Three days in a US hospital convinced me that America needs ObamaCare

The bare-faced callousness of the American healthcare system is obvious. This isn’t a hospital; it’s the Wild West.

But is it really? Image: Getty

 

“Yeah, you’re going to need to go to the emergency room with that.”

In a healthcare drop-in centre in Brooklyn, I’m paying a man in a white coat $130 to prod my puffy red hand.

I last set foot in an A&E when I swallowed a piece of Lego, aged three. An emergency room, though? It has that “let’s not fuck about with unnecessary words” sense of American urgency to it. An emergency room is where you go when you’ve been shot seven times in the spleen. It’s where humans reduced to bloody slabs of gristle are careered about on trollies, and doctors need amounts of things, “stat”.

It started with a mosquito. For unknown reasons, a small bite on my finger ballooned and left me with a buoyant ham where my left hand used to be. Despite having been told by a dead-eyed pharmacist, “It’s fine. Take Benadryl”, there was no way (as a formidable hypochondriac) I wasn’t going to get it checked out.

My sister lives in New York, so I’ve spent a lot of time in the States, visiting her. But this is my first time navigating my way through the USA’s Kafkaesque healthcare system. First comes the paperwork, a War And Peace-thick pile of it, on which I write my name so many times that the words “Eleanor” and “Margolis” become hilariously absurd. Good thing I’m right-handed. I’ve been an American patient for fifteen minutes and I’m already starting to sweat. I bought health insurance at home, but I’m convinced that the company will play dirty; trying every trick in their sputum-dripping book not to cover me. While my hand is getting bigger and redder right before my eyes, I envisage a bill for a mighty stack of dollars. This is met with a peel of laughter by my insurance company, because I forgot to specify on their forms that I have one tit bigger than the other. “I’m sorry,” they’ll say, “We only cover the evenly-breasted. Enjoy prison.”

As the US government shutdown draws to some kind of close, maybe, I find myself lost within the system that started the whole thing.

I’m in a hospital bed, on an antibiotic drip. Some kick-ass painkillers have started to take effect, and I feel like human cheese on toast. I’m sharing my room with an elderly Hispanic lady called Carmen. Carmen is motherly and flatulent. Worried that I might catch a chill, she covers me in a blanket, then retreats behind her curtain and loudly farts.

My attempts to get to sleep are intermittently interrupted by the nearby calls of a nurse with a thick Brooklyn accent.

“Mary!” she says, again and again. I hazard a guess at Mary being a difficult patient.

Day two. I’m woken by a man’s voice.

“Miss Margolis?”

Medicated and soporific, I murmur something.

“Uh,” I say, perhaps.

The owner of the voice draws back my curtain and, to my drowsy horror, I’m met not by one person, but a crowd. I’m sprawled out in a star shape and half my face is coated in dried-up saliva. The man (a doctor) has brought along an eager troupe of young med students, to ogle my freak hand. A few pretty blonde girls in white coats jot down notes as the doctor points to bits of me and says sciencey things. Blood rushes to my cheeks.

“I am not a monster!” I want to say.

The doctor ushers the students away, and I go back to sleep. I’m next woken by the Food Bringer.

“Breakfast,” she says as she drops down a tray containing something that might be egg. I pick at whatever it is and endure a rush of overwhelming sadness. I can’t clear my mind of the fact that I’m in a place where a lot of people come to die. In another room, someone is hacking up a lung. Unable to concentrate on even the trashiest of American TV, I spend what seems like an hour poking holes in a polystyrene cup with a pencil.

“Mary, don’t touch that!”

My brother-in-law arrives with coffee. Having just been doped up with more painkillers, I gaze blankly at the ceiling while he speaks gibberish over the phone to my insurance company. Kind and attentive as the hospital staff may be, it’s hard to appreciate that you’re recovering when you have that constant, underlying fear of a giant bill.

“I know you’re in there, Mary!”

Carmen is arguing with a nurse in Spanish. I make out the words “Medicare” and “Medicaid” – America’s vestiges of socialised healthcare. Poor Carmen. I hope she’s covered.

Somewhere nearby, I can hear a nurse talking about the government shutdown.

“They just have to have their ObamaCare,” she says, her words oozing contempt.

I begin to wonder how the Republicans have managed to convince even those in the very midst of a system that punishes the poor, that the slightest implementation of state-funded healthcare is an evil, communist conspiracy.

Day three. A good-natured Polish nurse has just hooked me up to a drip and given me an injection of blood-thinner in the stomach. Carmen is leaving.

“Get better, darling,” she says, “And remember – if you need anything – money talks.”

She chuckles and exits my life. With her final words to me, Carmen may have been joking – but she’s neatly summed up the bare-faced callousness of the American healthcare system. This isn’t a hospital; it’s the Wild West. As a foreigner with travel insurance, I’m lucky enough to observe American healthcare from a safe distance. But to someone fully enmeshed, like Carmen, ObamaCare is a tiny drop in the murkiest of quagmires.

Eleanor Margolis is a freelance journalist, whose "Lez Miserable" column appears weekly on the New Statesman website.

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The EU-Turkey refugee deal only succeeded in one thing

It swept the humanitarian crisis under the carpet.

The Greek island of Chios is a picturesque holiday resort, and home to some 50,000 Greek residents. The occasional cruise boat moors alongside the fishing boats which populate the main harbour of the island. Tourism and fisheries make up the majority of the island’s economy.  A 7km stretch of sea separates Chios from Turkey. It is so close that you can look across the water and see the lights come on in houses in Çeşme as night falls. This beautiful island is also one of the scene of an unfolding and largely untold humanitarian disaster. It is evidence that the EU-Turkey deal in March, intended to stem the flow of refugees, has failed. 

Chios is home to more than 3,000 asylum seekers. Refugees, mostly from Syria and Afghanistan, make the perilous crossing from Turkey every day. Smugglers launch tiny rubber boats in the middle of the night, over capacity to a dangerous level, to attempt the crossing. One Syrian boy told us that the smuggler on the boat counted down from 10 to calculate when the best time was to purposefully puncture the side of the boat in order to escape the Turkish coastguard, but be rescued from drowning by the Greeks.

As a result of these cavalier strategies, this scenic stretch of water has become the grave of thousands. Those who are rescued by the Turkish authorities rather than Greece are often detained. Such high stakes has not deterred the refugees - one family we knew of had tried 17 times to get to Chios from Turkey. 

The main camp on Chios, "Vial", is at the end of a dusty track and is housed in a disused aluminium factory surrounded by barbed wire. G4S, the private security firm, guards the entrance to the European Asylum Support Office compound. It looks more like a prison than a place of refuge. The majority of the refugees live in metal containers. The camp was constructed to hold 1,100 and now holds approximately twice as many.

Most of the migrants and refugees who arrived in Greece before the EU-Turkey deal have been moved to the mainland, nominally in the hope of relocation elsewhere in Europe. More recent arrivals on Chios (and those simply left behind) have been subject to the hastily-adopted Greek Law 4375/2015, which allows for the lengthy detention of asylum seekers on arrival.

While camps on other Greek islands operate as de facto prisons, on Chios, the police allow refugees to travel around (but not leave) the island. A bus service is provided between Vial and the island’s main city, to allow those housed in unofficial camps to come to Vial for appointments. This is a tacit acknowledgement that makeshift camps are needed for those who cannot be accommodated in Vial’s limited facilities. Thus, the entire island is turned into an open prison camp, with asylum seekers unable to leave until their claims are determined, a process taking upwards of six months. During that time refugees, many of whom have fled from unimaginable horror, are left in an endless waiting game.

In May 2016, a Human Rights Watch report called the refugee “hotspots” on the Greek islands, such as Vial, “unsanitary and unsafe” . By September, when we arrived, the situation had not improved. The conditions in the camps around Chios were shocking. Violence was a daily event - both between asylum seekers and from the frustrated local population. Children, at risk of sexual exploitation and abuse, would simply disappear. We would spend hours searching the camps, armed with lists of unaccompanied minors, asking everyone we saw if they had seen this or that child. Some had already become desperate enough to risk their lives in the hands of human traffickers, in order to escape from the very place where they initially sought sanctuary. Shortly after we left Chios we heard that seven people had suffocated to death in a fridge trying to reach the mainland. Isis were known to be recruiting in the camps. 

Unaccompanied children were left to live together in overcrowded containers, often without enough beds. They would take it in turns to stay awake on guard. Food was often inedible. Access to medical treatment was limited. In Vial, the medical facilities were located inside the disused aluminium factory. To be able to speak to a doctor, you first had to get the permission of the police officers manning the entrance gate. People were sometimes left waiting there for days in the baking heat of summer.

It is no surprise that most of the refugees we met were self-harming, severely depressed and suicidal. It is also no exaggeration to say that everyone we interviewed said they would rather be dead than live in this limbo on Chios. Many of the refugees who arrive in Greece are already seriously traumatised. Large numbers of them are victims of torture, or bereaved or wounded by the Syrian war. Almost all have been forced to flee their homelands because of incomprehensible suffering. The reception they receive in Europe only reinforces their trauma. “I didn’t expect Europe to be like this," a Kurdish Syrian refugee aged 18 told us. His entire family (26 members) had been killed in one bomb blast and he had been subjected to horrific torture under the Assad regime.

We volunteered in the camps on Chios providing legal aid. Any hopes we had on arrival of facilitating the speedy settlement of refugees in Europe were quickly dispelled. The structures in place on Chios for the processing of asylum applications were at breaking point. A tiny team of under-resourced and overworked staff from the Greek Asylum Service and European Asylum Support Organisation try to work through the mammoth backlog of cases, but with officers only conducting two asylum interviews per day each, the process moved at a glacial pace. Every day of infuriating bureaucracy is another day vulnerable people are left in appalling conditions. During this indeterminate period of delay in an individual’s protection claim being processed, the authorities failed to take any steps to disseminate information or timescales which would have minimised the psychological harm caused by the never-ending uncertainty.

So what can be done? A French legal NGO collected the accounts of 51 residents in the camps and applied to the European Court of Human Rights (ECtHR) to oblige Greece to take interim measures to safeguard the refugees from the risk of serious and irreversible harm. This application was quickly dismissed, with the residents being asked to wait (yet again) and abide by the usual procedures (yet again). The case of Raoufi and others v Greece, brought on behalf of several asylum seekers challenging their detention in camps in Greece, is pending before the ECtHR and doesn’t look likely to change the position for refugees in Europe any time soon. 

Some have placed their hopes in the controversial agreement between the European Union and Turkey, signed in March of this year. The heart of the EU-Turkey deal is the return of so-called "irregular migrants" to Turkey. Syrian refugees who reach Turkey are expected to make their asylum claims there and await relocation to Europe. Turkey will then, on a one-for-one basis, take migrants from Europe who have not patiently waited their turn. The supposed lawfulness of such a deal comes from the suggestion that Turkey is a "safe third country" to which to remove refugees. 

The attractiveness of this agreement to the EU, which comes at a cost of several billion euros, is that it may deter refugees from undertaking the dangerous (and politically inconvenient) crossing into Europe. While the European Commission has insisted that the numbers of refugee arrivals has fallen, their assertions are contradicted by aid agencies who point out that the temporary drop in arrivals following the EU-Turkey deal was short-lived. Refugees continue to arrive in large numbers on Chios, to face appalling conditions on reception. Few are returned to Turkey and the promised funding has not yet been provided to Turkey’s satisfaction.

Our experience on Chios was that the EU-Turkey deal is not only not working, it is fundamentally unworkable. Most of the refugees with whom we worked had passed through Turkey on their way to Greece. Almost all had stories of mistreatment in Turkey. In particular, we were told of guards on the Syrian border shooting and wounding at desperate people – including women and small children – attempting to cross into Turkey. Once in Turkey, arbitrary arrest and detention was the norm. Those migrants most likely to be returned to Turkey (because they cannot be returned to their country of origin) are Syrians, for whom Turkey is clearly not a "safe third country". Turkey’s systematic refusal to allow refugees fleeing Syria to cross its border is a clear breach of international law mandating the reception of refugees. Those refugees who manage to slip through into Turkey are left without meaningful protection or support. Kurds are systematically mistreated by the Turkish state while migrants in general face abuse by police, army officials and criminals. Turkey simply is not a safe third country for refugees, as is underlined by the tiny numbers of people found appropriate for return. 

The EU is seeking to resolve its refugee crisis by returning vulnerable people to inhuman conditions in breach of EU member states’ obligations under international law. The assessments as to whether the refugees are returnable to Turkey, are meaningless. Thousands of refugees are waiting for months for these assessments and yet a tiny minority have been found to be appropriate for return. 

In the meantime, a humanitarian disaster unfolds. The physical and mental health of those trapped in the camps deteriorate. Children are left without schooling or proper protection. Violence breaks out. Self-harm rises. Lives are irreparably damaged. Further delay, for political, economic or legal wrangling, is not an option. As long as the European Union fails to act, it remains complicit in these human rights violations. 

Miranda Butler, Maria Moodie, Bryony Poynor and Saoirse Townshend are barristers who recently volunteered in Chios, providing legal aid to refugees.