Commentary: Cuts to U.S. health funding will bring pain without end

I’ve just been in tooth hell for a week. An abscess left me dazed and in constant pain day and night. Finally, a dental surgeon cut my tooth into pieces to extract it, leaving a hole in my gum that still aches. I take two antibiotics, rinse with a third, wash with warm salt water and take pain killers.

I write about my tooth ordeal because as I sat reading National Geographic in the waiting room to distract my mind from the impending “procedure,” I thought of the billions of people who have such pain day and night throughout their lives. Pain without end.

These are the ones we see in the late night video fund raising appeals. Or those selling fruits in the background of news photos from Abidjan showing burnt trucks and soldiers strutting across the pavement.

I’ve spent more than a decade overseas in very, very poor countries writing about politics, war, climate and agriculture. But I always knew that when I or my family was in need of medical care, there was someplace we could go. In Casablanca or Bangkok or Colombo or Delhi I always found a well-trained doctor or dentist.

When my baby girl was born in Bangkok the obstetrician had been trained at University of Chicago. When she developed jaundice and need a full transfusion of all her blood the pediatrician had been trained at UCLA.

But as I traveled around India, Thailand, Cambodia, Laos and Burma in those years, I saw millions of people unable to afford even the most basic medical care or medicine. That’s why the exiled Thai prime minister Taksin Shinawatra won so much support from the poor – even though he’s a multimillionaire and convicted of corruption: he had set up ultra-low cost medical care for everyone or the first time.

My tooth brought home to me that hundreds of millions of people suffer constant pain that they cannot ease. It is pain that makes it hard to think, to sleep at night or to do one’s daily tasks.

When I hiked with a Canadian doctor in northern Pakistan several years ago, climbing through the villages towards the glacier off Trich Mir mountain (25,000 feet), an old man stood by the trail with his wrinkled hand out to we two foreign trekkers. Inside he held two small white stones. And he pointed to his mouth.

He was asking for aspirin for a toothache. We had nothing to give him.

Further down the trail we saw a cluster of villagers who asked us to draw near. A young man lay on the ground, his calf swollen and hot to the touch. Helpless, all we could say was to soak it in warm salt water. What it needed was an x-ray, draining, setting of a broken bone, antibiotic or other standard medical care. At worst, amputation could save his life from gangrene. But to reach a doctor he would have to be carried for three days down the mountain and then pay for a ride on a jeep to the district hospital in Chitral.

Yet hours later a helicopter flew over our heads up towards the glacier, returning down the mountain a half hour later. When we reached the glacier we saw a dozen climbers descending towards us – Italians. They told us the chopper had taken away the body of one of their team mates who died in a fall.

So even while dead the Western man had access to the ultimate in care. The cost of the helicopter ride could have covered the cost for medical care to the entire village for many years. But the old man with the sore mouth and the young man with the injured leg were left to suffer.

Private, religious and government aid agencies have brought medicine and treatment to millions. The U.S. government alone has spent billions to fight HIV/AIDS, malaria and TB; and to train midwives and health workers. In addition, most people in poor countries now live in urban areas close to government or missionary hospitals. Buying medicine is another issue entirely.

Yet even as countries from Egypt to Indonesia to Nepal struggle to train nurses and doctors, the brain drain lures them to Europe and America for a better life. Last winter in Katmandu I read an ad in the paper for nurses offering them $8 per hour if they move to London. That is about 50 times the government salary for a nurse in Nepal.

In Afghanistan in 2004 I met a man who was the only psychiatrist in all of northern Afghanistan. But instead of using his skills he was a driver for a foreign aid group paying him $500 per month, 10 times the government salary for a doctor.

My tooth-related thoughts came to me as our nation was gripped by the budget debate which seems all but certain to cut U.S. foreign assistance for health. So it is vital that U.S. aid agencies prepare to do more with less by:

-- investing in special medical procedures and medicine aimed at developing countries, perhaps using locally-available medicinal plants such as Chinese wormwood for malaria as well as high-powered generic modern antibiotics that can be stored in hot, humid climates for many years.

-- training trainers – teaching local people to spread knowledge and practice of hand washing, soap production, sterile wound dressing, tooth brushing and other basic health practices.

-- training local medical workers who can treat the basic illnesses such as sprains, skin lesions, bronchial infections and even pneumonia. But they know when to refer a patient to a hospital.

-- offering incentives to doctors and nurses that keep them from emigrating. Governments can give doctors land to build houses – a strong incentive to remain in country.

-- invest in clean water and food production while spreading knowledge of oral rehydration therapy for dysentery and healthy cooking practices that preserve nutrients.

-- use cell phones so health workers can collect medical histories, symptoms and photos of patients in the rural areas which can be emailed to doctors in the cities for diagnosis and treatment plans.

Of course much of the problem is cultural and will await some evolution. For example, in Pakistan and in Guatemala, even if there are sufficient doctors and dentists, they will not move their families to the bush where there are no schools and life is primitive compared the major cities.

A U.S.-funded hospital in Yemen’s Marib province had to build a separate house with two air-conditioned apartments and complete security to entice doctors to live in the midst of a desert far from the amenities of the city. With improved transport, medical teams could also visit remote areas for two days of treatment each week or two.

There is nothing like a week of unrelenting pain to remind me of how much needs to be done in the coming years to provide decent medical care to so many human beings around the world.

This applies as well to the 40 million American without medical insurance.

When I saw thousands of Americans in the Middle West flocking to a free treatment fair for dental care a few months ago, I felt ashamed of my own country. Now millions more face possible cuts in Medicare or Medicaid as budget cutting threatens the New Deal and the Great Society with a Darwinian future.


Ben Barber has written about the developing world since 1980 for Newsday, the London Observer, the Christian Science Monitor, Salon.com, Foreign Affairs, the Washington Times and USA TODAY. From 2003 to August, 2010, he was senior writer at the U.S. foreign aid agency. His photojournalism book — GROUNDTRUTH: Work, Play and Conflict in the Third World — is to be published in 2011 by de-MO.org. He can be reached at benbarber2@hotmail.com.