Of Umbrellas and Safety Nets: Health Care in Acute and Chronic Crisis

This past Friday and Saturday, a conference called Beyond Acute Care had speakers and panels discussing health care issues concerning the elderly, disabled, and other vulnerable citizens. The illustration of what is currently happening our health care system is something like this: there is an umbrella over top of this population, which takes care of most acute needs. However, when the need for care becomes chronic, the umbrella gets smaller and smaller, with more and more services needing to be paid for out of the pockets of the patients or their families.

These issues are of importance to everyone, regardless of age or health status. Many of us, if we are fortunate, will become senior citizens some day. With the health care system being so precarious now, worrying about what it will be like decades from now is justified. As well, life can change in an instant. There are those for whom an accident, a brain injury, or a serious mental illness suddenly took them off of their current paths and into the chronic health care system. As well, if you are like me, you may become a caregiver to an ill parent, taking precious time from your work time and social life to attend to her needs while being faced with decisions concerning what to do when the situation becomes too medically complicated to deal with, without some outside form of help - help which will likely come with a price tag.

The "umbrella" of which the organizers of the conference speak has another name: the safety net. One with a lot of holes through which the vulnerable fall. For example, an elderly person falls, breaks her hip, and has to be hospitalized. Her acute needs are taken care of: she gets a hip replacement, some initial physical therapy, and during her hospital stay gets medication she needs for the pain. However, due to her injury, she can no longer live at home, unassisted. She either has to get live-in help or move to a long-term care facility - neither of which are inexpensive options. Plus, she has prescription medications that, while subsidized because of her age, still cost a significant amount out of pocket for someone on a fixed income.

So really, when a medical situation goes beyond the need for acute care, things get quite precarious. Even within acute care, a person's finances can be stretched. Prescription medication is perhaps the best example of this. I had an ear infection requiring antibiotic drops a few years ago. The tiny bottle of medicine cost around $35. That is a lot of money for someone on a budget. People who have chronic conditions like MS have medication they have to be on for the long haul. Unless they have good private insurance from their employer (which is getting rarer and rarer these days) or have purchased insurance on their own, they are financially hooped.

Related to this are the ridiculous fees one has to pay to see a dentist, which is also not covered unless you have private coverage. Last year, I had to have two fillings, a check up, and a cleaning. The bill came out close to $1000. I don't have insurance, so the bill caused me quite a bit more pain than my cavities. It was also a reminder as to why I had not been to a dentist for five years. However, infections and abscesses originating in the mouth can lead to death. I can't understand why dental work is not covered by our health care system. Since we're talking about older people, they often need extra dental care and procedures like having dentures made for them.

Another issue affecting our health care system is the pay and treatment of Alberta Health Services Support Workers. The wildcat strike held by members of the AUPE at the Royal Alex and University of Alberta hospitals on February 16 was a wakeup call to many to these workers' conditions. Perhaps it is my OCD tendencies speaking, but I want the person responsible for sterilizing equipment for a procedure to be well-treated and well-paid. The very fact that over 60 elective surgeries had to be cancelled demonstrated the importance of these people to the proper functioning of the health care system. Respect them.

It is a government's job to make sure its citizens are healthy and protected. There is a provincial election around the corner. Pay close attention to what the candidates are saying about public health care. If anyone even breathes the word "privatization" - be afraid. Be very afraid. Because no matter how much they promise that the system will be arranged in such a way that everyone will have access, regardless of their financial situation, invariably it will turn into a situation where those who can pay will get treated first, and better. Instead, choose those who will make our public services a priority and put money where it is needed. After all, like closing speaker Maude Barlow (National Chairperson of the

Rally for Public Healthcare

On December 4, around 500 people rallied at the Alberta Legislature to show their support for public healthcare. Speeches were presented from Dr. Raj Sherman and his lawyer, MP Linda Duncan, Friends of Medicare Executive Director David Eggen, and numerous other people who deplored any suggestion that Alberta's healthcare system may become two-tiered. Dr. Sherman's lawyer announced that he will be launching an investigation into the whisper/smear campaign against his client for speaking out against the problems in the healthcare system. Here are photos from the rally as well as a video of Dr. Sherman's speech.

Access to Mental Health Care in Crisis

Although this first appeared in the October 2005 issue of Our Voice (a street newspaper in Edmonton), it is every bit as relevant five years later, especially as closure of beds at Alberta Hospital are on the horizon and have been widely protested. The cost to see a psychologist mentioned in this article has been adjusted to reflect current rates.

---

It was a Sunday afternoon, and my friend ran out of his medication he uses for clinical depression. Although he has a full-time job, he was lacking the funds to purchase more, and too proud to tell anyone. Thus, he went about his business until Tuesday morning, when he felt a psychotic episode coming on. He headed to his doctor’s office, where after explaining his situation (with the hope that his doctor could give him some samples to tide him through), he was told he would have to return for an appointment in the afternoon.

With what was left of his good senses, my friend knew he did not have until the afternoon to wait, and went to the Emergency room of the nearest hospital. After explaining himself to yet another front desk person, he was informed it would be up to two hours before he would be able to see a doctor.

That was the final straw. A combination of frustration and deprivation of his meds led my friend to lay himself down on a grassy area outside of the hospital, and do some funky things to his wrists with a pocket knife. Ultimately, he was found by police, who, in essence, temporarily committed him by depositing him back inside the same emergency room -- probably saving his life. He was treated for his wounds, physically and mentally, and later released. The knife was confiscated.

Welcome to the land of universal health care. Mental health is part of this, yet appears to be far less universal. I guess the people he dealt with did not understand that a mentally ill person without his meds is a ticking time bomb. He did the responsible thing by seeking help, but it was only when he became a clear danger to himself that anyone took him seriously.

If my friend had gone to emergency with a broken leg or in the process of a heart attack, he probably would have received swift and immediate attention. But because he was not in obviously physical pain, nor going to immediately expire in front of everyone, he would have to wait his turn, along with people who come to emergency with trivial matters that can be dealt with as well at a walk-in medial clinic.

Access to mental health services can be difficult, not only for the low-income person, but just about anyone in need of affordable services. Although covered by Alberta Health, it can take up to three months to see a psychiatrist, like just about any medical specialist these days, especially for an initial appointment. Psychologists are easier to access physically, but financially out of the budget for all but the wealthy – the standard rate for an individual is $150 per 50-minute session ($160 for couples), according to the Psychologist’s Association of Alberta. Even those who operate using a sliding scale do not slide far enough down for low-income clients, especially those who require services on an ongoing basis.

Then there are services like The Support Network that offer walk-in help, but only for short-term intervention. Crisis lines are excellent places for people to vent, as long as they are not put on hold, which can happen due to high numbers of callers and low numbers of volunteers. Have you ever heard the joke about the person who calls the suicide hotline and is put on hold? It’s really not funny, and it happens in real life.

Mental health consumers need to be taken seriously when they turn up at hospital emergency rooms, let alone in their own doctor’s offices. Often, they are breakdowns waiting to happen, and there is nowhere else for them to turn. My friend, despite the cuts on his wrist, was lucky. How many aren’t?

Healthcare Rallies and Local Events

Healthcare cuts continue to be a huge issue here in Alberta. I have attended two more rallies in the last week or so. One was to Save Alberta Hospital, and we marched and rallied around Alberta Hospital Edmonton. Here is my photo set and a video. This was the first time I ever ran through a cabbage patch during a rally!

On October 16, the United Nurses of Alberta marched from West Edmonton Mall to the Misericordia Hospital to protest healthcare cuts. Here are photos and the video.

In addition to activism, I've also been having some fun at local events. On Saturday, I went to the Old Time Country Fair in Churchill Square. This was my first time at the event. It attempted to recreate an old-fashioned carnival with games, jugglers, stilt-walkers, horse-drawn carriage rides, food, and balloon fairies. Take a look at the photos. My highlight was riding in the horse-drawn carriage around City Hall.

On Saturday night, I went to Storefront Cinema Night. This was the second year for this block festival, and this year it was expanded to two evenings. Friday night was the family program, while Saturday was the "main event." Three blocks of Stony Plain Road were shut down with movies projected in the windows of several of the businesses in the area. Live hip hop artists provided live entertainment, bonfires kept everyone warm (and it was a nice night, thankfully), and a "throwie" board in the parking lot of Jasper Gates Plaza attracted some attention. People threw coloured LED lights onto a magnetic board, creating a very colourful result. Take a look at my photos.

Keep Alberta's Healthcare Public

On May 9, around 1200 Albertans descended upon the Legislature grounds to protest recent cutbacks and deregulations to Alberta's healthcare system. Many people bused in from out of town, and there was quite a number of seniors there. Photos from the event can be seen at RaiseMyVoice.com and Flickr. I also filmed the event but a little differently this time around - from the perspective of the stage facing the audience.

Senior's Action and Liaison Team (13:01)
Raging Grannies (8:11)
Diana Gibson, Parkland Institute (4:48)
Transgender Community (2:18)
Notre Dame des Bananes (3:25)
Brian Mason, MLA (6:30)
Hugh MacDonald, MLA (5:34)
Musical Finale (2:01)