‘He is homeless, you see. Had we given him the surgery, there would be no-one to look after him.’
My consultant and I discuss our last patient, an elderly gentleman with highly advanced cataracts. His pupils had shone white against my torch, indicating that barely any light at all was making its way to the back of his eye. In the UK these are operated on promptly, restoring vision and a great deal of quality of life. Here in the Caribbean however, the waiting list is vast – not to mention this man’s unfortunate home circumstances, which had forced back his own surgery.
Money is an uncomfortable reality of medicine. Every doctor, every drug, every machine is a resource with a cost. At medical school, we are taught to be mindful of how we spend such resources: e.g. don’t blindly order every blood test going, but try to hone in on what might be relevant. Our gentleman today was a stark reminder that a patient’s own social and economic background can also raise barriers. His simple need to have someone around to administer his post-operative eye drops had meant a huge upheaval of his very necessary treatment.
The Caribbean has worked hard to invest in its eye services however, which was apparent in another cataract patient I saw. This man’s cataract had been successfully removed, but he had suffered a complication called posterior capsule opacification. This is where the clear capsule from which the cataract was removed becomes unclear and itself causes blurring. This can be fixed with something called a YAG laser, which was ready and waiting at the hospital.
With the patient sat securely in front of the laser, I watched as my consultant carefully aimed and fired it through the affected eye, creating a tiny series of transparencies in the capsule. After literally a few seconds (albeit with some odd phutt noises), the patient was taken through to the examination room, where he proceeded to read from the chart straight away. Pretty amazing.
Money is, to most medics, an incredibly dull topic. Seeing results like this however, I can appreciate that it’s important to keep aware of finances – be it your hospital’s, or your patient’s.