Rant: Buy your own damn machines

Where I live, we have a public healthcare system where most things are paid for, and I am fortunate to have much of the care for my chronic illness paid for out of my taxes. Having said that, I do not particularly like the care I get for said illness. Too frequently of late I have waited a long time in waiting rooms; an hour and a half for bloodwork (and this cannot be claimed to be an inefficiency of public care--bloodwork is generally done by private companies who are contracted to the government or individual patients), and regularly at least an hour to see my specialist. The only time I have not waited, they phoned me five minutes before my appointment time to see where I was, because everyone else was gone and they wanted to go home. You can guarantee that they don't phone me before my appointment when they are running an hour plus late. Not only do they not phone me, it seems to be against clinic policy to apologise for the wait. Clearly, given that they always run late, their appointment times are too short, but obviously this is okay because in this circumstance it is only the patients (whose time is infinitely expendable) who have to wait, not the doctors. So yeah, I'm not crazy about my hospital.

Where I live charitable donations are tax deductible, so come tax time every charity is out asking for donations. Now, I am all for giving to charity; I have a couple of donations that go out monthly to organizations I support, and I am tempted to add a couple more to the list. So around tax time, I got a letter from the hospital where I get my care, soliciting donations for some "hi-tech" new ultrasound machines to help "pregnant women and men with prostate cancer". Now, leaving aside for a moment the fact that I don't even like the bloody hospital, this is wrong on so many levels:

• They have my address because I am one of their patients. Not only does this show me that they are quite willing to use information I provided for reasons of healthcare to solicit for donations, it also shows that they are willing to ask for donations from those who already have the additional financial burden of a health condition bad enough to be treated at a public hospital (and yes, there are costs associated with illness even in socialised medicine). I've also had solicitations for donations from other public hospitals I have nothing to do with, and I'm somewhat suspicious as to how they got my information.
  
• They were talking about how wonderful these new machines were. There have been no truly significant developments in ultrasound since the 90s, so either they are very slow off the mark, or they're...dissembling.
• The government will be making a significant contribution towards the cost of these machines, and if the hospital cannot afford to replace equipment, it should either be asking the government for more money or looking at how it spends its operating budget (especially if these machines are just replacements).
• They do the routine about "obese, older mothers" benefitting more from ultrasound. First of all, it is at best debatable how much obesity is really a risk in pregnancy, and secondly, ultrasound is a difficult imaging tool to use on patients with a lot of adipose tissue, so these machines won't help obese mothers that much anyway.
• The letter also says how pregnancy and prostate imaging are "non invasive" diagnostic measures. Given that prostate ultrasound is performed transrectally, and pregnancy ultrasounds is often performed transvaginally, these people clearly have no idea what "invasive" means to non-medical professionals.
• Despite asking me to send them a cheque or my visa card details, a replay paid envelope was not included. This is not only rude, it means I am altogether too likely to make a mistake and send money to the wrong address.

Given the cost of postage, I truly wonder whether they will make any money on this campaign at all. I'm pretty annoyed about all the trees involved in doing a paper mailout like this, and I'm equally annoyed at being targeted for all the reasons I list above. Honestly, if the donation section had not had my name and address on it, I would have paid for a stamp to send it back with "you've got to be joking" written on it in big red letters. Because really, they've got to be joking.

Rant: Gynecology, choice, "annual exams", and the medical establishment

For those readers of this blog who are made squeamish by feminism, medicine, or vajayjay talk, I suggest you look away now. Consider yourselves warned.

Recently, I read a post on feministing asking how women felt about getting their "annual exams". I didn't weigh in on the topic, because where I live now, and where I lived before, "annual exams" aren't annual, and include only a pap smear, rather than the breast exam and everything else that seems to happen in the States. Also unlike the U.S., here these exams are usually done by your family doctor, rather than a gynae specialist. what this discussion reminded me of, though, was a pro-feminist framing of gynae care I'm not sure I am comfortable with. I'm not sure I can agree that gynae care is entirely feminist--while being healthy is certainly pro-woman, I'm not sure viewing the female reproductive system as something that needs to be checked once a year to remain healthy, or the pap smear as a pre-requisite to a birth control prescription is feminist. The first reminds me enormously of the medicalization of birth, with all the patriarchal control of female reproductive organs and disconnect between a woman and her own body and health (after all, what other body system needs so much checking out once a year?). Requiring a pap before prescribing birth control smacks of medical paternalism to me--even in the highly legalized medical environment in the U.S., surely a woman ought to be able to sign a waiver and get her birth control anyway (there are some places that offer this option, but from what I have heard they are in the minority). I think it is likely, too, that this insistence on intimate exams may actually prevent some women from getting hormonal birth control--this insistence will not force unwilling women to get gynecological exams, it will cause them to use other (potentially inferior) methods of birth control.

Combine this climate of control and medical paternalism (of which there is a long history with regard to women's bodies) with the fact that often women are not in charge of their gynae exams--take this and this as examples from the medical blogosphere and the feminist blogoshpere respectively that make my toes curl in their shoes--and you have a pretty ugly scenario.

In Australia, around 61% of women go for their pap smears every two years as recommended. That means 39% don't. To try to raise this number the government is paying doctors extra for treating women who have not been tested for a while (but you can guarantee that that extra money is not being passed on to patients). In a country the size of Australia, you can guarantee some of the problem is access and choice--when you're dependent on a rural health service that covers a wide area, well, it might take a bit longer to get to a doctor. Like anywhere, though, some women's reluctance will have to do with what doctors call "anxiety or embarrassment", which I believe is meant to cover everything from anxiety and embarrassment right up to fear and trauma. While the medical approach is that these women should "get over it for their own sake", I am a little disappointed to note the actual level of care being offered--I'm going to talk about the Australian model, because I've done some research about it.

In Australia, around 2% of the ordinary non-liquid paps are inconclusive (usually because they contain blood or mucus), requiring the woman to come back for another test 6-12 weeks later. While there is a more effective test, the cost of this test is not covered by the Australian government (unlike most other medical testing), and even where it is performed an ordinary pap must be performed anyway. In a traumatised woman, the additional testing, expense, and discomfort may be the barrier between getting successful health care, and not getting it, but it is much easier to trot out the line about how "women with cervical cancer should have come in for a smear" than actually address this problem.

HPV testing could be offered as an alternative to traditional pap smears, meaning women did not have to get tested so frequently, but again, this is not covered by the Australian government, and therefore does not actually help many women.

And then there is collection method. Blind sweeps, and self sampling (either with the traditional method, as this midwife offered, or with the newer mechanisms) can offer women an non-traumatic way to collect the necessary samples. The Australian cancer screening program., however sees 'no evidence' to support the use of this approach. I guess the women in this study who would use this approach but did not get regular pap smears are not enough evidence. As this paper says, self sampling could bring the participation rate in cervical screening to near 100%, but cynically I have to wonder if it is easier and cheaper to blame women for getting cervical cancer.

My point is this (and yes, I have one): I do believe that being healthy, and having a healthy reproductive system are feminist objectives. I also believe that choice, knowing one's own body, and questioning the patriarchy are feminist objectives, and given the above it is clear that (at least in Australia) choice is being restricted (and may pose a barrier to the health of up to 39% of women). I am all for taking care of our bodies, and I am grateful that (largely thanks to the feminists who went before us) gynecological care has advanced enough that women are allowed to get pap smears these days. Having said that, the fact that the medical patriarchy is denying birth control without a pap smear, or constricting womens choices about what kind of pap smear they have (financially, practically or informationally) quite frankly makes me think that too much gynecological care isn't feminist. Until women everywhere can get care in the way that works best for them, until the blaming of cancer victims for "not coming in for a pap" stops, until women are seen as intelligent beings and allowed to decide for themselves about the risks associated with birth control, I can't quite see the "annual exam" as feminist.

Rave: "Jamie's School Dinners" music programmer

For the first time tonight I watched a show called Jamie's School Dinners. It's about Jamie Oliver moving into schools in the UK and trying to serve children one nutritious meal per day through school cafeterias. Disturbingly, many of the "dinner ladies" he works with have no training, cannot even cook pasta, and appear not to like to eat vegies themselves. Under the circumstances is it any wonder that an increasing number school-age children are seeing dietitians? Scary stuff.

Anyways, good on Jamie for trying to change things, though had he asked me I could have given him a few pointers on how to make his changes more palatable (in more ways than one) to his wee charges -- for example, the healthy burger -- vegie pattie with wholemeal bun and lots of salad. I know this must have lots of fibre in it (one of the major problems the dietitian interviewed was seeing was kids with malfunctioning colons due to lack of fibre) because it would absolutely slay me. The kids, however, would still see it as a burger. New foods could be introduced slowly.

The real purpose of this post though, is to praise to the sky the music programmers for the show, who have bypassed dross like Britney, Eminem, and Coldplay and picked up in this episode alone Mr. Brightside by The Killers and Twenty Years by Placebo (though it would take a diehard fan like myself to notice that last one -- it was instrumental snippets only. But then I guess the show was for a general audience, and Placebo, generally speaking, are not).