I went to the Health Center today to investigate what seemed to me like a blockage in my left Eustachian tube – a common problem that leads to a feeling of fullness in the ear. Eustachian tube blockage, which I’m sure many of us have experienced, usually occurs as a side effect of the common cold, when nasal or sinus congestion inflames the mucosal lining of the tube and pinches it shut. The cavities of the inner ear cannot then adjust themselves to ambient air pressure, and the familiar feeling of fullness and disorientation results. It’s good to get it looked at, because once sealed, the inner ear can easily develop a painful and potentially threatening infection.
As it turned out, I did have the beginnings of an ear infection, but the pain that would have alerted me to this more serious consequence of the Eustachian blockage had been masked by the anti-inflammatory (Naproxen) I was taking for my knee, which I smashed at senior cocktails late in March, and it hasn’t gotten better yet. Something about a patellar translocation, I’m told.
I felt like a bit of a hypochondriac walking down to the Health Center for the third time in as many weeks, especially because I wasn’t really in pain and just wanted some information on how to relieve the annoying filled-up feeling in my ear. Fifteen minutes later, validated by the infection diagnosis and the five-dollar bottle of amoxicillin I’d been given, along with baggie full of Sudafed, I found myself reflecting on the feeling of security of having the Health Center, well staffed with friendly people (who knew me now by name), within walking distance, and covered by my health insurance.
Last week I wrote about catastrophic care and boutique doctors, but now I find myself reflecting on a much more banal sort of health care. Perhaps as a society we have become dependent on the specificity and technological gloss of modern health care, and perhaps we could manage quite well without the minute attention to our bodily needs that coverage at a place like the Health Center enables. But without easy access to those services, my knee would still be making me limp, and I would be facing a nasty infection on the performance weekend of the play I’m in. It was disconcerting enough to find myself lagging in my chamber quartet thanks to the muffled roaring in my ear—small reminders of the pitch-perfect performance I expect from my still youthful body.
One of our professors here, Sue Fisher, has written copiously on the importance of community-level health care and envisions a single-payer health service (that is, a national insurance program somewhat like Canada’s) centered around local clinics, with expensive, elite procedures consolidated in hospitals. These clinics would ideally employ a mix of traditional and alternative care providers, and would rely primarily on nurse practitioners instead of full MD’s, with doctors relegated mainly to the hospitals where their more elite, aggressive training in combating disease surgically and chemically would be better-suited.
The substantive point for me is that these little health troubles, insignificant compared to anything covered by catastrophic insurance, are far more certain to occur than a debilitating injury. While coverage for those disasters is essential, we should remember the importance of mundane, preventative care in enabling our comfortable everyday lives. As our health care system continues to emphasize late-stage, dramatic intervention in illness, and relies more and more on market forces to distribute care, those who cannot afford insurance become increasingly vulnerable to the effects of minor health troubles, which, left unattended, can easily become debilitating, at which point it is much more difficult to treat them.
Community-level health care, built around easy access to information and preventative care, is an attractive idea to me. It returns the focus of care to the ongoing maintenance of a healthy body, as opposed to heroic interventions at crucial moments. It encourages personal responsibility for health while providing care on the level that makes productive everyday life possible. For communities with deep social and economic troubles, it is all the more essential. Remember that poverty is inversely correlated with every measure of health and every measure of access to care. This double bind leads to neglect and crowds the meager facilities provided for the health emergencies of the poor.
Deeply tied to this issue, though a topic for another discussion, is the role of social position in determining the reality and substance of the moment in which care is delivered. It has been demonstrated consistently that uneducated and socially marginalized people fare much worse with primary care physicians than do people closer to the physicians in terms of knowledge and economic security. Forming clinics on a local level softens the opposition between the culture of the hospital and that of the surrounding area, while enabling truly productive communication about health.
Comments, criticism, and suggestions can be emailed to Nick at ngerrybullar@wesleyan.edu.
Leave a Reply