Keruah Usit
Juli, a pseudonym for a young woman I met in Kuching, was crippled at the age of 34 by tuberculosis of the spine.
Several months before, she had left her young children in the ‘ulu’, the hinterland, to travel six hours on a rough, rutted track to the nearest district hospital.
Juli told the young doctor there of back pain and lifeless legs. She was driven to the nearest referral hospital, three hours away, and underwent blood tests, X-rays and a CT scan.
She was sent from test to test, as helpless as if she had been on a wretched conveyer belt, like Graham Greene’s ill protagonist in his story ‘Under the Garden’.
Neither the young doctor in the district hospital nor the overworked specialist in the referral hospital could put a name to her pain.
Juli’s doctors were unable to pay for her to undergo an MRI scan of her spine in a private hospital 10 minutes away. The director of the public hospital at the time had prohibited such ‘luxuries’ in the name of cutting costs.
Eventually, months after she had lost the use of her legs, she was sent to Kuching for an MRI scan, by the only available government-owned machine in the entire state.
She had never been to the big city, and was penniless and terrified, but in Kuching, the diagnosis was finally confirmed. She was started on treatment for tuberculosis, but it was too late for recovery.
She remains virtually skin and bones to this day, and has a debilitating bed sore that will not heal. She was eventually sent back to her small district hospital.
From there, she was discharged to the ‘Rumah Sakai’, a decrepit hut set aside for poor people from the ‘ulu’, with a perpetually blocked toilet and no supply of clean water.
The hospital had told Juli it did not have a budget to provide her the fare to her village. She finally found her way home with donations from well-wishers. She is now cared for by older folk; her husband left her while she was away.
Any 1Care for the poor?
The government has promised to protect the poor in the implementation of its planned 1Care health financing reforms.
Yet, it has not outlined any concrete details, not least the household incomes that will be exempted from contributing to the proposed National Health Insurance Fund.
The Health Ministry has, at least in public, insisted that 1Care “has not been finalised“, but has been announcing to selected audiences that 1Care is a fait accompli and “has been accepted by the government”, according to campaigning group TakNak1Care. Sarawak PKR leader Baru Bian (right)points out that 1Care financing will sideline many poor, undocumented Sarawakian citizens.
“If indeed the 1Care programme is to be based on documents like the MyKad, I’m afraid thousands of poor Sarawakians will lose out,” he toldMalaysiakini.
Baru noted that obtaining citizenship documents is a major problem in his own, largely rural, state seat.
Many Ba’Kelalan residents were born citizens, he said, but their births went unregistered as their parents were too poor to travel long distances to the registration offices.
Attempts to register later led to “suspicion” among the registration department officials, Baru explained.
“Therefore, a so-called ‘reformed health programme’ will not have any meaning for these people. They will be in a worse position than now.”
Baru also opposes the potential restriction of the visits to doctors to several times a year, as postulated by opponents of 1Care, based on the Health Ministry briefings on 1Care and the average national figure of six medical consultations a person each year.
“I can tell you that this does not augur well for the rural poor. There should not be any limitation on the poor to accessing healthcare, if this system is meant to assist the poorer section of society, as some people (in government) say,” he said derisively.
Increase health spending instead Prominent doctors in opposition parties, such as Dr Michael Jeyakumar Devaraj and Dr Tan Kee Kwong, have demanded that government health spending be increased, and private healthcare curbed, instead of imposing a costly new financial administration that will be vulnerable to corruption.
Baru agrees that the 1Care health insurance is the wrong reform to consider at present.
“I would like to see roads and infrastructure being built in rural Sarawak and more clinics built in isolated areas. These two developments must go hand in hand,” he said.
“Implement these basic things first before we talk about this ‘highly sophisticated’ 1Care health system.
“The rural poor in Sarawak need genuine, basic medical facilities, together with sufficient medical personnel to administer these clinics.”
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