What does health inequity look like?
In February 2016 I spent three weeks in Cambodia with a short-term medical missions team. The team was comprised of roughly 30 fourth-year medical students from the Medical College of Georgia (MCG), team overseers Drs. Ted and Sharon Kuhn, and a few others such as myself and Dr. Corson (father to Covenant graduate Anna Beth Corson ’20). The purpose of the medical team was twofold: give the med students a glimpse of rural tropical medicine, and encourage the local church by visiting villages of local missionaries.
We traveled to various sites around the country, including the southernmost province Kampot, and villages outside of Phnom Penh, Cambodia’s capital. At the daily clinics, we primarily offered general medications and screening for various conditions. With limited medical technology, including an EKG and ultrasound machine, we screened for heart abnormalities and other common conditions, such as colon polyps, gallbladder stones and internal bleeding.
The sites where we set up clinics were scattered. Typically we traveled on a bus from our host site to rural villages that otherwise had limited access to medical resources. The roads were dirt and filled with potholes, and occasionally we would drive several hours to a village. Among the people we saw were young adults with malaria, malnourished children, and adults with parasites.
One of the daily clinics was set up in a school, essentially just a two-story concrete structure built with wide rooms and an enclosed courtyard. This setupset up was convenient because it contained the team and, with a few temporary rearrangements, lended privacy to visits with villagers.
A young woman, perhaps 27 or 28, came to Dr. Ted Kuhn about her heart. She was slightly overweight but not obese. While standing, her body shook with every heartbeat, almost as if she had rhythmic shivers.
Per routine Dr. Kuhn applied a twelve-lead EKG and then took a look at her heart with the ultrasound probe. Within minutes he gave his expert medical opinion: she had a significant triple-A, an abdominal aortic aneurysm (AAA). The AAA is essentially a weakening of the largest artery sending blood from the heart to the body; if it ruptures, the internal bleeding is massive and often irreversible. Dr. Kuhn determined she had less than six months to live unless she sought immediate help from a cardiologist who might be able to repair the condition with surgery.
When the Cambodian woman heard all of this from the translator, she sobbed.
This scene is etched in my memory. Concrete walls, Dr. Kuhn sitting with hands folded and expression somber. A med student and I were unsettled bystanders, watching the woman heave. Immediately I felt helpless against this illness.
What allowed this woman’s illness to persist? She likely did not have the money to pay for surgery or for the routine health screening that could have caught her AAA months earlier. What made her cry? Perhaps it was the thought of the family she would leave behind, possibly paralyzed without her, or the trauma of finitude brought sharply into focus, or a cry against the injustices that robbed her and many like her of access to a self-sustained health system and basic preventative health education.
I wish I could ask her. Too many like this woman cry for absent hope, cry for their families, and cry out against the injustice of deprivation of the most basic human right: the right to health. Many with stories like this are not simply born into poverty (of access, connection, equity), but are born into failing systems that cannot realize their right to health.
As a short-term team, what we had to offer was prayer. Reflecting on those moments with the doctor and the Cambodian woman, I am struck by the likelihood that her illness was not just a heart defect. Her illness was imaginably broader than that, systemic and one of deprivation. Overcoming such an illness will require prayer, but it will also require outlining what contributes to systemic inequity and analyzing whether current health systems are able to address the inequity.