Another week in America and Remote Area Medical.

I love living here; I really do. I love Los Angeles; it is a wild, happening crazy city and there is always something to do.

It's a great place to eat and if you mention that there is a new restaurant or coffee shop that's opened people are all ears; they gather around. This applies to all classes as here everybody eats out a lot – we eat out about three times a week.

3rd Street is full of restaurants and there was an article or series in the LA Weekly some time ago where the writer tried to eat his way through all of them; he ate through all kinds of ethnic food and all kinds of meat including goat – which I ate once and found delicious – so this post is not meant to be anti-American.

I received an e-mail the other day from a friend in England and he said how great it was that the Obama Health Care Plan had been passed by Congress.

Indeed it is wonderful that it is on the books but it wasn't the health care plan that Obama set out to achieve; there is no public option.

Most of us here don't know what has been passed and how it will affect us but what we do know is that on the day the bill passed the shares in health care insurance companies shot up – so they think it's a good deal for them.

Everybody will have to carry health insurance whether we can afford it or not.

Now let me tell you how many people in this country, the richest country in the world, are without health insurance – 40 million.

If these people are sick they have to buy Robitussin from the pharmacists and hope for the best; if they suddenly have appendicitis they find themselves $25,000 or so in debt which usually ends up in bankruptcy; in fact the majority of bankruptcies here are for medical reasons; they call them medical bankruptcies.

So whether the Obama Health Care Plan is going to have any legs is anybody's guess.

Last week the Remote Area Medical team came to the sports centre here in Los Angeles - you will see above at the top of the page ordinary middle class people waiting outside.


On the first day, Tuesday, they carried out procedures which included 95 tooth extractions, 22 oral surgeries, 470 fillings, prescriptions for 140 eyeglasses, 45 mammograms, 43, HIV tests and 96 Pap smears.

You have to ask yourself why the equivalent of Doctors Without Borders are in the second biggest city in the richest country in the world? And I think I have answered that earlier.

In Los Angeles 22% of adults are without medical insurance; that's why they are here.

I have to conclude that it may be too late here for a national health service or any kind of universal health care – or what they call here socialized medicine; I hope I'm wrong.

Remote Area Medical – or RAM – was started by Stan Brock; I looked him up on Wikipedia and he was was born in 1936 in Preston, Lancashire, England.

He was educated at Canford School, Wimborne, Dorset. His father, a civil servant, was posted to the British Colony of Guyana.

He was known on TV for a show called Wild Kingdom and seems to have had, so far, an amazing life – wrestling with anacondas in the Amazon Basin for example.

When RAM were here last time there was a problem as they couldn't bring doctors into the state unless they had a Californian licence to practice; so the doctors without borders status had to be kicked into touch.

So each time they visit a state they have to advertise for volunteers; I think we might volunteer next time; not because of our medical expertise – even though Margaret is a qualified nurse (in the UK) – but to help organizing the queues etc.

They need to people to stand in line for somebody who has to relieve themselves or go to another queue and, you know - it'll be an experience.

At the sports centre they have notices saying 'line for fillings,' line for extractions,' 'line for spectacles' and all the other ailments.

There have been interviews on the radio with some of the doctors – on kpcc.org if you fancy listening – and one of the doctors said that it is just like being in the third world; the poor of the third world are the same as our poor.

Stan Brock shows up to each venue and uses a loud hailer to organise things; he said he sees many things but gets the greatest satisfaction when he sees people newly fitted with glasses; it's as if they've been given sight from being blind, I suppose, and I can easily understand it.

There are very sad cases; a doctor said there was a patient who had diabetes and hadn't taken her meds for six years; the doctor said she was dreading the results of the examinations as the organs will be in failure.

The RAM will be travelling on next week to Tennessee, Kentucky, Maryland and other states and each time they will be looking for volunteers.

Here's a letter from Stan Brock - http://www.ramusa.org/about/letter.htm - if you want to write a screenplay what better subject could you want?

The difference in health care between the UK and America.

Here we are back in our own beds; since we left Scotland we haven't slept in the same bed for more than a few days running.

Here we are back in our own beds; since we left Scotland we haven't slept in the same bed for more than a few days running.

I want to give an example of the difference in health care between the UK and American and this will be based on very recent experience.

My wife, Margaret, has pneumonia; she catches pneumonia like other people catch colds and in the last six years she has had it around five or six times. It's worrying but she seems to get over it and is caused by a weak immune system due to an auto immune disease she has.

The symptoms are easy for us to detect by now and they usually start with a cold; if we can catch it there it's great but if not we know the outcome.

So last week she picked up the chicken pox virus and woke up in London in a cold sweat with a high temperature; we called a doctor's surgery – what they call in the USA a doctor's office – and they agreed to an appointment. We had to be at the doctors for 11:15 and wait to be 'slipped in' between proper appointments.

As we are not registered with that particular surgery we had to fill in a form with my wife's national health number included; this we did.

The surgery was a very modern building in Ealing; it was split into 3 reception windows; one for the doctors and the other two for clinics. When a doctor was ready for you a beep was heard and whomsoever was next had their name displayed on a neon notice which told you what room to go to; much like any doctor's office in the US.

After about forty five minutes we were called in to see a very pleasant and attractive female doctor of about forty who greeted us at her door - not like in the USA where you are shown into a consulting room and told to sit on the edge of an examination bed where you wait for what seems forever.

The doctor had a computer on her desk and we sat next to her. On the computer was the Internet and my wife's name was on the screen with her national health number. The doctor mentioned that there was no information about my wife and we explained that we live in America. If we lived in the UK and had been to the doctor – any doctor – in recent months that information would have been on the screen; I don't know if this happens in the USA yet but I suspect not.

The doctor examined my wife, took her temperature and asked her to go to the lavatory to produce a sample of urine in case my wife had a urine infection. This she did and the doctor tested it there and then.

Of course the doctor, as all doctors do, didn't believe that my wife had had pneumonia so many times; she listened to my wife's chest and said it was clear. We explained that it was always clear at this stage and the doctor then prescribed an antibiotic.

This was a broad spectrum antibiotic meant to cover a whole range of infections and as I mentioned in the last paragraph she didn't believe us about the pneumonia.

So we went to the pharmacist, which was less than a hundred yards away, and the pharmacist filled out the prescription and gave it to is – by the way no money changed hands either at the doctors or the pharmacist – universal health care you see.

As it happens the antibiotic didn't agree with my wife as she experienced one of the side affects mentioned on the pamphlet so, as they advised, she discontinued use. She carried on with the aspirin and other pain killers but because it was Saturday evening she didn't bother to get the antibiotic changed; looking back she could have as all surgeries do a night and weekend service.

So when we arrived back in Los Angeles I couldn't really call anybody as it was Labour Day – a holiday. If we called our doctor we would have been told to either go to the ER or call 911 but in any case it was late in the day so I called the doctor yesterday – Tuesday.

Now bear in mind that this is our regular doctor in Beverly Hills; not all residents of the USA have this kind of access especially if they don't have health insurance but the doctor is available to everybody providing you have the means and are willing to pay for it.

Also – he is our regular doctor and has my wife's medical records with the history of pneumonia over the past six years; but they don't have it on a computer; not yet!!

As with the doctor in London there are no appointments; so I had to talk to the receptionist to try and put a case forward for the doctor to see my wife as soon as possible. I explained about the previous bouts of pneumonia but she still wanted me to describe symptoms and temperatures and when I explained everything she said she would have a word with the doctor and call me back.

She did call back and said the doctor wanted my wife to have an x ray and that she had sent a fax to the imaging company that do them to authorise it – we have been many times to the place over the past six years so that's what we did.

When my wife had the x ray they saw something on her lung and called our doctor; the doctor instructed them, over the phone, to do a catscan (ct scan) and this they did.

We were told to call the doctor and we did on the way home and the same receptionist told us that he would call us later at home. When he did he told my wife she had pneumonia; then he called the pharmacist and gave them the prescription over the phone

I went and picked it up and it cost $65; we didn't see the doctor at all so we were kind of treated over the phone or by proxy – no TLC there.

To be fair to the British system it would have been different if they'd had my wife's records on line with her history (or the back story as they are annoyingly saying these days).

They would have treated her accordingly but blood tests and x ray results usually take longer than this as a rule in America and I'm not sure how that would have worked in the UK.

I leave it to you to judge which system is better but in the UK it's available to everybody through the National Health Service and no such system exists in America where forty million people cannot go to a doctor as they have no health insurance.

They can go to an ER and they will treat them and the government will pay for that I believe.

This is my one hundredth post so here is a photo I took of our cat yeaterday - welcoming us home with a smile