Medication or food?

Kenesha Robinson is a budding comedian with a gift to make people laugh. But that is on stage. At home, caring for her ailing 77-year-old mother is no laughing matter. At night, she cries, especially when there is no food for her mom to eat before taking her medication.

Mavis Robinson has been diagnosed with diabetes, hypertension, lung, heart and kidney problems, as well as a plague of complications that accompany the illnesses. In recent years, she has had two strokes and two heart attacks, the last very severe, doctors say.

“They wanted to operate on my heart, but I said no. I don’t want them to put me to sleep and then I don’t wake up back,” Mavis told The Sunday Gleaner in a shaky voice during an interview last Thursday at her home in Southboro, Portmore, St Catherine.

“I just have to trust God. The Bible says you live three scores and ten. This is how God wants me to live with it. At my age, I can’t manage any surgery.”

Mavis takes 11 tablets per day: five and a half in the mornings and five and a half at nights.

Like the elder Robinson, thousands of Jamaicans are juggling healthcare and daily life as they battle chronic lifestyle diseases. Last year, diabetes, hypertension, central nervous system illnesses, and cancer accounted for the major spends by the National Health Fund (NHF) to provide drugs for needy Jamaicans.

For the poorest among them, however, accessing such services involves long waits at public health facilities to secure prescriptions for free drugs. This, at the expense of hours that could have been used to hustle the night’s dinner, which, in many cases, come minutes before their pots hit the fire.

Estimates by the United Nations Development Programme (UNDP) suggest that some 2.8 per cent of the Jamaican population – some 78,000 people in 2020 – are multidimensionally poor, while an additional five per cent (141,000 people in 2020) are classified as vulnerable to multidimensional poverty.

The developing country’s multidimensional poverty index (MPI) measures each person’s overlapping deprivations in their country across 10 indicators and in three equally weighted dimensions: health, education and standard of living. It gauges aspects of nutrition, school attendance, cooking fuel, sanitation, electricity and drinking water.

“The MPI value, which is the share of the population that is multidimensionally poor adjusted by the intensity of the deprivations, is 0.011. In comparison, the Dominican Republic and Trinidad and Tobago have MPI values of 0.009 and 0.002, respectively,” the UNDP report notes.

ENDS DON’T OFTEN MEET

She might have a roof over her head, but Mavis Robinson numbers among the multidimensionally poor.

As a senior citizen, she pays only $40 to participating private pharmacies to fill each drug, and up to $240 for six items or more dispensed from the JADEP drug list. She can also access 77 prescription items, covering 10 chronic illnesses at Drug Serv outlets free of cost.

In her case, however, there is one heart medication, Procoralan, which is not among those on the JADEP drug lists. Even when subsidised, at one private pharmacy contacted by The Sunday Gleaner, 60 tablets of Procoralan costs $16,500 after the NHF discount of $4,335 is applied.

Along with Robinson’s other medical supplies, this brings her healthcare expenses to just over $30,000 monthly – money Kenesha said she still does not have.

“I am very happy for the NHF card, believe me. Otherwise, her medication would probably be in the region of $50,000 a month,” Kenesha said wide-eyed. “Even with the card, though, it is still rough on us. Every day, I have to find food for me and her. My shows are not steady, and it is not like I can leave her by herself during the daytime to go work. She is sickly and I am alone here with her.”

Kenesha, 44, is the youngest of Mavis’ children and has three other siblings living elsewhere. Her sister is also dreadfully sick, while the two brothers try desperately to fend for their own families while helping with their mother’s expenses.

At times, ends don’t meet, Kenesha admitted, and utilities – like the National Water Commission (NWC) supply that has been disconnected for the last four months – have to be sacrificed.

“Everybody tries to help when they can, but there is a whole heap of money owed on the water, so we can’t really afford that right now. Her health is more urgent right now,” she stressed, pointing to her mother’s incontinence products, muscle rubs, spray disinfectants and other supplies that burden the household daily.

On numerous occasions when she falls ill in the middle of the night, there is no taxi fare to take her to the hospital.

“But God has been good to us, and I have a lot of friends here, who, if I don’t have food, they will help, or if I need to rush with her to hospital in the nights, they are going to carry us,” Kenesha told The Sunday Gleaner.

‘Can we even afford to eat healthy?’

Inside one waiting area at a clinic inside the Kingston Public Hospital (KPH) last Tuesday, frustration was etched on the faces of many patients, who looked on wearily as names and instructions echoed over a PA system. Generally, they praised the National Health Fund (NHF) programme, but frowned at some nuances that caused fatigue as they waited on their much-needed medication from the government-run Drug Serv pharmacy – one of several locations across the island aiding Jamaicans with life-saving medications free of cost.

“I am glad for the [NHF] card because I usually go to Edna Manley clinic and get medication, or sometimes here. They deal with me real good,” said Jaqueline Thomas, a hypertensive 72-year-old. “But the last time, the doctor told me that the eye drops are not on it (NHF list). They said I have to buy that one.”

“It has been about three years now that I don’t work. I am sick with my eye,” continued Thomas, who lives off Mannings Hill Road in St Andrew. “I have only one daughter and she helps me. When it comes to food, I just have to eat what I can afford, you know – everyday food.”

Metres away, inside the hospital’s pharmacy, Tivoli Gardens resident Diana Carnagie, who is diabetic, was deep in worry as she sat waiting.

“My eyeglasses are lost, my father is in the hospital, and everything is just stressing me right now,” she lamented when approached.

“I don’t know where I am going to get money to replace the glasses,” she said. “Sometimes I don’t even eat when I remember my father. Luckily, I get the medication for free, and when I collect this, I will try to buy little food on the road or I am hoping somebody will give me a little food.”

One female pharmacist at a drug store in downtown Kingston was overheard scolding one customer who protested a $2,000 charge for a drug after using the NHF card. Before subsidisation, the same drug would have cost more than $23,000, the pharmacist argued. Still, she understands the hardship facing some patients.

“We see chronic diseases, particularly diabetes, every day,” she said, “and I don’t think it is so much about weight gain and obesity. To me, it is more about how people eat and take care of their bodies.”

“We need to become more conscious about what we are eating, but again, money now becomes a factor. Can we even afford to eat healthy? People buy the ‘bullo-slush’ kind of food because that is what they can afford and so that is what they are eating,” she told The Sunday Gleaner.

If only that warning was yielded by John’s Lane resident Adjua Campbell, 44, more than 25 years ago. Diagnosed with diabetes, she is paying the price for not taking her health more seriously.

Since 2018, her sight has been deteriorating, and she has had at least three of her toes amputated.

“I was on insulin, but I wasn’t taking it seriously. It was when the foot started getting bad on me that I started to take it seriously,” she said, praising the NHF for affording her free medication for her illness.

“Outside of that, it is my son who is helping me out. It is him alone. Sometimes my daughter will try to help, but it is really him who takes care of the household because I can’t work,” she revealed.

n corey.robinson@gleanerjm.com