Dehydration

My wife and I spent the day in the Emergency Room yesterday with our daughter Sophie, who had become severely dehydrated due to gastroenteritis induced vomiting. The folks at the University of Chicago emergency room were very kind to us. I hope we never have to go there again, but if we do, it looks like the generosity of the founder of Lands’ End will make our next visit even better.

I don’t know whether, in another era, Sophie would have died from this or not. Probably not. But, I do know she was a largely unresponsive rag doll when we got her to the hospital, and 8 hours of IV fluids later, she was back essentially as good as new.

All this gave me a new appreciation for a research paper that I have always liked by Doug Almond, Ken Chay, and Michael Greenstone. They document that when racial discrimination in access to hospitals faded in the 1960’s, black babies (especially in the rural South) had huge improvements in survival rates, which the authors are able to tie to simple things like avoiding death due to dehydration. The infant mortality rate for blacks was 6 in 100 in the Mississippi Delta as late as 1965. Six years later, it had fallen in half.


GP

Wish your daughter all the best!

In my country, there's a very different and much more dangerous discrimination in the health care system. It's discrimination against the poor. Effective public health care is almost nonexistent, and private clinics demand payment before treatment. In a country where more than 30% of the people live with less than $1 a day, that's just unacceptable.

fft

Responding to the comment only.. GP- what do you want? Whose fault is it for not providing effective public health care?? Whose fault is it that more than 30% of the people live with less than $1 a day?

George S

Responding to GP: Based on your viewpoint, anytime you put a price on any good or service, whether it's a bus ride or medical care, you are discriminating against those who do not have the ability to pay. (I'm referring to the modern political definition of the word discrimination as it is used today).

By that logic, it is discriminatory to work only for employers who can afford to pay you, rather than those who cannot pay you but might need your services more.

The fact that I do not consider what you described to be discrimination does not make the situation in your country any less tragic, however.

Gringo_Nordestino

All the best to you and your family, you aree in my prayers

michigan

30%... What country? The U.S hovers somewhere around a 12% poverty rate.

prosa

"30%... What country? The U.S hovers somewhere around a 12% poverty rate."

The link to GP's blog says he's in Singapore, which seems odd. I'd thought it was considerably more affluent.

Consumption Rules

US Poverty Rate, 2004: 12.7%

Singapore Poverty Rate: N/A

orangeandbrown

We've been there ourselves. Its practically a rite of passage, for the parents.

GP

In case there's any doubt, I'm a Cambodian. True I'm in Singapore now, I've been here for the last 2 years doing my bachelor's degree.

In case you don't know the country called Cambodia, ask yourself whether you've heard of Angkor Wat temple or the Khmer Rouge (Pol Pot) regime. Those are the two extremes of Cambodia, and unfortunately those are the pictures by which the rest of the world identify my country.

As to why I called the health care system in Cambodia discriminatory, consider these facts.

Cambodia has a notorious record of being among the poorest in the world. It depends on roughly $600 million in foreign aids annually, a large part of which either goes back to the donor countries (development contracts are usually awarded to big foreign companies and the donors use a big chunk of the money simply to pay for the luxurious lifestyle of their own citizens who work as consultants in Cambodia) or goes straight into the pockets of a bunch of powerful politicians (sadly, Cambodia's also one of the most corrupt countries with the 2005 corruption perceptions index score of only 2.3).

The tax system is inefficient, resources are scarce and annual budget deficit is not uncommon. Out of the slim budget, in 2003, only less than 3% of the budget is allocated to what the governement calls "priority sectors":education, health, agriculture and rural development. Worse still, the actual budget disbursement to health care amounted to only 59% of the allocated figure.

Am I wrong to say there is discrimination against the poor in healthcare? Of course private clinics need to make profit, but if the people are so poor that they can't afford to pay why does the budget for public healthcare is so miniscule? You also have to note that even in public hospitals, patients have to pay fees that sometimes are ridiculously high, enough to rid them of treatment (I did state that a lot of people live with less than $1/day). And as I said earlier, hospitals demand payment before treating the sick. So is the priority of a hospital to save lives or take them if the patients couldn't pay? Which one is more important?

Most of you live in the US so you might not believe me if I tell you some people in Cambodia die while waiting for treatment simply because they don't have the money to pay now (even though they promise to pay later when they can borrow or somehow find the money).

Isn't this discrimination? I believe that healthcare demand in cambodia and the ability to save life are in a condition that economists call highly elastic. A small increase in healcare budget (say another percentage point of the total annual budget) and a little bit more efforts to make public healthcare more accessible will save a lot of lives that are otherwise taken away so unnecessarily. A lot of people are simply living on the edge that a little action can cause a big effect. Why the government is not doing this, I simply have no idea. So someone asked who disriminates who. I guess, the Cambodian government discriminates its own people. (Sorry if this is out of topic. I think the American government is also discriminating its own people by sending them to Iraq).

Read more...

michigan

It's a sad situation. I would have to believe that most people have heard of Cambodia... Next time clarify where you speak of, it will help in making your point.

Cambodia consistently ranks in the top 50 "worst" country's for infant mortality rates.

According to the United Nations and the International Chamber of Commerce, "Bureaucratic delays are commonplace and corruption is a rampant problem." Labor laws are very rigid.

ozarkhick

As a physician who takes a developmental history of each and every patient I see at their initial visit, I really have to question just how useful any measure of "intelligence" is at 8-12 months. The only correlation I have ever found between achieving developmental milestones and intelligence later in life is that extreme delays are a bad sign. Talking or walking early, even extremely early, does not a genius make. Many of my patients who didn't talk until 16 months hold high powered degrees and jobs. This is just a clinical impression, but my "n" is about 4-500 at this point.

ozarkhick

Oops, put this under the wrong heading.

trieu

My mother suffered from the same thing when living in Vietnam. Before she was brought to the hospital, put on an IV, and recovered, she thought she was going to die. Before going to the hospital, she knew she needed water, but there was simply no way for her to get it into her system.

GP

Wish your daughter all the best!

In my country, there's a very different and much more dangerous discrimination in the health care system. It's discrimination against the poor. Effective public health care is almost nonexistent, and private clinics demand payment before treatment. In a country where more than 30% of the people live with less than $1 a day, that's just unacceptable.

fft

Responding to the comment only.. GP- what do you want? Whose fault is it for not providing effective public health care?? Whose fault is it that more than 30% of the people live with less than $1 a day?

George S

Responding to GP: Based on your viewpoint, anytime you put a price on any good or service, whether it's a bus ride or medical care, you are discriminating against those who do not have the ability to pay. (I'm referring to the modern political definition of the word discrimination as it is used today).

By that logic, it is discriminatory to work only for employers who can afford to pay you, rather than those who cannot pay you but might need your services more.

The fact that I do not consider what you described to be discrimination does not make the situation in your country any less tragic, however.

Gringo_Nordestino

All the best to you and your family, you aree in my prayers

michigan

30%... What country? The U.S hovers somewhere around a 12% poverty rate.

prosa

"30%... What country? The U.S hovers somewhere around a 12% poverty rate."

The link to GP's blog says he's in Singapore, which seems odd. I'd thought it was considerably more affluent.

Consumption Rules

US Poverty Rate, 2004: 12.7%

Singapore Poverty Rate: N/A