"WR6_gUnUj-ztiW07KQcOCnTel9A"/> Notes From Atlanta: September 2009

Friday, September 25, 2009

Nigerians Who Come to America to Have Babies (II)

By Farooq A. Kperogi

It needs to be pointed out, however, that relying on emergency departments for the delivery of babies can be dangerous. This is because American emergency rooms, especially in big cities, can be remarkably busy. I have no statistics or even anecdotal evidence of Nigerian pregnant women who have died waiting in line for their turns in emergency rooms, but a 2007 survey in New York found that several Emergency Room patients have died due to excessive wait for hospital beds.

Emergency Rooms, once the last resort for most people, have now become the first resort for many, especially those without health insurance coverage. An earlier state-by-state survey of average wait times at Emergency Departments, conducted in 2006 by Press Ganey Associates, and USA Today, found that the average wait time for Emergency Room patients is 3.7 hours. The lowest wait time is 2.3 hours, and that is in the rural state of Iowa, while the highest is 5 hours, and that is in the arid state of Arizona. For a woman in labor, that’s an incredibly long time to wait.

The second option for people who can’t afford the cost of the wait time in Emergency Rooms is—or used to be—free clinics. Yes, there are clinics here that not only treat people for free but that give free drugs to poor, uninsured people irrespective of their nationality. According to the McClatchy Newspapers, America’s third largest newspaper company, there are currently more than 1,200 free clinics across America, most of which are owned by religious and charity organizations.

Two of the best known—Mission of Mercy traveling clinic and Muslim Community Center Medical Clinic—are run by Christian and Muslim organizations. They are typically the first and preferred recourse for the millions of uninsured Americans who want to avoid the exorbitant charges of emergency departments. Of course, as should be obvious from reading my previous accounts, regular hospitals are not even an option for uninsured people: they don’t treat people who have no health insurance.

Sadly, free clinics are now under tremendous strain. The economic downturn has drastically reduced the amount of contributions they receive from donors. And since they are entirely dependent on the goodwill of philanthropic individuals to survive, they are now increasingly demanding health insurance from patients. Besides, they are now even more overcrowded than the emergency departments of hospitals. That can’t be cheering news for Nigerian (and other Third World) women who come here to have “anchor babies.”

The executive director of the National Association of Free Clinics, Nicole D. Lamoureux, told the McClatchy Newspapers recently that over the past year, free clinics across the country have seen a 20 percent decline in donations and a 40 percent to 50 percent increase in patients. “Last year, the clinics the association represents — which largely have been excluded from the health care debate — treated 4 million people,” the paper said.

These are some of the core issues in the healthcare debate here. Obama wants every American citizen to have health insurance—with some assistance from the federal government. The big pharmaceutical and insurance companies who profit from the current state of affairs want none of that. To defeat Obama’s plan, the (Republican) representatives of big pharmaceutical and insurance companies in the U.S. Congress have stigmatized Obama’s healthcare proposal as “socialized medicine.” And, in America, the only word that evokes more visceral emotions than “socialism” (and all its inflections) is “terrorism.”

That’s why even poor white people who will be best served by Obama’s healthcare plan are up in arms against their own self-interest. For wanting to extend health insurance coverage to nearly 50 million helpless and vulnerable Americans, Obama is tagged a “Nazi,” a “Muslim Marxist,” a “Communist” and so many other devil terms that have profound cultural resonance here. Indeed ignorance and stupidity are blind to geography and level of development. You wouldn’t ordinarily expect this sort of crass asininity in a developed country like America.

My friend and former classmate in Nigeria sent me an email the other day asking to know if I would be safe from Obama’s “controversial healthcare reforms.” He had been monitoring the healthcare debate in the American media from Nigeria and all he sees, he said, are people protesting Obama’s proposed health care reforms. The substance of the reform is never discussed in the media. So he concluded that Obama must be proposing something really terrible for America.

It was his email and the discussion we subsequently had over it—and of course my own recent, first-time personal experience with American healthcare— that prompted my reflections these past few weeks. I hope the reader has learned a thing or two.

Friday, September 18, 2009

Nigerians Who Come to America to Have Babies (I)

By Farooq A. Kperogi

A reader who read my article last week asked to know how Nigerians who come to America to have babies get medical attention from hospitals since I said you need to have health insurance (somewhere between $1,500 and $2,500, that is, between N232,000 and N386,000 in upfront payment to insurance companies every year in addition to what your employer pays the health insurance companies) before you can be admitted and treated in hospitals here.

Well, there are three possibilities. First, it’s entirely conceivable that wives of wealthy Nigerians who come here to have babies have international health insurance coverage that is acceptable in America hospitals. There are several international health insurance carriers for travelers, for families on vacation, etc that hospitals here accept. But certainly not all Nigerians who rush to America to be delivered of babies in hopes of getting American citizenship for their children are rich enough to afford the kind of international health insurance coverage that will be accepted here. So how do they work the system?

I think it’s usually through one of two means. The most common, from my discussions with people here, is outright fraud or, if you like, emotional blackmail. The women wait until they are really due, rush to the emergency rooms of hospitals and compel emergency room doctors into delivering them.

You see, the redeeming feature of the American health-care system is its provision that no one should be denied medical attention in the emergency rooms of hospitals, although the cost of medical treatment in emergency rooms, as you saw from my personal story last week, is more than five times the cost of regular hospitals. But to visit a regular hospital, you not only need insurance; you also need to book an appointment at least a day before you visit.

Well, it had not always been the case that anyone who showed up in the emergency rooms of hospitals got treated. It was in 1986 that the U.S. Congress passed a law called the Federal Emergency Medical Treatment and Active Labor Act (EMTALA), more popularly called the Patient Anti-Dumping Law, which forbids emergency departments of hospitals from refusing to treat patients on account of their inability to pay.

Now, if you’re an American citizen or a legal resident who got treated in an emergency room, you will, of course receive your bill after the treatment, which you must pay within 45 days. If you don’t pay at the specified time, your case will be transferred to a debt collection center, which will continue to harass you wherever you go in the country until you pay your debt in full—or until you declare bankruptcy or offer other reasons why you can’t pay.

And—this is the sad part—whether or not you pay, the fact that there was a need to employ the services of a debt collection center to get back the money you owed is sufficient to ruin your creditworthiness and prevent you from getting loans to buy a car or a house, or even doing something as basic as renting an apartment or owning a cell phone. But if you’re non-American, which means you can’t be traced, you can escape. But that means you will transfer the financial burden of your treatment to American taxpayers.

I suspect that’s why the visa section of the American Embassy in Nigeria takes particular exception to uninsured Nigerians going to America for the sole purpose of having babies. During my various visa interviews, I have seen many Nigerians denied visa on account of evidence that they had in the past gone to have babies in America at the expense of American taxpayers.

To be fair, it’s not only Nigerians that do this. Citizens of many developing countries also come here to give birth to babies because they want such babies to grow up to be American citizens. Some Americans derisively call such children “anchor babies.” They are so called because it is believed that non-Americans use the citizenship status of such children as an “anchor” to return to America and become citizens too. The Immigration and Nationality Act of 1965 has a “family reunification” clause, which allows citizens (and “anchor babies” qualify as citizens even if they were born by illegal immigrants) of the United States to sponsor their relatives—spouses, children, parents, etc— for immigration to the United States.

This “anchor-baby” phenomenon, along with the spate of uninsured (read: poor) Americans who patronize the services of emergency departments that they can never pay for, has imposed a huge financial burden on American healthcare. A 2003 study by the American Medical Association, for instance, showed that American emergency doctors, on average, provide $138,300 (over 21 million naira) worth of uncompensated care on a yearly basis under the auspices of EMTALA.

In the new healthcare bill Obama is pushing in Congress, it will become hard for illegal immigrants or “anchor-baby-seeking mothers” to work the system like before. Proof of citizenship or immigration status will now be demanded before treatment. That proviso to the bill was included at the instance of conservative Republicans.

Sunday, September 13, 2009

Being Sick in America

By Farooq A. Kperogi

When you are in America, don’t fall sick—as if anyone can choose when and where to fall sick! But, seriously, if for any reason you fall sick, don’t go to the emergency department of a hospital unless, of course, your very survival is contingent on it. Well, except you’re stupendously affluent. I committed this error a few weeks ago. And I’m not some moneyed aristocrat. You want to know what price I paid for this? Then read on.

I came down with an unusually infernal fever the day I returned to Atlanta, my first in over a decade and only my third in my entire conscious life. It’s perhaps this infrequency of febrile encounters in my health history that hyperbolized the sensation of extreme danger I felt. The severe spasm of excruciating pains I underwent made me think I was actually in the throes of dying. So I called my friend here and requested that he leave whatever he was doing and come drive me to the nearest hospital immediately. “I’m dying over here,” I exclaimed.

Alarmed, he drove down to my apartment at once. But he met me not nearly as hopelessly clutched by the jaws of death as my exaggeratedly anguished plea for help suggested. So he advised that I book an appointment to see a doctor the following day. In America, unlike in Nigeria, you don’t just walk in to a hospital without at least a 24-hour prior appointment and expect to receive treatment. The only section of the hospital that accepts walk-ins is the emergency room. I insisted that we go there forthwith.

“But let me warn you: ERs (emergency rooms) are very pricey,” my friend said. But I thought my life was more important than any price the hospital would charge me. So off to the ER we went.

During the course of my brief triage (sorting) interview with the nurse on duty, I mentioned that I had just returned from Nigeria. And the mention of Nigeria changed the conversation dramatically. “Did you just say you returned from Nigeria?” the nurse asked, her mien now grave.

She immediately left the consulting room and went to get a face mask for me. I asked her why I needed to wear a face mask. “Well, it’s just in case you have malaria.” Well, but, malaria is not infectious. You don’t need much medical education to know that.

But I was in no mood for unavailing arguments. Besides, I have lived long enough in this country to know that Africa has been stereotyped as the diseased continent. A Nigerian friend who has lived here longer than I have told me I was lucky that I was not immediately quarantined; he said that’s often the fate of many people who return from Africa with a sickness, any sickness.

And that’s not difficult to believe. When I lived in the state of Louisiana, a Portuguese friend of mine once asked me to accompany him to a blood donation center. He wanted to donate his blood for charity. It was there I discovered that the first question they ask people before accepting their blood is: “Have you been to Africa in the last one year?” If the answer is yes, they would politely decline your offer to donate your blood. I was outraged by this discovery. But my friend said it’s a standard question even in Europe.

Well, to get back to my story, the nurse took me to the doctor who also repeatedly asked me if I had just returned from Nigeria. He then put me through a battery of tests that were, in retrospect, needless, even pointless. In the end, it turned out that nothing was wrong with me. I was as fit as a fiddle. The three different blood tests tested negative to everything, including to malaria. The X-rays, urine tests, etc also showed that I was in perfect health. I was probably just stressed. I was relieved.

But two weeks later, I received a bill in the mail. Guess how much it was? A walloping $4100, that is, about N635,000! More than half a million naira for mere mundane tests, two IV bags (drips), and two aspirins? And I spent just about four hours in the emergency room! Well, that’s American capitalism for you. Even sickness is a commodity to be exploited for crass profit.

Fortunately for me, I have health insurance to which I’ve been paying for years but have never had cause to use. My health insurance company will pay most of this outrageous bill, and I am going to pay only a fraction of it.

But almost 50 million Americans (most of whom, by the way, are Blacks and Hispanics) are not that lucky: They have no health insurance. If they were to find themselves in my kind of situation, they would be irreparably ruined financially—and many have been. And regular hospitals won’t even admit much less treat them.

That’s what Obama is trying to reform. But representatives of big business who are profiting from the current system are mounting a spirited resistance and are whipping up vile and mean-spirited sentiments against him to accomplish their goal.

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