Some time ago I worked, along side a Presbyterian Medical Missionary, in one of the more impoverished areas of Sub-Sahara Africa. Malawi is a very poor country with limited resources and only the slightest hint of a supportive social network or government infra-structure. While there, I had the opportunity to go into several villages, collections of huts really, with no suggestion of sanitation, knowledge or application of health care and a very high incidence of neonatal deaths.
My missionary friend told me that when she had first arrived to work in Malawi, she had asked why so few of the women from these village groupings came to the hospital where she could deliver their babies safely and with a markedly lowered mortality.
The answer she was told was “Tired Legs.”
At first she wondered if this was a statement of some cultural or religious norm that prevented the people from using the hospital as a source of care. Upon further inquiry, she told me, the answer was far more simple and at the same time, heartbreaking.
The women, who were in labor, ran out of energy on their long trek to the hospital to give birth and their legs were too tired for them to walk any further. Their babies were born and often died at the place where their tired legs just gave up.
Sometime this month, the Supreme Court of the United States will decide whether or not the Health Care Reform Act,passed by Congress in 2010, and referred to by many as “Obamacare” fits into the legality of circumstances as defined by our Constitution. At stake in the debates over this law are such things as whether all people should be required to have health coverage and whether Medicaid, the “safety net” government funded plan to provide access to health care for the poor, especially women and children, should be expanded to more of those in need.
It is hard, at times, for me to balance these two extremes. In our country, we exhaust ourselves, arguing ideological views on who deserves what, set against a background of the most advanced health care system in the world. Rather than embrace the excitement and good fortune of what exists that could forever prevent any “tired legs” from accessing quality, supportive, preventive and equitable health care, we wear ourselves out, trying to limit how such care is obtained.
In the villages of Malawi, and in millions like them around the world, the people exhaust themselves in the sheer effort to get to someplace, where someone who cares, will give them the barest minimum of help.
We have come to a time, I think, when we must re-think what it means to have good health and the ability to obtain health care. There is a saying “that a rising tide raises all boats,” meaning that what is good and of equitable distribution in one area will likely lift the prospects of those in other areas as well. I believe when we come to a time where we stop arguing about who should have health care and start applying our incredible minds and resources to assuring that everyone does have access then we can see the tide rise. I believe also that this is the only way we will see the cost of care decline rather than steadily increase. I do not hold to an allusion however, that this is a one way system. All of us must engage in ways of maintaining good health in order to be able to have access to the health care we desire. That is part of the obligation to ourselves and to each other.
But in the end, I come back to the images I forever will carry in my mind of desperate women, tying to reach a place of safety for themselves and their babies, whose legs are too tired to carry them any longer. We must never forget the lessons to be learned from them. It is time to move the health care reform debate out of the courtroom and use that energy to move aside the ideologies of restraint so that we reach a point where we all access, achieve and hold onto the best health possible.
Perhaps then, our own tired legs will be at rest.