Swine flu: a tale of two cities?

Why are nearly all deaths from swine flu in the developing world? 
Denyse O'Leary | 17 June 2009
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Now that the World Health Organization has declared swine flu (virus H1N1) a pandemic, their first since 1968’s Hong Kong flu, we might consider how it emerged. But first -- Panic Alert: People who are not already frail will probably be sick for about 48 hours if they get the swine flu. Symptoms, here, are typical flu symptoms. When visiting anyone in frail health, please observe all sanitary precautions that medical authorities advise.

Now let’s talk about two cities -- Mexico City and Winnipeg, Canada, where the virus was first identified. Health care differs greatly between the two. In Winnipeg, every sick person — rich or poor — just goes to “the hospital,” and is examined by a nurse practitioner and/or a physician who can order lab tests and a ward bed -- in an isolation unit, if necessary. It’s all tax-supported, so no one goes bankrupt from using the system.

Mexico, it is true, features world class medical centres, staffed by US-certified physicians — for the rich and for visiting Americans. Government and corporate employees get adequate care from managed health systems. But what of the poor, an estimated 44 million, more than twice the population of Australian and considerably more than that of Canada. These poor - people earn US$4 per day.

Mexico spends the least of the 30 members of the Organization for Economic Cooperation and Development on health care, and it shows. Mexico’s public hospitals are widely considered dirty, dangerous, overcrowded, and medically shortstaffed. So the poor avoid them. They do what poor people always do: Look for a solution they can afford.

And that solution is the pharmacist. Poor Mexicans go straight to the pharmacist, who can prescribe, in the words of a physicist friend who lived some years in Mexico, “practically anything,” based on the patient’s account of symptoms alone. The products may be cheap bio-similars.

Berkeley health economist Paul Gertler, who has worked in Mexico, told the Pittsburgh Post-Gazette (May 10, 2009) “Delaying medical care is a characteristic of poverty. For people living close to the edge, taking off a day to visit a doctor or staying home sick is literally taking food out of their mouths.”

So no waiting. And no big income loss. But also, no doctor, no lab tests, no isolation. That’s where the problem starts.

The poor man’s system sort of works. True, the pharmacist might be prescribing an anti-bacteria medication to fight a virus. But in crowded, dirty conditions, bacteria compete with viruses to see the patient into an early grave. So knocking out the competition gives the patient’s weak immune status an edge. What it doesn’t give is vital information to health authorities about the progress of an epidemic.

Sadly, some of Mexico’s host of self-medicators became too sick to be saved, including younger people who would likely beat the illness in Winnipeg. This is the difference between health care systems that work and ones that don’t.

Flu kills thousands of people worldwide every year. But most are frail elderly who would likely die in the next few years of another cause, perhaps a different flu. In a global world, media attention should more usefully focus on health care defects in developing countries.

And for Christians, the key message is, someone else pays when we don’t. If we insist on the cheapest price and the cheapest labour, we tacitly maintain failing systems elsewhere, and we share some responsibility in the outcome.

Denyse O'Leary is co-author of The Spiritual Brain. (A link of interest: Brian Lilley’s Hype or right?: Did the media overplay swine flu or perform a valuable public service?)

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