Can you fill me in on....

Canada has an excellent health care system where no one is turned away. I can't believe that an "inspector" went to someone's house, saw ashtrays and took away the home oxygen. That would never be condoned by any health region and I've never heard of health care inspectors either. Home care case managers might visit a home and make suggestions about the safe use of oxygen if ashtrays were present in the home, but wouldn't have the authority to take the oxygen away.

There are definite criteria for things like dialysis and organ transplants, medical criteria that have nothing to do with a specific person or their habits, per se. There are several types of dialysis and they are used under different circumstances. Peritoneal dialysis is something that can be done at home, but it requires an intact abdominal wall and abdominal organs, access to running water, a place to store a large quantity of supplies and scrupulous personal hygiene. It has been successfully done on some of the remotest reserves in Northern Manitoba for years. Continuous venovenous hemofiltration can only be done in a hospital, usually in ICU. It's the gentlest form of dialysis and is used for people who would not tolerate the huge fluid shifts of hemodialysis, or the electrolyte shifts that also occur. Hemodialysis is done in hospitals or free-standing dialysis clinics and as the population ages and the number of diabetics suffering renal failure increase, so does the demand for dialysis.

Organ transplants have their own set of criteria, both medical and ethical. There are certain absolute contraindications to transplantation that have little to do with lifestyle choices; the presence of malignancy is one. Immunosuppressant drugs act like Miracle Grow for cancer, so why go there? Just as not everyone is a candidate for the priesthood, not everyone is a candidate fro transplantation. Here in our hospital we've done heart transplants on children who have been turned away elsewhere due to the complexity of their illness; we've delivered an infant with a known lethal defect at 37 weeks because a heart was available. No one is turned away for inability to commit to long-term followup, compliance to the plan of care or the ability to pay... for the surgery, the hospitalization, the after care or the drugs.

Does that clear some things up for you?

We don't have nearly the number of illegal aliens as the US does. But their status doesn't matter initially. If they need health care, they get health care and the financial stuff is sorted out later. Earlier this year there was a woman from a Caribbean country here visiting her sister. She was 36 weeks pregnant and while she was here she delivered her baby, who just happened to have hypoplastic left heart syndrome. The baby had her Norwood a couple of weeks later. Then midway between the Norwood and the Glenn, the government presented to mother with a bill for hospital costs. (The surgical team had donated their services.) The mother of course could not pay the bill and went to the media for help. In the end, the mother gave custody of the baby to her sister, who is a Canadian citizen so as to avoid any further bills and the baby had her Glenn. This has all been in the papers so I'm not breaching confidentiality at all here. The point I'm making is that we do what's needed first then ask questions. Incidentally we've also provided critically needed health care to children from Afghanistan, Somalia and Croatia in the not too distant past who were visitors to our province.

No thanks necessary. I know whereof I speak... my son has had open-heart surgery, three and a half years of chemotherapy and radiation treatments (for a blood disorder, not cancer), a liver transplant, seven weeks in ICU following several strokes, and ongoing follow-up for more than 18 years. I pay for parking, meals and meds other than his immunosuppressants. My daughter has had several gynaecological surgeries for endometriosis and others for ortho injuries for which I paid for parking, meals and analgesics. The other daughter has been treated for multiple sports injuries and allergies. She pays a portion of her med costs. Hubby has hypertension and Type 2 diabetes. His meds are all covered by his employer. I've had five surgeries and get annual screenings for the usual culprits.. no out of pocket costs... We've been blessed by being born in Canada.

Things have sort of leveled off lately. Thanks for asking. Our son will likely need tendon releases on his right leg in the next year for increasing spasticity and skin problems on that foot. The Botox injections (no out-of-pocket costs except parking) he's been getting for the past four years aren't as effective as they used to be. All of his expenses will be covered and I will get two weeks off work with pay to care for him while the acute pain subsides. Hubby has been seeing a hypertension specialist and his med regime has been completely overhauled, with good success.

I'm going to see SiCKO tonight with a friend from work. The production company has offered free admission for all Canadian nurses for the next four days and Michael Moore has offered to reimburse the United Nurses of Alberta for the 150 tickets they bought and distributed to the general public a couple of weeks ago. It's too bad that in this case he's preaching to the converted... nurses being the biggest supporters of public health care in Canada. Maybe they should do the same thing for politicians!

The movie was very good. There were a lot of disturbing things revealed about the system in the US, and some slight overstatements about the system in Canada, but over all it reflected the mindset or philosophical differences between the two. There were lots of laughs, and some emotionally difficult parts, like the scene in the Cuban fire station... but I would see it again.