Bad Medicine

If you think the NHS is struggling now, just wait a few years...

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1. Bad Medicine

My consciousness returns hesitantly; more a gradual blurring of the difference between wakefulness and oblivion than a sudden shift between the states. With my slow awakening comes the expected stabbing pain; that at least is a relief. They actually got round to performing the surgery this time rather than postponing it yet again.

Alerted by my wristband sensors, a young nurse arrives at my bedside. She consults her handheld terminal before asking a question of me in an incomprehensible tongue. No sooner has she finished speaking the device blurts out an English translation in an uncanny, though obviously artificial facsimile of her voice.

"How do you feel, Mr- ?"  Both she and the machine trip over the pronunciation of my surname, rendering it unrecognisable. Not that it matters: I'm no longer a patient, or even a 'customer' as the old management BS speech used to term it, but merely a depersonalised 'service user', a commodity to be bought, sold, and traded in this brave new healthcare world.

"As if I've been cut open." I reply.

"Pardon, I do not understand."  My feeble attempt at humour fails to bridge the cultural divide.

"I feel about as well as someone who's just had a laproscropy and cancerous tumours removed from their intestines ever likely to, but my wound is really starting to  hurt. Is there anything you can do to ease the pain?"

"From your notes I read the operation has been very successful."  she reassures, checking my IV drip and adjusting a small valve on it."I can give you more sedative, but not too much. It is not good for you. Sorry I cannot give you anything to eat or drink by mouth until it is approved." says the tiny voice issuing from the cheap tablet's speaker. I let out a resigned sigh as the nurse does what she can to make me comfortable. "You try to sleep now." she adds, before leaving me.

My body clock is a mess, thrown out of adjustment by the anesthetic and the travelling. As I wait to drift back to sleep in the grey of the early morning, I cast my mind back to how things ever got to this state.

We all knew what was coming; in fact the process had been under way surreptitiously long before the general election, the Tory landslide, and the issuing of White Paper on health care 'reform'. Over the previous years a constant drip feed of unsubtle propaganda softened public opinion up to the point where a majority of dupes were only too eager to support the de facto abolition of the NHS in favour of a privatised service. The collective kick in the balls we gave ourselves as a nation that May being the culmination of a successful campaign to undermine one of our country's greatest achievements.

Given the green light a veritable swarm of 'consultants', profiteers, and other assorted shysters descended like a plague of locusts blocking the sun. Everything was wide open, nothing was off limits, and even the most bizarre proposals were taken seriously. That's how many consultations with general practitioners which had formally taken place face-to-face were moved online to remote physicians, often based outside the UK; with only those cases requiring hands-on examinations referred to a greatly reduced network of surgeries.

If you managed to leap that first hurdle of triage, as I did, you could still be assessed as an out patient in a local hospital; but these days 'local' is a relative term. At least once I'd been examined the process quickened; those promises about reducing waiting times for treatment were fulfilled, but in a manner few people expected.

The shifty, slippery people wearing nasty business suits stretched the definition of telemedicine to the limit. Reasoning that if a patient lived hours away from their treatment centre it didn't matter by what means they travelled during the time it took to get there or where the facility was located when they arrived, the majority of therapy became outsourced. Regular out patient clinics - my follow-on chemotherapy included - are still cost-effectively available within the UK, as are urgent major trauma services, but most elective surgery beyond minor procedures has now been 'relocated'.

Logic was contorted beyond credibility to make it sound like a good idea at the time. As globalisation had affected so many aspects of our lives, it was only a natural extension of the principle to medical care as well, so the argument went. Buying services abroad it was claimed would obtain the best value for the taxpayers' and Health Supplement Account payee's scarce funds as well as relieving the pressure on UK hospitals. And rather than import the health workers, why not export the patients? It sounded fine in theory, but by the time it was realised the practicalities were so very different to the starry-eyed promises the process was too far gone to reverse; the 'surplus' land and buildings had already been sold off at a discount to be developed into yet more unaffordable flats.

And so I found myself, international medical visa in hand, along with a group of others awaiting our flight to who knows where. My unknown destination dependent on where a long chain of ever increasingly cut-price brokers had been able to source my treatment and keep as much of the fixed cost fee for themselves as possible. We waited for a hour while the chartered jet was converted from the standard arrangement to a combination of seats and stretcher accommodation, before being embarked on our mystery tour.

As expected we flew high over the remnant European Union; the costs there are too high, the profits non-existent. Moscow or Ankara were our most likely destinations according to the general consensus. In the end it was Turkey, at least for some of us; the rest - myself included - flew further east. There was a refuelling stop at Lucknow, India, where more patients, - one a worsening in-flight emergency case - were disembarked. My name wasn't called so I and about a third of the original passengers remained aboard.

So where to now? It had to be Beijing, as it proved to be for all but a score of we unwilling health tourists, and I was one of that number. We were bound somewhere in southeast asia then; even if that was more expensive than China, unless... No, that would be ridiculous, utterly crazy in fact. Not even they would consider it, but...

Our worst fears were confirmed within an hour of taking off; with a growing sense of cold, gnawing dread we understood where our journey would end. On arrival our papers were inspected by officers wearing Ruritanesque uniforms, we were offloaded onto a worn looking bus/ambulance, seats still warm from the previous group of patients catching our shuttle home, and driven to the hospital.

I think I must have passed the journey in a detached state of shock reinforced by the occasional sight of a distant landmark. The crazy bastards actually did it... How could they get away with this? Yet they did, and here we are, brusquely settled into an overbearing concrete meatball surgery assembly line. In - done - and out again just as quickly as possible.

Time has passed, it's much lighter outside now. It must be about six am. I expect the Medical Liaison Officer will examine me today, and assuming all is well book me on to the next medivac plane leaving in a couple of days. I'll be only too pleased to leave; I want to be well clear of this spartan place and it's creepily menacing air just as soon as I can: With any luck I can keep my time off work and my insurance excesses down to an absolute minimum - assuming I've still got a job to go back to: In these days of scant protection nothing can be taken for granted.

However, that is the least thing unsettling me. What I can't get out of mind was the conversation I overheard as my pre-med was beginning to take effect. I'm sure it was real and not a drug-addled figment of the anaesthesia. I swear I witnessed a British politician - one of those lower ranking ones you can almost but not quite recognise - on an inspection visit speaking to what must have been a high ranking official here, and saying verbatim "...and based upon the excellent way in which this scheme is operating, it would obviously be in our mutual interest to expand our cooperation to other spheres. We've plenty of our unemployed who could be sent here at short notice according to your needs; a bit of hard work wouldn't do them any harm and you'd only have to provide the basics of subsistence. It's a win-win situation for everyone; you get the labour you need to fill the gaps in your remarkably growing economy, and we'd be freed of the burden of looking after them. I understand your leadership are keen to begin as quickly as possible..." I don't remember any more than that, even though I feel as if I've looked down a kaleidoscope tube into the infinitely recurring fractal pattern reflected in the mirrors of what is left of our humanity once we become inured to selling each other down the river ad infinitum.

The ward is beginning to come to life for the day. There's the rotund little cleaner who's sole duty appears to making sure the twin portraits of the Great Leader and Dear Leader found everywhere remain spotless. Soon the window blinds will be drawn, revealing what view there is of the Pyongyang streetscape in all of its depressing glumness. The sight of it will be a punch in the stomach for me; a reminder there are some nightmares which can't be awoken from but must be consciously endured.

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