In Engineering Terms

I don for a moment my engineering hat, that I wore for more than fifteen years before hanging it up to become a globe-trotting teacher.

Fundamentally, there are 2 types of maintenance: preventive and corrective. Corrective maintenance occurs when a system suffers what's called catastrophic failure. Machines cannot run, buildings cannot be occupied and roads cannot be driven on in that condition. Workers/technicians are deployed to effectuate repairs, and they stay on the job until the system is again safe for use.

Preventive maintenance is the periodic care of systems. Daily, weekly, monthly and at greater intervals, aspects of the system are cleaned, inspected and oiled/greased/lubed/tuned. Belts and chains and other moving parts are checked for wear. If they show any, they are marked for replacement. If failure is imminent, the component is replaced immediately. After that check-up and possibly any needed  corrective maintenance found during the preventive maintenance tasks, the machine or system is returned to service. 

As a cost saving measure, preventive maintenance has a proven track record. The adage 'time is money' applies in any manufacturing concern, and lives could be at stake if the system in question is a building, a bridge, or a road.

By comparison, corrective maintenance causes costs to skyrocket! System downtime, possible replacement/rebuilding costs, probably injury to humans. My calculator just reached an error trying to figure it all up.

Let us parlay the concept of preventive and corrective maintenance to health care. Annual checkups,  mammograms and physicals would fall under preventive, and 'Oh, what a pain I have!' or 'What is that bulge in my abdomen?' would obviously be corrective.

Just as systems (and buildings and computers and roads and bridges) require preventive maintenance of select components at certain intervals, so do humans. Women are recommended to a bone density scan after age fifty, to name one. Another would be a colonoscopy after that age, for both men and women. 

I have not had a physical exam in the 7 years I have been here. I have no idea what my blood pressure is or if I, like my father, suffer from hypertension and high cholesterol (another routine check after age 50 – and I am 4 years past that age). This very minute, I could be incubating a cancer, like everyone in my mother's family succumbed to, including her.

Since moving here, I've only been to the doctor for corrective procedures: balancing my thyroid, getting stitches in my head and having X-rays done on my leg. At no time during any of those visits was my blood pressure measured, my temperature taken, my cholesterol checked (high levels is a common side effect of thyroid disease, that can lead to heart attacks) or my weight recorded – all standard health screening procedures used in the west.

I think about healthcare in China. Doctors are put upon, overworked, underpaid and under siege – from all of the reports I've read and from what I've witnessed. And, it seems no one here really goes for the preventive care approach so prevalent in the west. From what I gather, healthcare here is all corrective.

Perhaps there is no opportunity. After all, with patients far outnumbering doctors and those worthies constantly assailed, maybe the idea of routine patient examination is too far out of the realm of possibility.

But on the other hand...

Were yearly checkups the norm, doctors might not be under siege by supplicants and their families demanding the unwell be 'repaired'. Perhaps if such conditions that drive people to the hospitals in droves – cancers, heart attacks, respiratory problems and gastrointestinal ills were caught early, they might be treated, easier managed, or prevented altogether before a catastrophic failure sets in.  

One factor deterring Chinese from seeking routine medical care is shame, according to one study. This applies especially to women, whose reproductive system ills are simply ascribed to the female condition. Money is also a factor. Since the privatization of healthcare in China that started in 1979, many simply cannot afford a doctor until one is desperately needed and, even then, sometimes the funds do not cover needed treatment.

At this point, with so many Chinese finding new wealth, the latest craze is medical tourism; America being the prime destination. That country's health care system is touted as the best in the world and I admit: they have preventive care down to a science.

However, the American medical system has its flaws, probably the biggest being cost, and insurance to offset it. All attempts to make health care affordable, such as the Health Maintenance Organization Act of 1973 and, more recently, the Affordable Care Act, neither of which necessarily make health care more affordable, are dismal attempts to alleviate people's suffering. 

What China and America have in common with regard to health care, besides cost, is the referring of patients to specialists or for further tests. In America, it seemed my General Practitioner sent me to another doctor with every visit I paid her. In China, one fee guarantees a consultation with a 'front line' doctor, maybe equivalent to an American GP?, and then patients pay upfront for each further service: X-ray, lab work, or to be seen in the proper clinic for the ill currently being suffered.

The end result is the same in both countries: more money, more money, more money. Some of my friends here complain that the 'doctor runaround' and additional care recommendations are solely for the purpose of generating revenue. It certainly seems to be the case, seeing as most every doctor's visit ends with a stint in the 'transfusion room', where patients are to endure an IV drip of... antibiotics? Could be just saline, for all I, or any other patient knows.    

The preamble to the WHO constitution reads “health is a state of complete physical, mental, and social well being and not merely the absence of disease or infirmity". It goes on to say that good health is a fundamental human right. Surely that means health maintenance, not seeking a doctor when an ominous symptom manifests, right?

And if health maintenance is a fundamental right, shouldn't it be affordable and guaranteed?