A folder and a notebook were my first purchases following diagnosis. After only the fifth medical visit over a period of ten days, I quickly realized that I’d have to get organized. One doctor’s visit could lead on to two or three more tests, which would then lead onto more consultations. And each separate medical visit produced its own set of papers, from authorization slips to health risks or methods of preparation for any given test.

One week’s agenda looked something like this:
Monday morning: gynecologist public hospital/mammogram. Afternoon: medical certificate. Evening: MRI of breast and ultrasound.

Tuesday: Consult private gynecologist.

Wedeneday morning: Second opinion. Afternoon: Ultrasound of abdomen.

Thursday: Collect result of electrocardiograph.

Friday: Deep tissue biopsy with ultrasound and insertion of tag for surgery.

The following week was something similar with the inclusion of a PET scan, blood tests, chest x-ray, bone scan and another MRI.

God, is this what every person diagnosed with cancer has to do? I never realized there were so many different machines for so many different tests. Nuclear medicine, radio diagnostics and the new era of imaging tests. And all the doctors, nurses, ancillary staff and the space, a designated nuclear-insulated space for each huge scanning machine that requires a patient to be injected with radioactive tags.

Then there are the waiting rooms, always full to the brim with people. Are they all sick?

I’ve always had the good fortune to be well and healthy and even though I’ve imagined to a certain degree of empathy how it must be for those closest family members and good friends who have suffered through illnesses, I could never really fully comprehend the implications of being seriously ill.

Here I was with a folder and notebook organizing my bits of papers and appointments. While in the whole of Spain, the Spanish government, or the Spanish civil servants or whoever is responsible for the Spanish Health System are organizing their agendas and folders for the millions of receiving sick people of a premium health care.

Wow!

The immensity of co-ordinating 40 million people through births, vaccines, minor sicknesses, major diseases, medical emergencies, senior citizen care, recovery or palliative care to death was unfolding before my eyes on a daily basis. The hour long or more delays in the waiting room suddenly became less and less significant (and I fill the time with incessant writing or reading!)

And I have never put my hand in my pocket. No money has ever been exchanged between me and a nurse or a doctor or a secretary. I know receiving healthcare is not like going out to buy a fridge but it certainly costs a lot more. Scratching the surface just a little I have compiled a short shopping list with my findings:

• Ireland’s first state of the art PET scanner installed in a private clinic in Dublin in 2002: €3.8 million. (The first one to appear in Spain was in 2003 in La Paz public hospital, where I am being seen to by my oncologist here in Madrid).
• MRI scanner: From as little as $175,000 up to $3 million, obviously depending very much on quality and performance.
• Gamma camera: (and I copy and paste from a kind of buy and sell of medical equipment website)
  Gamma camera system: $350,000
  Total Capital Costs: $350,000
  Operating and Ownership Costs
  Service contract for years 2 through 5 = $32,500/year
  Salary and expenses for 2 full-time technologists in years 1 through 5 = $90,000/year
  Cost of Nuclear Regulatory Commission licensing = $20,000/year
  Cost for accessories, such as syringes, film, and optical disks, at $15/procedure
  = $30,000/year in years 1 and 2: $33,000/year in years 3 through 6
  Cost for radiopharmaceuticals at $250/dose = $500,000/year
  Total Operating Costs = $640,000 in year 1;
  = $672,500/year in years 2 through 5
  Present Value = $3,306,311
• Etcetera.

So who is paying for all my treatment? Well I am of course (although I haven’t contributed enough yet to foot the bill so many more working Spanish citizens are digging deep on my behalf) as I benefit from both private and public healthcare. Living and working in Spain, I pay 4.7% of my contractual salary for social insurance, which covers not only health but pensions and unemployment benefits also. My employer, The British Council pay the other 23.6%, which is generally passed on to the employee as a lower salary compared to Ireland, for example. (I get paid a lot less here as a teacher in Spain than I would in Ireland). But now I know I can rely on a premium healthcare; I get my deduction’s worth.

Having a major illness has opened my eyes to the truth of the saying “health is your wealth”. But the wealth of a country should also be measured by the organization and efficiency of its Health System. In my opinion, health and education are the fundamental cornerstones of any democratic society.

Elena, my home helper, from Romania tells me about her cousin who is receiving chemotherapy in her home country for stage 4 breast cancer. If she doesn’t pay out something to each person who deals with her along the way, the nurse who draws her blood, the surgeon who performs the operation, the oncologist who organizes her treatment, they’re not interested in her. Their salaries are so low that the sick people themselves have to subsidise them. A “pay or you’ll die” kind of system.

And in Venezuela nowadays if you want chemotherapy, the oncologist gives you a shopping list to browse on the black market: http://www.nytimes.com/2016/05/16/world/americas/dying-infants-and-no-medicine-inside-venezuelas-failing-hospitals.html?smid=fb-share&_r=0.

I don’t like that I have breast cancer but I do feel fortunate and blessed that it’s 2016, when the prognosis has never been so good. And I feel privileged that I live in a country where the choices for cancer treatment are amongst a multitude of centres of excellence. I would like to say it’s a right but since not every sick person around the world has the same choice as me, now in 2016, I feel the healthcare I am receiving is still a privilege. And referring back to a previous post on the fairness of this situation, I think now this is where the real unfairness and inequity lies.

Sickness is a harsh reality but caring for the sick should be a fair right for everyone.