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I have nightmares in which I go on a trip having forgotten my medication. Or in which I run out of my medication unexpectedly. Or cannot find it. I’ve had these dreams for about ten years now. In others, I am prescribed something that makes me unable to talk. Or I dream about the doctors. Like the one who, upon hearing my explanation in broken Korean of the pain in my hands, shrugged, smiled and waved me away.
I think often about a doctor in Quebec who, after warmly asking, “Français? English? Russkiy?”, spent the following 15 minutes not looking at me again before giving me three new diagnoses and a script for everything other than the medication I needed. My “affect” was normal, his notes said. When the doctor is a gateway between you and treatment rather than a guide to it, your affect is crucial. You won’t get anywhere without it! At the doctor, I try to keep the fear of dismissal out of my face, nod, make eye contact. I smile while they tell me things; I do not admit that I already know the things. I pretend to be curious about one or two small details: “What does ‘CRP’ stand for?” Some doctors like this very much. They like very much to tell me what things are. As they talk, I respond with the appropriate markers of attention: eyebrows, murmurs, nods. If one’s affect continues to be so very “normal”, one might get one’s needs met.
Another recent experience in Montreal involved a doctor who made me read out loud to him from the DSM. I’m not sure I passed the affect test on this occasion. He instructed me to read the overview of a disorder, then its symptoms. After each symptom, I was to say “yes” or “no”. If your symptoms are not adequately represented in this momentous little book, they do not qualify for medical attention. They are illegible, like you. You are a diagnostic trespasser. So it goes.
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As is often the case with any bureaucratised system, the human is supplanted by numerical representation. For healthcare, one needs money.
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In both South Korea’s and Canada’s national healthcare, my experience is that the system works well enough for garden variety illnesses and physical trauma emergencies that are studied and understood. When I lived in Korea, for instance, even dental care was covered (absurd that elsewhere it is not), and I will never not loudly tell friends about walking out of a cleaning or filling procedure and paying 4 000 KRW (roughly 50 ZAR). These boons are not insignificant. However, despite the enormous benefits, these systems do not – cannot – cater for the complex grey areas of pain, exhaustion and ambiguous psychological problems that those with volatile nervous systems encounter continuously, at times to the point of debilitation. The public system is not concerned with vulnerability. It is concerned with numbers, with clear-cut diagnostic criteria. Lab ranges are taken as omnipotent indicators, and there is much less interest in symptoms and lived experience. As is often the case with any bureaucratised system, the human is supplanted by numerical representation. For healthcare, one needs money.
Maddeningly, the private healthcare I experienced in South Africa achieves care for the patient-cum-customer. But only for a few. When I could afford to see a private doctor, they often took my symptoms seriously and did not take the visit as an opportunity to impart wisdom to a delinquent. I could rarely afford follow-ups, however, and I did not see a dentist for seven years. Good care is reserved for the wealthy.
I truly believe that medical care should be freely available for all. I also believe, however, in overhauling the sociocultural presuppositions that shape the field. This overhaul is impossible in any medical system that has to operate under the pressures of capital and its endless desire for profit, whether the system is to be privatised or embedded in state bureaucracy, with its fraught relationship to large-scale finance. State ideology and austerity measures are eroding national healthcare systems globally. In Canada, public medical services are underfunded and under-resourced and are suffering a dangerous backlog as a result. Given current economic norms, similar erosions are an almost unavoidable trajectory for new attempts as well. Ultimately, under capitalism, health and care rarely intersect. Where they do, there is wealth.
Emelia Steenekamp is a writer and PhD student in Montreal.
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Can there be a dance between the health sciences and the arts?
Die Nasionale Gesondheidsversekeringswet: ’n onderhoud met ’n prokureur