A Tale of 2 Healthcares

Today I did something I didn't want to do... admitted I was vulnerable. I hate doing that. It's the worst. I'm supposed to be the strong one.

I've been here in Jerusalem for 50 days, and most of those 50 days have been spent walking between 4-6 miles on hard bumpy stone and up/down uneven steps. My family (and pretty much anyone who sees me on a bad day) know that from time to time my knees flare up. They have for years - it's nothing new.

We also expected that much of my time here would be spent walking, so I did the right things to prepare. On the application and in the interviews and training I disclosed that my knee pain was a potential problem, I sought medical attention from my PCP before the trip, Her verdict was that because of recent weight loss the structure of my knees had shifted, but with time and exercise I'd be fine. Walking 5 miles a day would be the BEST thing for me! So I went to physical therapy, a chiropractor and trained at the YMCA to get stronger. I must have been committed, since the co-pay and deductibles cost about $2,000.

This is not a post in which I intend to make you feel sorry for me, gentle reader. There are still many, many difficulties suffered every day by people who cannot pass a checkpoint to get to the hospital on time to deliver a baby or make their chemo appointment in the better-appointed Israeli hospitals. That's a huge issue over here.

And this post is maybe a little self-indulgent. Because my knees, ya'll? It's like hot knives with every one of the 11,000 daily steps. 1200 mg of Ibuprofen twice a day ain't cutting it. So today I caved, admitted my own vulnerability and followed my housemate's good advice to go to a local clinic.

Honestly? The whole process left me a little star-struck by the healthcare system over here - and by here, I mean the Palestinian Authority because the closest health centers to us are Arab-run. With all the news I read about the potential roll-back of the ACA in the US and how the new plan will throw 24 thousand people off, I couldn't help but share my little story in hopes that someone who can make a difference will read it and do the right thing (which is to call your Senator and ask them to block it! Right now. Don't delay!)

With that little political nugget out of the way, back to my story. My knees have been taking a beating. I've gotten some great stretches from my rock-star body builder friend, Kelsey - which helped. After this morning's 4 mile walk, I decided to visit the Al Hayat Medical Center in neighboring Sheik Jarrah to get them checked out. I even sprang for a taxi, that's how much I hurt.

Walking- no, hobbling - into the building, I was nervous about the cost, since Al Hayat doesn't take my traveler's insurance. In the US, an ER visit can cost thousands. I was also concerned about the time. It was about noon, and if I had to wait the 6 hours it takes in the states to be seen that means I'd be out in the dark, which is a no-no security risk. I had all the cash that I have left in my monthly allowance, hopefully it would be enough (or maybe they take credit cards).

I have my own history of being uninsured. When I began working full time as an associate pastor at the church I now serve as senior pastor and didn't have health insurance. It was my fault. I declined the UCC coverage because my husband had it from his work, and it would save the church money. When he lost his job a year later it took a few years of prayer and advocating for myself and my family to get Plan "C", the lowest cost/highest deductible package the wider church offers.

When your family lives paycheck to paycheck, unexpected medical bills can ruin you. Anyone who has been un (or under) insured knows what's it's like to avoid those expensive annual exams and tests and pray that your kid doesn't get something that will require antibiotics and an office visit or GOD FORBID, a cast. You live in fear of finding a lump or a new weirdly-shaped mole. You put off care as long as you can, because you KNOW you can't afford it. When you finally decide to address the issue, there's a dreadful pit-of-your-stomach-what-if-we-lose-everything kind of anxiety to deal with, so just in case you check the limit on your credit cards.

When I got there, a kind woman at the front desk asked for my information and what was wrong. There were no forms, she just needed my first and last name and date of birth and a few words about my symptoms which she printed out on a tidy computer-generated form and handed to me.

Then, she asked me to pay the doctor's consultation fee up front, which was 100 shekels, or about $27.50 USD.

Next, she told me to wait outside the emergency room. I was the second person in line, which took about 5 minutes. In the ER room, the doctor and nurse were compassionate and gave me an order for X-ray. I brought the order downstairs and was seen immediately by the technician. When he was finished, he told me to go back to see the doctor, the films were already loaded into the computer system. I was given a CD of the images to share with my doctor at home.

Cost of X-rays? 50 shekels, or about $13.71 USD.

Returning to the ER doctor's office, he told me "You are in a great deal of pain." (well, yes) This is because you have no cartilage on the inside part of your knee joints - the left is worse that the right. It's rubbing bone on bone, osteo-arthritis with some tendinitis - which is worse on the right from overcompensating. Made worse by the walking unevenly on stone. I will give you a shot so you have some immediate relief, and here are prescriptions for a muscle relaxer, an anti-inflammatory and glucosamine/chondroitin - don't worry, it's organic. Come back and see my in 10 days, or come and see one of our orthopedists, we have 3 on staff here. Maybe when you get back to the states you have surgery, that's up to you."

Cost of medications, combined? 227 shekels, or about $62.28.

If you've done the math, that's $103.49. To have, what seems like, a pretty significant diagnosis.

Time taken to arrive at this new bit of information? About an hour. In fact, the walk BACK to the placement house was probably longer than the time I spent at the clinic.

I leave you to guess what the US system would charge an uninsured person with similar needs. But here's the $5,000 dollar question (that's my guess, btw)... if occupied East Jerusalem can provide affordable, excellent health care for its residents and guests like me, why can't the United States? Please don't answer with "if you like it so much, then stay there", because that's just mean and unhelpful. Besides, thinking like that won't move us forward in a way that cares for our neighbors and "least of these" as is the call of those of us who claim the name Christian.

Oh, and BTW, I know for a fact that there are plenty of people who do not claim my religious identity but are on the same ethical path. We are are a pretty big squad, actually.

At the end of the day, the healthcare system in the US is a problem that we ALL need to come together to fix, no matter our label. Can't we do better? Shouldn't we try? 

p.s., The meds are working and I'm not scheduled for anything too strenuous in the next few days, so I'm hoping that my next 38 days are more comfortable! Your prayers are ALWAYS appreciated!!!