Covid19 and confronting our mortality

I remember the first time I pronounced someone dead. I was an intern at Port of Spain General Hospital and it was just after midnight when my phone rang: “Ms P has no vitals.” I sprang up from the couch and made my way upstairs to the second floor of the rickety Central Block, rehearsing the alphabet in my mind: “A, airway; B, breathing; C, circulation.”

I parted the curtains and saw the patient, an Afro-Trinidadian lady, her cachectic frame long and wide. “Seventy-two-year-old with pancreatic cancer. Doc. She wanted to go in peace.” I performed medicine’s death rituals: I flashed a light into her pupils, felt her pulse-less body, auscultated her silent chest, and left her in peace.

Doctors deal with death every day. We realise very early that our job is not so much about curing and saving as it is about comforting and empathising. We learn how to recognise death’s impending arrival and try our best to prepare the patient and his/her loved ones for it.

What I cannot imagine and am not prepared for, is dealing with over 700 deaths in one day caused by one disease. Since the first case was reported in Wuhan, China last December, covid19 has, at the time of writing, infected 306,395 and caused 13,031 deaths. In the 2003 SARS pandemic, 774 deaths were recorded. The daily death toll in Italy over the last few days has been about 700.

But forget the numbers. When in your lifetime has the world been brought to a complete halt like that we are witnessing? Borders closed, sporting competitions postponed, exams cancelled, congregations banned. It is unprecedented in modern history. Everyone is forced to stare mortality in the face at some point; we have all lost loved ones.

But now, isolated in our sanitised homes, looking at the worried faces of our leaders, our entire species is confronting its mortality collectively. As tragic as this pandemic has already been, what will be even more tragic is continuing life, when it is over, as though nothing ever happened. As a country, we desperately need to rethink our priorities.

From a health care perspective – and leaving aside the public health response to covid19 for the time being – our priorities in TT are messed up. There is no other way to say it.

We have six stadiums capable of hosting world-class events. In our public health system we have one cardiac catherisation lab manned by two interventional cardiologists to serve an entire population. As heart disease is the leading cause of death worldwide, this situation is ludicrous.

In our wealthy nation, working people pay health surcharge: $33 every month if your monthly income is more than $469.99. For someone making $30,000 monthly, this is 0.1 per cent of her salary; $100,000 and it works out to 0.03 per cent. This is absurd!

In Germany, 15 per cent of a person’s monthly salary goes toward national health insurance. Canadians, proud of their egalitarian health system, just accept that a chunk of their salary must go toward universal health coverage – and that is that.

Which leads to other questions: are we satisfied that in sweet TT the wealthier you are, the more likely you are to survive a heart attack, because you are able to afford timely treatment privately? Do we want to live in a country where a person’s chance of living depends on the size of the bank account?

Do we want to live in a country where people like Ms P take her last breath in a building that cannot pass a safety inspection? If no, then it is up to all of us to change it – not only our politicians – whether through advocacy or contributing more from our pockets.

And to the politicians: you do have the power to change things, as demonstrated in the UK by Aneurin Bevan, architect of the NHS; and in Canada by Thomas Douglas – politicians who believed that striving to provide quality health care to all was a moral obligation.

A pandemic is unfolding before our eyes. The death toll keeps climbing every day. Let us rethink what type of country we want and work together to achieve it. Be safe, everyone.

Taureef Mohammed is a graduate of the University of the West Indies and an internal medicine resident at Western University, Canada.