For all the rancor infusing the debate over health care reform, we can be grateful in the United States to be arguing from a position of plenty.
Think about the issues that have proven so divisive. Should Medicare rein in the number of tests and procedures it spends on patients at the end of their lives? Should insurance pay for annual mammograms for women between the ages of 40 and 50? Should expensive insurance plans be taxed?
We have in this nation a bounty of medical resources and know how. The debate, at its core, is how to use those resources wisely and fairly.
Earlier this year I got a first-hand look at the other end of the spectrum.
Chicuque Rural Hospital is a collection of whitewashed concrete buildings on the shores of the Indian Ocean in Mozambique, a southeast African nation that ranks among the world’s poorest.
Founded in 1931 by a medical missionary, the hospital is one of the rare institutions to have survived Mozambique's tumultuous history, which includes three decades of war, ending in the early 1990s.
The wars left the country with little capital or infrastructure. More than half the population can't read or write, so it's not surprising that medical personnel —everything from surgeons to public health workers — tops Chicuque Hospital's list of needs.
That list is extensive and basic. Disposable gloves, a staple in any U.S. doctor's office, are in short supply at a hospital that supplements inadequate government aid with overseas charity. When the stock runs low, workers launder the gloves between uses.
Early morning brings lines of patients to the hospital's courtyard. Many pass the time resting on straw mats underneath trees. They will pay little or nothing for their care.
Some are there to take medications for tuberculosis and HIV infections. Others are acutely ill with malaria and dysentery. Many come with hernias, a common affliction in a land of heavy lifting. About 300 women give birth at the hospital in an average month.
"This is where the babies stay," said a surgeon, as he showed our group a room where sick children and their mothers rested on cots. “It is not much. We’re hoping to do more.”
You hear that a lot at the hospital. The staff hopes to one day have better lab equipment. They would like to build a special clinic to help malnourished children. Hope runs ahead of resources.
Jeremias Francas, the hospital administrator, thinks the best way to cope with the shortages is to reduce the supply of patients.
"In an African setting, there isn't as much a need for sophisticated technology as for education," he said. "If we can prevent cholera, we won't see those patients in the hospital."
He's right, but nothing is simple in Mozambique, where villagers still believe that the traditional "medicine men" can cure them of AIDS.
It’s been a struggle even to convince people that mosquitoes are the source of the devastating illness that is malaria. The insecticide-treated nets the hospital distributes are a tempting — and marketable — substitute for fishing nets.
Slowly, as funds and labor become available, the hospital is gathering a staff and building a community center that is meant to be a hub for health education. Its name is “Center of Hope.”
From the open windows of his small office, Francas can hear birds chirp and sandals slap as staffers and patients walk on the dirt paths outside.
Francas has seen the flip side of scarcity. He earned a master’s degree in hospital administration from the Texas State University in San Marcos.
There, he saw the long corridors and gleaming equipment and well-stocked supply rooms of a U.S. hospital. He went home to become Mozambique’s only professionally trained hospital administrator.
Francas doesn't begrudge the nations of plenty. He just hopes not to be forgotten.
“The first thing we need is prayer,” he said, as befitting the administrator of a Methodist church-affiliated hospital. “And we need friends.”
After that, they need nurses, bandages, medications … just about everything.
The one common thread between Mozambique and the United States is that health care is complicated, it’s frustrating and progress takes much too long.