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Who Should We Let Die?: How Health For All Failed, And How Not To Fail Again

Who Should We Let Die?: How Health For All Failed, And How Not To Fail Again

By: Koye Oyerinde
Published by: Atmosphere Press
Publication Date: April 5, 2022
ISBN: 978-1-63988-262-5
Reviewed By: Barbara Bamberger Scott
Review Date: April 8, 2022

Medical expert Koye Oyerinde probes the reasoning – or lack of it – within the health care systems of multiple nations, finding that they offer scant hope of best practices for many – if not most – of those who rely on them.

Oyerinde’s zestful, zealous account begins with one of his earliest experiences as a practicing “house officer” (comparable to an internship) just setting out on his career in Lagos, Nigeria in 1989. A well-dressed but very poor woman whom he directed to the casualty department when he met her on the street soon became a patient in his care, suffering from a miscarriage that threatened her life. His introduction to the internal hospital system began when he was told that she could not have the surgery she desperately needed until she had purchased the medical supplies required, some of which might not even be available at the hospital. By borrowing and begging, the surgery took place, and her life was saved. But the young doctor had much to contemplate – the practice of charging patients in advance for supplies and services is still a common one in every country, he states, one of many thorny issues raising the question posed by his book’s title.

Oyerinde currently serves as the Policy and Advocacy Chair on the Executive Committee of the Section on Global Health of the American Academy of Pediatrics. As a world traveled physician and health policy researcher, Oyerinde explores these vital issues in depth, with personal stories and professional erudition to underpin his philosophical theses. He makes many salient points including: the pitfalls of medical insurance – who pays and who should pay?; expansion of technologies for better cure rates that paradoxically add more cost and may thus exclude the very people who most need the services; concern that well-meaning actions of charitable organizations such as Médicins Sans Frontiéres may give some national governments the excuse to provide citizens fewer services; and the reality that those charged with investigating health care practices may deal only with the elites of the system, not with the desperate recipients - or non-recipients - of their services.

There exists a tendency for some lower-level medical workers in public facilities to practice what Oyerinde calls “D.N.A.” - disrespect, neglect, abuse of patients - possibly evoked by their own burdens of understaffing and underpayment. He notes that such crises as the Ebola and AIDS outbreaks in Africa, and the Covid pandemic have made the pressure for universally available healthcare ever more crucial. Two international conferences, Alma Ata in 1978 and Astana in 2008, endorsed systems “for achieving health for all” – but those goals have yet to be met. Oyerinde presses for their institution, reminding us that “minorities, poor people, and the elderly” are disproportionately vulnerable in such cases, leaving us to wonder if by not addressing these issues, we are tacitly approving their suffering and death.

Quill says: Oyerinde has written a diligently researched, highly relevant work to alert readers to the necessity for changes in health care policy and practice in all countries, at every level.

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