Imani Tafari-Ama | People-first approach to healthcare

The United States (US) presidential debate is of interest beyond its shores. This is because the tentacles of US political influence reach far across the globe. The public jury pronounced Kamala Harris the winner over Donald Trump mere weeks before the November election. The issue of public health, especially sexual and reproductive health and rights, was one of the big-ticket items on the agenda. The abortion question ransacks the state’s authority to regulate peoples’ personal body politics. This ongoing dispute is answered by social-change activists who argue for a woman’s right to choose what to do with her body.

Donald Trump is responsible for overturning the decades-old Roe vs Wade ruling, which protected women’s rights to have control over their bodies. Currently, states have put the abortion issue on the ballot and are voting accordingly. Leaving the decision to the states is likely to result in conservative backlash, the cementing of state regulation of the embodied law, which put women on trial for their reproductive choices.

Sexual and reproductive health and rights has become a flashpoint for conservative voters and justice advocates alike. Being pro-life is considered conservative and influenced by (evangelical) Christian beliefs. Harris scored points for declaring that if she won, she would support the reduction of state interference in women’s reproduction decisions. She champions returning this agency to women and their partners.

That is, of course, easier said than done. Affordability barriers prevent many women from accessing healthcare in general. Abortion, which is socially stigmatised, also carries connotations of being a privilege rather than a right.

On the other hand, pro-choice proponents are stereotyped as devious and morally flawed. There is a class-specific line drawn in the sand of these polar positions. Under current arrangements, only those who can afford to pay the costs to cross state lines can terminate a pregnancy in supportive states without compromising their health safety and that of the unborn. Thus, safe abortions are available only to the few and not the many.

POWER TO REGULATE

Should the state decide? Is it the Church’s business? In the face of pervasive problems like sexual abuse, incest, child trafficking and exploitation, which may result in unwanted pregnancies, who should retain the power to regulate the sexual and reproductive health and rights frameworks that should govern the abortion arena?

The refusal of the Jamaican state to legalise abortion has left life-threatening practices of unsafe terminations in place. This risk is reinforced by cultural taboos like calling women who do not have children “mules” and those who terminate pregnancies “cemeteries.” This taboo ends up penalising women who interrupt the process of childbearing by any means.

Health has also been a hot topic in Jamaica recently, following the outlandish death of a traveller at the Sangster International airport. 71-year-old Leroy Smith, who visited the island to attend a funeral, was about to check on a JetBlue flight to Orlando, where he lives, when he fell and hit his head. Due to unsatisfactory administrative and medical responses, he ended up dying on the airport floor.

In a video that went viral on social media, an eyewitness, Celia Foster, recounted the tragic incident. According to Foster, the unavailability of an ambulance to respond to this emergency was a major contributor to Smith’s death. From Ms Foster’s story, she was standing next to the unfortunate gentleman when he fell and hit his head. The fumbling response by those in authority revealed the dysfunction plaguing the health sector in the island’s tourism capital.

There was pronounced inaction from the airport staff for about half an hour after the tragedy struck. No functioning ambulance could be identified at the Cornwall Regional Hospital (CRH) to address the emergency. After Ms Foster found Mr Smith’s phone and identified and contacted one of the last person’s called, she was, incredibly, asked to confirm if that person could pay the US$400 charged for securing the services of a private ambulance.

This person turned out to be Mr Smith’s nephew, who agreed to the fee. However, he was charged J$10,000 since although the ambulance arrived, it came after Smith had already passed.

MASSIVE INVESTMENT

The massive investment in the infrastructural development of the CRH, the main health facility in Jamaica’s tourism hub, was initially estimated at just over $5 billion. Today, the cost for improving the hospital has ballooned to $21.5 billion. In light of this escalation, it is shocking to hear that someone could have died due to the unavailability of an ambulance. The nearby fire brigade that is supposed to also have an available ambulance to complement the CRH’s service had none.

Therefore, you have to wonder what resources were allocated in the $21.5 billion budget to accommodate the expansion of the CRH. Did the planning not take into consideration state-of-the-art facilities like ambulances? What are the indicators of a resource-sufficient city when it comes to providing assistance for people facing medical emergencies?

Prime Minister Andrew Holness and the Minister of Health, Christopher Tufton, concur that international inflation costs have been responsible for the skyrocketing spending for rehabilitating the CRH. Ms Foster also reported, though, that while Smith was bleeding out on the hospital floor, there was no medical personnel at the airport to address the crisis or to provide a solution. It also raised the question, as the eyewitness did, whether it might have been a different response if it was a white tourist who had graced Jamaica’s shores and experienced such an unfortunate incident. The current US advisory against Jamaica cautions visitors about availability of a responsive health sector, so this is not a good look.

Mr Smith’s nephew claimed in a radio interview that someone should take responsibility for the negligence that resulted in his uncle’s death. It is certainly an eye-opener about the erosion of the access to adequate health services that citizens should take for granted.

These deficiencies are the glaring results of the on-the-backfoot balance-of-payments approach to dealing with the economy under agreements with institutions like the International Monetary Fund. The health sector has suffered contractions for decades due to the sacrificing of services for debt payments. It is time for Jamaica to come full circle and demonstrate to regulators like the US that it can stand on its own two feet in this fundamental arena. This comes from a people-first approach to policy and development.

Imani Tafari-Ama, PhD, is a Pan-African advocate and gender and development specialist. Send feedback to i.tafariama@gmail.com and columns@gleanerjm.com.