The Real Socialized Medicine

      

“Our policy is to create a national health service in order to ensure that everybody in the country, irrespective of means, age, sex, or occupation, shall have equal opportunities to benefit from the best and most up-to-date medical and allied services available.”
          —Winston Churchill, March 1944

     Having lived in two countries with national health care programs, Canada and Israel, and having lived in the United States with its “best health care system in the world” that permits, if not encourages, private health insurance companies to profit on human suffering, I remember with fondness the real socialized medicine. I was lucky enough to have experienced it while living in a kibbutz in the Jordan Valley in 1963-64, and again for several months in 1966. 
     While there, I worked in our orange, grapefruit, and pomegranate orchards, in our extensive fields of bananas, and in our elaborate complex of fish ponds where we raised and harvested tilapia. During the only three days I spent assisting in our communal kitchen and dining room­–washing dishes and performing various other cleaning and food preparation tasks–I discovered I had fifteen different "mothers and grandmothers" I never had known were mine.
     And then there were the chicken coops.

We raised the inhabitants as an income producing “crop.” The section of the coop I worked in for several days was a frame structure, approximately thirty by fifteen feet. The second most unforgettable experience of working with chickens was creating a wake while walking, more like shuffling, with great care through the mass of hundreds of yellow chicks that swarmed around my feet. We had to inoculate them against specific diseases, although I never was the needle man. It was enough for me to cup a chick in my hands, stroke its fuzzy, almost weightless body, while being as gentle as possible to avoid breaking any of its delicate bones.
     The chirping of a swarm of fuzzy yellow chicks was at once beautiful and heartbreaking. Their lives were pointless, short, and uncomfortable.

     But, there is karma. The revenge of the chickens was simple, and required no special effort from them. Where there are chickens, there is chicken something-else, hereinafter “shit,” “crap,” or, once in a while, “stuff.” Anyone who has not experienced the aroma of a deep accumulation of chicken crap on the floors of chicken coops in the heat of a Middle East summer, should not be in a hurry to make up for the loss. 
     We didn't have the luxury of ignoring the stuff. Chicken crap must not be allowed to accumulate forever. There is, as it were, a chicken crap limit. We used the crap as valuable fertilizer to spread around the base of the banana plants, which were so vital to kibbutz economies in the Jordan Valley. 
     As dried fertilizer, the chicken crap aroma was sharp, but inoffensive. It also was tolerable if the thick layer of chicken deposits had a chance to form a crust while on the floor of the coop. But, of course, the crust had to be broken in order to shovel what was beneath it into the large collection wagon. When the shovel penetrated the crust, that was the instant anyone lucky enough to be present would wish to live a long life without ever again seeing a dead or alive chicken, eating a cooked chicken, or even hearing the word "chicken." 
     Sturdy, corrugated 4 x 8 sheets of asbestos were fastened to the joists of the coop to form peaked roofs with a low slant. The roofs were due for their periodic whitewashing to reflect the intense sun and keep the coops and the chickens comfortable while they matured for the slaughter. Wanting to work in fresh air, I volunteered to be the one to use the handheld pump sprayer to apply the whitewashing. At the end of the workday, the task required another half hour, so I stayed behind to finish the job. Everyone else went to have a shower, a nap, and then late afternoon tea, known as the 4 o’clock meal, a vestige of the former British presence in Palestine.

     It was easy to walk on any one of our chicken coop roofs, provided care is taken to step on the roofing material directly above the joists. If you misstep, you can fall through the roof. If you’re lucky when that happens, you won’t be standing over the area of the coop where workers have collected the shit into a deep layer, its temporary home before being used as crop fertilizer. 
     However, if you don’t land in chicken crap, it might mean that something had broken your fall. For instance, you might have defied gravity by straddling a joist, in which case, chicken crap would be the least of your problems, particularly if you are among a certain one half of the population that aspires to fatherhood, one day. I know this because my left leg penetrated the roof all the way to, shall I say, to just below the lower button on the fly of my work shorts. My right leg penetrated only to mid calf. Too shocked at that moment to assess the personal damage, the dilemma was how to extricate myself before anyone might walk by and see me sitting on, or in, the roof. Members of the kibbutz tend to laugh at such things. For a long time.
     With arm strength, adrenaline, and some interesting wiggling, I pushed myself high enough out of the two holes on either side of the joist to place my right foot on the roof. With a few more interesting if not graceful wiggles, I was free. A self-inspection revealed that, other than a few large scrapes on my legs, and a loss of dignity, there was more apparent damage to the roof than to me. 
     Following the line of a joist, I scooted down to the edge of the roof. In an moment of polytheistic reverence, I thanked all the gods I could think of, and a few I invented on the spot, upon discovering that my ladder still was leaning against the coop. I climbed down. 

     After telling the appropriate people about the roof repairs we would be doing in the morning, I visited with a family for the end of their 4 o’clock meal. I was experiencing no physical effects whatsoever from my close encounter with joists of the chicken coop, so around seven o’clock I ate dinner in the communal dining hall, and then sat outdoors with friends before going to sleep. 
     Early in the morning, when there was no sign yet of the coming dawn, and only the night guards were at work, I was awakened by the intense pain of a left ankle and foot, both swollen and several shades of blue and purple that, in other circumstances, I might have thought were lovely. I knew that my friend and workmate, Uzi, would check on me when I didn’t show up for our early start on what was supposed to be a normal workday for me in the fish ponds. As I thought would happen, Uzi came to my room. When he saw my injury, he and our other friend and workmate commandeered a kibbutz jeep to drive me from the Jordan Valley into a Galilee regional medical facility. 

     The intake procedure at the facility began in a predictable way: I gave my name and address. What was unpredictable was the remarkable interchange that did not happen next.
         I need your picture ID and your insurance card. 
         I don’t have any insurance. 
         Well then…how do you intend to pay? 
         Do you think we could talk about that after you stop my arterial bleeding? 
         I can have you talk to one of my supervisors, if you insist, Sir. 
         Wonderful! Please try to find the one who knows how to tie a tourniquet. 

     As luck would have it–and I think I earned a little luck after almost falling into what ought to be shoveled–a female physician’s assistant or nurse practitioner, just magnificent to look at, even through my veil of pain, expressed concern about my increasing discomfort. She suggested I be given pills to reduce the pain. On the other hand, remembering the panoply of gods I had thanked for having watched over my ladder, I offered a new prayer that the pain would continue and I would be admitted as an inpatient for a day or two or forever. 
     The high quality care continued with a series of x-rays, followed by an exam from the medical staff. Alas, they determined there were no broken bones, and no need to detain me. 
     “Are you sure about that?” I said. “ I dunno. I’m not so sure.”
     “We’re sure,” said the doctor, with a look that suggested he had been in this scene before.
     They sent me away with a bandaged ankle and foot, pain pills, crutches, and instructions (identical worldwide) to apply ice, elevate the leg as much as possible, and put no weight on the foot for a minimum of several days.

     The next morning, my foot and ankle were still swollen, still painful, and had acquired glorious shades of blue and purple that extended beyond the edge of the bandage. I can't remember who it was, but someone brought me breakfast and lunch, while I lay in bed staring at the ceiling wondering when I might be able to move around with crutches or a cane. Mid-afternoon, there was a knock on the door, and Uzi’s mother took a few steps into the room. She was a small woman, perhaps a few inches above five feet tall; as usual, she wore a simple housedress and a serious expression. Uzi was standing behind her, and his bright smile was set at high beam. He covered his mouth to stifle a laugh. Without speaking, Leah walked to the table and deposited a plastic bag. Uzi came further into the room and now was looking right at me, and shaking his head, as if to say, “It’s not my fault.” 
     “Good morning, Leah. How are you?" I said.
     “Never mind me,” she said, with a wave of her hand. “I brought you something good.” 
   
     Like most women in the kibbutz (yes, it was the women), Leah would bake tasty cakes and cookies. I liked her very much. I welcomed the treats I assumed she had brought me, and told her so. Leah opened the plastic bag on the table, and removed from it another plastic bag filled not with cake or cookies, but with no less than a pound of chopped white onions. The instant she opened the onion bag, the room reeked; the aroma was more tolerable than that of the chicken coop; that’s all I'm willing to say.
     “Wait...what are you doing, Leah? I don’t need onions; I don’t want onions; I don't eat onions. ”
     Uzi fell into a chair next to the table and now was laughing without trying to conceal his pleasure in what he knew would be the next round of the healing process, the round that would not involve current Western medical practices.
     “It’s not for eating,” Leah said, without looking at me while she fussed with the bag.    
     “Leah, I don’t want to do this, whatever it is. The smell is awful. What are you doing to me?”
     “Don’t worry,” she said, still fussing and still not looking at me.
     “Uzi, please. You have to help me. Tell your Mother.” 
     But he was laughing too hard to be of help to anyone.

     Leah removed a roll of plastic wrap from the outer bag. With the plastic wrap in one hand, the bag of chopped onions in the other, she walked to my bed. She put the bag and plastic wrap near my foot. 
     “We have to remove the bandages.”
     “Alright, Leah. I give up. Do what you want.”
     “This is the only thing that will make you better.” 
     Sitting upright on the bed, I watched as she removed my bandages, studied the swollen, discolored ankle and foot, and tore off a long section of the plastic wrap. She helped me lift my leg a few inches off the bed so she could put the plastic wrap underneath my ankle and foot. I watched as Leah packed the chopped onions around my ankle and foot, and tightly wrapped everything in the first layer of plastic wrap, and then a towel to hold in the warmth. She wrapped everything in another layer of plastic wrap. 
     “The onions work; in the morning, your ankle will be better,” Leah said, with a wave of her hand. Someone unfamiliar with a typical Israeli way of making a point might have interpreted the wave as “Goodbye” or “See you later.” In fact, it was a “We’re finished here,” or “You don’t know. You’ll see tomorrow morning, maybe before.” 
     “I might be dead by morning, Leah. But thank you very much. Oh, yeah, and you, too, Uzi my good friend.”
     Leah and Uzi left, she very serious, he still laughing.  
 
     It didn't take long before the package–that is, my ankle and foot–became very hot, and continued to fill the room with its unpleasant onion aroma, even with an open window. Overnight, I slept while the onions were on the job. At dawn, I unwrapped the package and did the best I could to dispose of the onions, beginning by scraping them into the plastic bag Leah had left behind. 
     My ankle and foot were much less swollen and discolored; I was surprised that I could move my foot back and forth, and side to side, with only mild discomfort. I used crutches for a day, but then walked unassisted.
     No matter how many times I scrubbed my ankle and foot, they reeked; people did a lot of sniffing and looking around when I sat near them in closed spaces, like the dining room.  
 
     There is more to this somewhat humorous episode than chicken crap and onions. In this and other communes like ours, “From each according to ability, to each according to need,” still meant something real during my time there: injured ankle and foot; no bill from the medical facility for the emergency x-rays, other care, and medicine; no humiliating and infuriating request for insurance cards before emergency treatment; no charge for food and shelter from the commune even though I was not able to work; no loss of a job; and, best of all, a free lesson in efficacious Eastern European folk medicine, though it did come with a small price–one week’s worth of becoming best friends with a pound of pungent, chopped onions. This was awful, indeed, but not as awful as ripe chicken crap.
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     One way to maintain the larger and proper perspective on this entire episode, is to remember another lesson of history, albeit not about communes, but about communal effort. In the early months of World War II, the same Winston Churchill whose words began this story, delivered those other renowned words to honor the airmen who had just won the Battle of Britain: "Never was so much owed by so many to so few." To paraphrase this statesman, I shall honor my comrades in the kibbutz, and shall honor the real socialized medicine, from x-rays to onions: “Never was such a small price paid by one person, for so much, from so many.”
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