20 January 2011

BAHAMACARE

BAHAMACARE
By Andy Weddington
Friday, 21 January 2011


                                                   “It would not be possible to praise nurses too highly.” Stephen Ambrose


The small one-story bright pink cement health clinic at the end of the harbour’s main government public dock was under renovation—long overdue renovation; inside and out. The inside had been gutted and was being redesigned. Some of the old window openings had been filled and new larger holes roughly punched out for more natural light. The plywood ramp for wheelchair and handicap access remained—it too was likely on the schedule of work for a facelift.

The clinic under renovation—sandwiched between the museum to the north and the Post Office and Police Station to the south—faced Bay Street. Back Street, all of five paces wide and nothing more than a patch-work concrete path that accommodates mini motor vehicles, golf carts, bicycles and pedestrians—the bi-pedal as two-way traffic, runs directly behind.

The temporary clinic is in a cottage on the opposite side of Back Street about forty yards south. About fifty yards due east, if that, is the mighty Atlantic--as in ocean.

During eight previous years I’d not needed medical care--none. This year was different.

A sore throat, cough, a slight fever, and generally feeling lousy over the course of a few days deteriorated into a problem overwhelming the immune system.

It was quarter past nine on a Wednesday morning. From our cottage it was a short walk—all of about thirty yards north on the narrow Back Street—to the clinic. I turned right, took a step up and five paces forward, and climbed nine deteriorating cement steps painted a fading bright blue that was showing its age. The paper sign on the front door—“OPEN”.

The “waiting” room was small—maybe a dozen simple chairs. Some preventive medicine flyers about influenza, STDs, and hypo and hyper glycemia were tacked to the walls. A simple wall chart depicted services.

I could hear a couple of women talking behind a closed door but their voices low and not decipherable.

A few minutes later, a woman dressed in white opened the door, smiled, and told me she’d be with me in a moment.

True to her word she finished with her patient, opened the door, and the young woman she was caring for passed by me on the way out.

Nurse Sands introduced herself, escorted me into her treatment room, and asked how she could help. The moment I began speaking she could hear the problem.

She pulled a sheet of paper to start her record. She asked my name and to describe how I was feeling and for how long. A thermometer placed under my right arm confirmed a fever. She checked ears, nose, and throat. Then she retrieved a stethoscope and listened to my breathing; deep breaths an impossible task without coughing. She said I was well into bronchitis and it was good I came to see her. With any luck treatment would prevent pneumonia which some on the island had developed neglecting to seek earlier care.

She next retrieved a small brown paper bag—to hold pharmacies. She prescribed tablets for the fever, a liquid expectorant, and the major weapon to fight the infection--antibiotics. She suggested stopping by one of the two nearby grocers for a box of Claritine. She told me to drink plenty of water and squeeze fresh lemon juice into it. Her final advice was to rest and come back in a week so she could make sure the bronchitis had cleared.

Nurse Sands was a “one-woman” health clinic.

There was no automated telephone appointment system.

There was no pre-approval for services.

There was no days or weeks waiting for an appointment.

There was no receptionist.

There was not a stack of forms to complete.

I was not asked for a photo ID nor passport.

I was not asked for an insurance card.

I was not asked my level of pain on a scale of one to ten.

I was not shuffled from the “waiting” room to a “treatment” room to wait longer still for a few moments with a busy doctor.

I was ill and had Nurse Sands undivided attention. She listened to me describe how I felt and set about her business to confirm what she suspected from my description and sound of my voice.

She also wore the hat of pharmacist--hand writing and cutting dosage labels for the medicines from a sheet of adhesive paper.

She even took a call from a patient during our consult. And she apologized for the interruption. Apology not necessary as someone else was in need of Nurse Sands—otherwise they’d not have phoned.

She was thorough.

Not until after she was finished with assessing, treating, and assembling medications did compensation for her services come up—and I had to ask.

She wrote an itemized receipt on clinic stationary for the medications and her services. The bill was more than reasonable. I paid cash and added a bit more knowing the clinic could use it.

As I was departing she said I should be feeling better in a day or so. And reminded me to come back the following Wednesday. I wrote all of her instructions and underlined the note about a follow-up visit in my sketch book.

Nurse Sands was right. Little more than 24 hours on the antibiotics and I was feeling better. Sleep was not so great but steadily the bronchitis cleared.

By the following Wednesday I felt cured. But I went to see the Nurse as directed. I was first to arrive at the clinic and had to wait on the porch. The paper sign read “CLOSED” and there was a second piece of paper noting she’d spent the night on another island tending to patients. Other patients began to arrive. They believed she’d be on the ferry that arrived about 0920 (20 minutes after the clinic officially opens).

This day she was clad in white top and blue slacks. She was being "escorted" by a fireman who met her at the dock. He needed care. She opened the clinic, invited all in, and first tended to the fireman. I was next and within in a couple of minutes she declared me healthy and I was on my way with advice to use an over-the-counter remedy should any symptoms return. Six or seven others were in the queue for time with Nurse Sands. She was going to have a busy morning.

My two visits were among the most efficient and effective medical appointments I can recall.

Nurse Sands tends to the islander’s—citizens, part-time residents, and visitors—health.

For care beyond her education and skills a doctor is readily available via phone and, if necessary—routine or emergency, a short boat ride away.

Seconding Ambrose, I could not praise Nurse Sands too highly.

Oh, and beyond all else she does, she makes house calls.

I thought about BAHAMACARE. I thought about how thankful I was Nurse Sands was there to tend to my illness. And a day or two later my wife's. And without bureaucracy.

Then I thought about OBAMACARE—and the irony of the similar sound of the words and that our Representatives and Senators could not take the time to listen via emails, phone calls, letters, and town halls to their patients—constituents—nor read the bill before prescribing it for America. Sounds like incompetence and malpractice. Perhaps their Oath of Office should include the Hippocratic Oath? Why not?

I’d like to say it’s “unbelievable” but I can’t. Disappointing. Sad.

BAHAMACARE, though delivered on a micro-level, suggested, at least to me, there’s a better way.

Fair to compare a small nation of islands and cays healthcare with that of the United States? Sure. At least on some fronts.

Thank you Nurse Sands.

OBAMACARE? Sick. And not in the hip way today's youth use the word.

Post Script

Last year I painted a landscape of those fading bright blue steps leading into the temporary clinic (last year it was not a temporary clinic but a mere empty cottage) and the focal point of the painting was a lone blooming pink rose (painting posted left). I had titled the painting “Survivor.” Twelve months later I visit the cottage—now temporary clinic—and there’s a small rose on the same bush. This time, thanks to Nurse Sands, I’m the survivor. Huh!

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