Sishemo tested HIV positive in 2004 after giving birth to her second born child. Unfortunately, her child was born HIV positive as well and they have since been on medication. Sishemo works as a maid in one of the affluent neighbourhoods in Lusaka. She has no medical insurance but accesses a free ART clinic where she and her daughter have access to HIV treatment and other infectious diseases.
The recent news of missing medications and possible withdrawal/reduction of donor support in medicines and medical aid caught her attention as she overhead her madam listening to the press briefing by the American Ambassador. She then took it upon herself to ask what was going on exactly. And her boss informed her that medical aid by the USA government was going to be reduced by January next year and that government would have to start pumping in more money into the Ministry of Health and that hopefully, this would not affect those people receiving free ART treatment. As Sishemo sat on her stool that evening, warming herself on the little charcoal remaining on the brazier after cooking supper, she could not help but worry if ever she would need to start paying or buying HIV medicines. With a salary of K 1500.00, well at least now with free education, she was not paying school fees but rentals of K800 for a 2 roomed apartment, garbage, electricity and water bills of K120 which her landlord collected, charcoal costs, she could not even remember the last time she bought a 25kg bag of mealie meal or what the cost was as she survived on pamelas (small packaged plastics of mealie meal) and sometimes she was lucky to take home left over food from her work place which would be left over nshima or rice. The thought that maybe, just maybe, she might have to start paying for ART services made her wake up with a terrible headache the next day.
There is a psychological distress that occurs when one has no medical coverage or insurance and it can happen to anyone. The worry Sishemo feels is the same worry a person who was a manager in a well established organisation will feel when they lose their high position and now have to only depend on the government scheme which has limited private clinics.
An individual who has a social role of the provider of health insurance coverage for his/her family, after a disruption in coverage would no longer be able to fulfill this role of provider, placing stress on oneself. In this instance, it is not necessarily the specific reason for the loss of coverage that brings about psychological distress by experiencing unemployment, nor is it being fostered by the duration of time during which one is uninsured. Instead, it is the social consequence of the disruption in coverage, and being in a state of lacking of coverage, that is acting as a stressor and fostering psychological distress. For those with private health insurance the majority of this coverage is offered through an individual’s employer, and loss of a job can also lead to loss of one’s private coverage. For instance, someone who was working for a top government parastatal and does not have his or her contract renewed, will lose out on both the private coverage and the government medical scheme. Even if the individual chooses to continue the government medical scheme by paying on their own, there will be a brief disruption before updating or amending their records so that their account moves to a personal one from being under an organisation. Now, imagine having a medical emergency in the middle of the night and not been attended to at the nearest clinic because your medical scheme is suspended and this results in costly medical bills or you want a certain medical test done and you are informed that you have to wait for confirmation if the government scheme can cover it. As a person who has taken a patient to a clinic and getting informed that your insurance is suspended due to non payment, you end up raising your blood pressure, a condition which was normal before arriving at the hospital.
If you are not in the shoes of Sishemo, because you have a good job that covers your medical insurance or are financially stable business-wise that you can afford the best medical services, you will not understand the panic that people who depend on free medical care have felt in the past weeks at the thought of interruption in their health care. Every condition an individual has is different, there is ongoing need for medication and doctors’ visits. There are people living in chronic pain and are constantly on medications and adding the thought of them not being able to access medical help is draining.
We can cut a lot of expenses in life but lowering medical expenses isn’t always possible. Medical bills are usually full of surprises even when one has insurance because at times, you end up going home with a prescription or simply told this or that is not covered, please pay for it.
The thought of medical bills makes people skip seeing doctors and resort to looking up their symptoms online and end up self treating which of course is risky.
As the country says its high time we stood on our own feet and met our medical bills, we need to be realistic and think of what our friends who have relied on free medical aid must be going through stressing on the possibility of not fully accessing free life saving medical aid which clearly is not affordable to majority of our people. Financial stress on its own causes divorces, trouble with kids, physical pain or even death. The thought of finances is always on the back of your mind when you have a medical condition and you are the breadwinner in this economy while having no medical scheme and this stressing over finances especially medical bills, brings about anxiety, trouble sleeping, muscle pains, high blood pressure and a weaker immune system.
When faced in a tough situation and feel you overwhelmed, talking to someone is the first step in getting help. Government hospitals have officials from social welfare and if you approach them, they can be of assistance to look into how best you can get help by getting free medical assistance. Sometimes, asking for help from family and close friends may not be such a bad idea. Others can offer emotional support; help you feel less lonely or even be able to offer financial help and ease your stress. Reaching out to our community such as the church can be a good idea. There is no shame in asking for help for medical expenses from loved ones or other resources because staying silent as you struggle with medical bills just adds to the stress and this is the last thing you need.
Today it’s Sishemo with no medical scheme, tomorrow it might be you, be empathetic.
Seek help when in need, visit a counsellor near you!
About the author
Aka Monde, is a licensed Professional Counsellor who holds a Master of Science in Counselling from the University of Zambia. She believes in the adage “a problem shared, is a problem half solved.” Speak to your pastor, church elder, elderly family member or see a professional counsellor when in need.
Email: [email protected]
