Good health care depends on how services are organized, facilities staffed and the attitudes of the people who provide care. “Serve the people” was the slogan of the Chinese Communists. In the first 25 years following the 1949 communist revolution, Chinese medical and public health workers brought about the most dramatic increase in life expectancy, and the steepest decline in death rates ever seen in any population in history. This stemmed from a revolution in attitudes and distribution of limited resources according to need, not because of high-tech hospitals.
In capitalist China, infant death rates among infants are rising again, now that free services have been eliminated. The following cases are from a major U.S. “public” hospital, but they could be from ANY major U.S. “public” hospital.
A 60-year-old man was admitted with a new diagnosis of diabetes. His doctor prescribed insulin and a new diet. Ordinarily, the “Diabetic Teaching Team” (DTT) would then have seen him. The DTT is a group of nurses who go floor to floor, instructing new diabetics how to give themselves the proper dose of insulin, draw their own blood and check their own sugar level. The patient then understands how to manage the disease. But the administration eliminated the DTT two years ago, saying the floor nurses could perform this task. But the floor nurses were already overworked with other new responsibilities, all in the name of cost-cutting and “efficiency.”
After only 24 hours, the patient was sent home where he lived alone. He gave himself insulin as he thought he’d been instructed by the floor nurses. Two days later, his daughter broke into his apartment and found him unconscious. He was rushed to the hospital and into intensive care, diagnosed with dangerously low blood sugar from insulin overdose. He remained in a “persistent vegetative state” (coma) and was sent to a special hospital for long-term care.
A young woman having her first baby did well in labor but had a hard time pushing the baby out. After about 2_ hours, her doctors called for a Cesarean Section, but there were no nurses because a reduced staff was busy handling trauma cases. She pushed for another two hours. When the baby was delivered, it was almost dead and had to be resuscitated. Only time will tell if there was permanent brain damage.
A woman was admitted to the maternity unit for evaluation. An HIV test was requested. The special team handling HIV had more patients than it could handle. Her blood was drawn even though the counselors had not spoken to her. She went into labor and delivered her baby. The early discharge program sent her home before doctors discovered she was HIV-positive. She wasn’t notified until she had been home breast-feeding her baby for a week. The risk of her baby being infected with HIV, during delivery or through breast-feeding, and dying of AIDS is over three times what it would have been had the HIV result been known before delivery.
Honest self-criticism, anti-elitism and serving the working class are communist ideas. They reached a pinnacle in Chinese hospitals during the Cultural Revolution in the 1960s. These ideas inspired health care workers around the world.
As fascism develops in the U.S., we see the opposite. Mistakes are covered up. Decisions once made with collective input from nurses, therapists and interns, are now made in a dictatorial style by head doctors. Hospital budgets are cut to the bone and selfish attitudes are pushed.
We must fight hospital bosses who want to remove life-saving services from our patients. We must struggle against the insidious growth of anti-patient and anti-worker attitudes among health professionals. But none of those fights will lead anywhere unless they are connected to the overall fight for working class power. When the workers hold power, “Serve the People” will be the order of the day.