#219: Restore a man to his health, his purse lies open to thee.

I haven’t updated in a long long time. And I wouldn’t have written this normally. Most of my musings are now confined in my head, popping up randomly in the middle of the day, chewed and pondered on for a couple of minutes before pulling away from said distraction so I can get back to work doing MRs and reviewing medication orders. I do feel stifled in all these, my creative muscles long stiff and achy from underuse. My tablet lies untouched for the past 3 months as my sister slowly learns to stop bothering me about the drawing commission I promised her months back. My little log book of book reviews laying wasted on my side table, obscured by my printed guidelines and patients lists.

But I digress. In any case, I write this post while wrestling on public transport on the way to work (Edit: I was. But I wasn’t done by the time work started so here I am continuing at night), riding escalators and staring at the edematous legs of the person in front of me, varicose veins of the woman diagonally to my left, recalling an incident that just happened earlier than inspired this spew I would’ve usually kept to myself and spend the early morning commute catching up on Reddit instead.

As I was walking up to the MRT entrance, a frail old woman dressed (retrospectively eerily) in all white – a white head cover, white shirt white pants and a carrying a white plastic bag to boot – looking kind of worried and lost. She stood out like a sore thumb despite her stature and her demeanor indicating that that was the opposite of her intentions.

I know she noticed me, she looked up at me, paused, and waited for me to walk closer. I debated on how I should present myself moving forward, as my walk along the side walk brought me closer and closer to her fidgety self. I am a morning person but I still hate people exclusively before 7am. What did she want from me? I can do the basics. Directions, bus numbers, closest [insert common store name]. She looks kind of sad, I could help her.

I kept a neutral face and a steady pace. As expected, she stepped to me as I got closer.

“小姐啊” She said hesitantly.“ 可以帮帮我嘛?”


“我没钱买药,” she started, as she unfurled her palm revealing a purple metered dose inhaler. At least it looked purple in the dim pre-dawn. I think it’s Seretide. I didn’t look at her face. I just looked at the inhaler. I’ve read about it, but I’ve never used one before. I don’t know how much it costs. I don’t think it’s expensive.

“对不起,我有急事。” Then I scurried off, not looking back. (I wasn’t wrong, was just on time in the end). I know people were walking behind me. Maybe she asked them, maybe she asks everyone that passes her. Maybe it’s just another day, and I’m not the special one who she chose to reach out to and I’m not that heartless person to ignore her plea.

People who know me know my unpopular economic / political views. In fact my views are so wildly unpopular I won’t elaborate too much on them in this post. But that aside, I’ve always somewhat trusted how the government allocated funding for medication. Medications get stratified to standard list 1, 2 and non-standard list based on inherent cost as well as cost-benefit analysis for the drug choice. SL1 is dirt cheap (maybe a few cents per tablet), and SL2 is quite cheap as well. Medicine don’t appear out of thin air to cure our silly asses, so expensive medicines can be expensive (NSL), perfectly reasonable. If you’re really poor, get the social worker to apply for financial assistance for you. The needs assessment would ideally reveal the tier of subsidies you qualify for. I’ve seen patients pay next to nothing, and still get the important treatment they need. Isn’t that great!

As with any system, people fall through the cracks. Even with a 99.99% satisfaction rate, you have 0.01% of the people accidentally getting the short end of the stick. But you can’t call it a bad system. Do we overhaul a 99.99% good system to save the 0.01% unlucky individuals?

The PC answer is yes, because all lives are valuable and everyone is entitled to having accessible healthcare. The sensible answer is no, because you can’t please everyone and money and resources and time are limited and we are all human please don’t be unreasonable when our statistics show great successes what more do you want from me.

Little white lady reminded me of the Lepax lady, who cried to me at the dispensing counter when the cost of her antidepressant was made known to her. “I can’t afford this antidepressant. But the doctor says it’s good for me,” Big sigh. “It’s just making me more depressed.”

Little white lady reminded me of a chronic Hepatitis B patient I interviewed just recently. “I don’t take Telbivudine anymore, I just can’t afford it.”

Little white lady reminded me of the countless patients I had to counsel medication compliance for, who were halving or quartering tablets without permission, taking the medicine every other day or “only when I feel really bad” – “Medicine very expensive you know!!”

Do they know the subsidies they can apply (were they ignorant about the systems in place)? Did they try but were rejected (did the system fail them)? Are they just stingy with their money, or put life-saving medication a low priority in their budget? (You’d be surprised)

I could’ve given little white lady some money for her inhaler. One inhaler contains 120 doses, assuming 2 puffs BD that would last her a month. Then what? Heck, I don’t even know if it was a legitimate cry for help or just a scammy money-begging shot, from that half a second interaction. I can’t sit her down for a 30min financial counselling to see if she understands her Medisave/care/shield entitlements or if she’s poor at managing her existing finances. I felt pretty damn useless then, and I’m still feeling damn useless now.

I don’t know. I still wouldn’t have given any money. Am I horrible.

Patients are patients. Patients are not statistics. But when you look at them as a population, that’s what they are eh?