The rest comes from China and Japan
where, we can deduce, senior citizens just don’t have the same quality
“right stuff”, as those from here in Buenos Aires.
Back we go to grandmother’s house. She is carefully snapping the lid on a
container careful not to spill a drop. The great majority of donors belong
to Buenos Aires’ middle classes, they’re over 60 years of age and retired.
And, for taking the time and effort to fill the jug, they are paid nothing.
Nada. Zilch.
Oh, they do get a lovely monthly gift. Well, it isn’t all that lovely. It is
actually worth almost nothing. You see, there is this little law in
Argentina that prevents ‘the commercialisation of parts and materials of the
human body” which would make any form of official payment for the urine
illegal. So, to stay within the law, Biomás hands out household goods
ranging from breakfast trays to juice jugs. Apparently the juice jugs are
recyclable, if you know what we mean.
Why do elderly women go to all this trouble for kitchen trinkets? The most
common response that donors give is that ‘it helps women that cannot have
children’. Although there are sometimes other, less obvious, incentives: “I
like to donate because it’s like helping. They greet me…and that’s nice,
above all for me because I live alone,” says another donor.
Not all of the women are completely sure of what the future might hold for
their unconventional donations once they make their last deposit and put the
drum out on the front porch before turning in to bed. “They explained to me
that it was for medicines and for creams, I think, I don’t remember,”
confesses one of the donors, aged 70.
The future of this potentially colossal market leads to some fabulous mental
images: makeshift hollow stools amongst a daily vegetable market where
elderly women display clusters of yellow vials. They take turns calling out
their individual GNRH1 counts and prices per litre.
- - -
So if pee could potentially be worth as much as this, I guess the old phrase
'golden shower' has a whole new connotation!
Quickroute Paddy in buenos
aires
beatroot
Polish health service needs
the kiss of life
Or
something even more intimate. The Polish government have decided to have a
‘White Summit’ where government, president, medical profession and unions
all get round a table and talk about stuff.
The health service is short of doctors, who, like nurses, earn a pittance.
Strikes and threats of strikes are the norm. Some of the often crumbling
hospitals are a health risk to anyone unlucky enough to be sick in one of
them. The sector needs some radical surgery and intensive care. The
government may have to administer some bitter pills (and other
pharmaceutical metaphors). It needs the kiss of life, but all the health
service gets is a talking shop and another opportunity for Tusk and
President Kaczynski to get at each other’s throats. It’s another case of
this government looking like it really hasn’t a clue what to do. So better
set up a commission, a round table, a summit. I think they are just passing
the buck.
Personally, I go private
Usually. Today, however, I had to go to the state works doctor to get a sick
note and medicine for my chest infection. When I turned up and said to the
nurse, whose head appeared through a square hole in the middle of a wall,
that I needed to be seen, the doctor – a miserable, toad-like individual –
initially didn’t want to see me. I think I was keeping him from his private
clinic duty – the only way a doctor can stay in the profession is to do
private work.
“But I have a contract with this organization, I pay social insurance and I
am sick. I want to see a doctor. Oh, and I want some antibiotics, too.”
I always self diagnose. It seems to annoy doctors – which is fun.
Grudgingly, he relented: “Get his card and tell him to wait,” I heard him
tell nursey.
So I waited. And then, I waited a bit more. I read some of the drug company
flyers hanging around the place. And then I did some more waiting. I paced
around the little waiting room, all the while waiting some more. I went
outside the waiting room and down the corridor - but even there, I was still
waiting.
I went back to the hole in the wall, just to give me something to do while I
waited. The nurse hadn’t even bothered to get my ‘card’ yet.
“Can I have my card”?
No I couldn’t, because I didn’t have a card, because I had never been to see
the doctor there before.
“And you can’t see the doctor without a card.”
“So could we…make a card?”
She got out a card. “Pesel?” It's a number and I don't actually know it.
“If you don’t have a number then you can’t have a card. And if you don’t
have a card then you can’t see the doctor,” she said triumphantly.
I completely lost my temper - I am sick, after all - and ripped up the half
filled out ‘card’ (very dramatically) and stormed out the door.
What have you gotta do in this place to get to see a doctor? So I went
private.
In the LIM clinic in the centre of Warsaw, about seven rather nicely dressed
receptionists are waiting to help with every need, as long as it is medical.
They fill out the cards for you as if they were honoured to have the
opportunity. They smile and talk about the weather. They then assign you a
doctor. They give you a clinic number and say: “Room 9 and that will be 80
zloty, please.”
I waited outside No.9 for five minutes, sitting next to a man whose heal on
his foot appeared to be pointing forwards, with his toes pointing backwards.
Nasty. And then the doctor called me in.
She was nice but did what all Polish doctors do. They diagnose you, and then
they write out a list of medicines and supplements as long as the Magna
Carta. And the cost of the anti-biotics (yup, I got them) plus nose
decongestant, chest decongestant, calcium (they always prescribe calcium for
everything) something to counteract the effects on the stomach of the
anti-biotics you are taking, anti-cold remedy….comes to the total planned
Polish health service expenditure for 2008.
Are doctors on the make with drug companies, or what?
I would like to go to only state doctors in a state health service. But
until they get serious, fund the thing properly, get rid of the inefficiency
and corruption, I’m going private.
beatroot
at 1/22/2008
ex 007 in Africa
One Issue Voter
December 10, 2007
I fear I have become a one-issue voter. My
issue? Health insurance.
Surely there's got to be a better way to do health insurance, from a country
that is so technologically-sophisticated, and customer-service orientated.
This always happens:
1-I go to the dentist/gynecologist/doctor once a year.
2-I work with the medical office to ensure that my paperwork is accurate and
up-to-date.
3-I pay the entire bill. My insurance promises to reimburse the allowable
fees. That still leaves with having to pay $538.20 that day, of which $300
will be covered by my health insurance and $248.20 (I sometimes really
wonder why I am paying $150 per month and yet still have to shell out $250
out of my own pocket).
4-I go home feeling healthy, yet disgruntled at having had to wait 1 hour to
see the dentist/gyncologist/doctor, when I arrived perfectly on time.
5-Three months later, I still haven't been reimbursed the $300.
6-I call the insurance company. They tell me that my dentist/gynecologist/doctor
hasn't submitted the claim.
7-I call my dentist/gynecologist/doctor. The office tells me that they did.
In fact, they sent the claim months ago. The office is annoyed, but sends
the paperwork again.
8-I wait another month until reimbursement.
Can you imagine if you had 3 kids, which means three times as many
appointments, and just a 1/3 of the time to follow-up with all of these?
What if you were a cashier at Giant on your feet all day, then had to rush
to school to pick up the kids at 4 pm, then spent all your evening cooking,
checking homework, giving baths, and doing laundry. It's impossible!
No wonder people are reluctant to go to the doctor's.
Whichever candidate proposes to streamline and simplify the process, gets my
vote in November 2008.
ex 007 in Africa
southron
Health insurance? What’s that?
Providentially for me, I enjoyed decent health until the accidents that
crippled me in 1998. By that time I was living outside the United States, so
I was able to afford health care even without insurance. (Admittedly, some
of the health care was provided by practitioners whose credentials might be
considered by some–anyone with an IQ above 30 –as suspect. I remember that
on the island of Nevis they only had one class of physicians, and
consequently even Chiropractors could prescribe drugs- “take two of these
pills daily, and return three times a week forever”. The the university
degree of the chief health officer of the island, a doctor whose name I do
not remember, was R.N.)
But all of that changed when I came to Uruguay! Every legal resident who
pays Social Security is entitled to choose from among several HMOs which are
totally paid for by one’s Social Security contribution. In addition, there
is also a government health service to care for the needs of the poor, and
private health insurance as well (for which I could not qualify because of
my pre-existing conditions).
Since I am working and paying social security I now have health insurance.
Santiago researched the various plans and chose COSEM because it was reputed
to have the best doctors and the newest facilities.
Eight days ago I went to COSEM for the first time to see a general
practitioner in order to get a referral for a specialist. I was impressed
with the modern facility. I did have to wait about an hour to see the doctor,
but I have waited longer than that in the US and then had to pay $120 for
the privilege. This visit cost me nothing. The doctor gave me a referral to
a dermatologist to deal with the skin on my left leg which had been ravaged
by a seven-year long staph infection.
Perhaps the most impressive thing was that the doctor did not tell me to put
Dr. Selby ointment on my leg–in Uruguay Dr. Selby is the equivalent of “take
two aspirin and call me in the morning”.
Santiago went to the front desk to make the appointment for me. He was told
that there were no dermatologist appointments available for more than a
month. However, the general practitioner had marked my need as “urgent”, so
the scheduler told Santiago he would find an appointment for me quickly and
call us with the time and day. That was Friday, March 7.
My appointment with the dermatologist was on Tuesday, March 11. I don’t
think I could’ve gotten in that quickly in the US under any circumstances
short of third-degree burns covering 80% of my body.
When the day came for the dermatologist appointment I cleared my calendar
just in case there would be a long wait. To my pleasant surprise, there wasn’t.
I was the second person on the list, and don’t think I waited more than 10
minutes. The dermatologist was knowledgeable, and gave me some prescriptions
that have helped me tremendously. I started seeing improvements very next
day. Some of the things the doctor prescribed were available right there at
COSEM’s pharmacy and were extremely inexpensive. The rest we had to buy at a
local pharmacy, but the price there was discounted as well because of my
COSEM membership.
The whole process was easy, and frankly, encouraging. Virtually every
encounter I have had with physicians in Uruguay has been positive.
I say virtually because there was one doctor that I had to endure who
started out with the tired old litany of “you’re overweight”. Gee, really? I
didn’t know that: I thought I was the perfect weight for someone 7′6″ (2.25
m). That encounter was actually pretty funny because, as she was talking, in
Spanish of course, Santiago became visibly upset. He told it was because he
knew I would not like what she said. I told him that I would absolutely not
be angry or upset because I intended to ignore her completely.
Those who know me even casually know that I am a libertarian/right-wing nut.
By rights, I should hate the medical system here. But I can’t, because even
before I am a libertarian, I am a utilitarian; and Uruguay’s medical system
WORKS!
southron
Docs and Quacks