Meet Paulo Machado, the man who has lived in hospital for 45 years | Hacker News Reader

Meet Paulo Machado, the man who has lived in hospital for 45 years

bbc.co.uk

70 pointsMcKittrick24 comments

Sweet.

I only know one person who contracted polio, when he was 10 or eleven polio was nearly over in the US, he was one of that last children to get it here, and his case was relatively mild, he basically just lost functionality of his left calf muscle. He showed me his leg once, it's a really interesting contrast, one leg is full and normal looking and the other looks like it was taken from one of those starving african children, it's really just skin and bone.

He's been a judge in Philadelphia for more than 30 years.

The unanswered question upon reading this article for me has been, "how do these two afford this kind of care for decades?" Wealthy parents? Generous relatives? Great national healthcare coverage in Brazil?

It's just unthinkable for a normal family in the United States (I understand that these two are in Brazil) to be able to afford this, at least in this day and age.

According to Wikipedia it seems that Brazil has universal free health care http://en.wikipedia.org/wiki/Health_in_Brazil

Yes, but it's generally crap and everyone who can afford private insurance (or just paying list prices at private clinics), does.

<-- works with many Brazilians and spends about a month of each year there.

Worse than that — it is universal in theory but not in practice, as often there will be no doctors around in the State‐run health system, and not enough medicine and other medical supply.

Genuine question - what happens for these types of cases in the US if the patient isn't rich? Does the patient get turfed out onto the street once they run out of money?

Medicaid pays for it. (And eventually Medicare when they get old enough.)

People have such a strange view of medical care in the US. Medicaid is available to anyone who needs it (i.e. financially plus special medical circumstances).

And all children in the US are able to have medical coverage - if they can't afford it the government pays for it (or gives a pro rated discount).

There is no such thing as not [being able to] have coverage for your kids because you can't afford it.

So basically the old and the young are both covered. The gap is in the middle.

So he would be kicked out of care after reaching the age of 18 in the US?

The age varies (the younger the age the higher the income limits are) but in any case if he needed special medical care he would be shifted to a different program, but the coverage would stay.

Not a wonderful situation, though, is it? $78k for a hip replacement will make one hell of a dent in the money you saved up for retirement, but hey, once you're poor you can get Medicare.

http://www.nytimes.com/2013/08/04/health/for-medical-tourist...

You don't have to pay $78K though. If you are old enough medicare will pay almost all of it.

And if younger you should have catastrophic insurance which will pay all but a few thousand of that - and that type of insurance is very cheap.

PS. No one - at all - pays list price for medical care. So completely and utterly ignore such numbers unless your goal is to be disingenuous. The numbers billed by medical providers are from the output of a random number generator, they have no basis in reality, and no one pays it.

> If you are old enough medicare will pay almost all of it. And if younger you should have catastrophic insurance

You ignore the situation this man was, at 67, not eligible for Medicare and not insurable.

> So completely and utterly ignore such numbers unless your goal is to be disingenuous.

He already pulled strings to get the price of the implant in the US down to $13,000, 'list price, no markup'. Crazy.

Medicare starts at 65. I don't know what's going on with this person. I suspect we are not being told everything in order to make a good story.

And that's something to keep in mind: The strange stories you read are in the news precisely because they are so unusual.

> $13,000, 'list price, no markup'. Crazy.

That's what he paid out of the US as well, I guess that's what it costs.

Please explain why you said $78k in your original post.

> That's what he paid out of the US as well, I guess that's what it costs. Please explain why you said $78k in your original post.

No no, you're mixing up different numbers. By the way, the $78k ($13 + $65k) didn't even include the surgeon's fee:

"[...] he reached out to a sailing buddy with friends at a medical device manufacturer, which arranged to provide his local hospital with an implant at what was described as the “list price” of $13,000, with no markup. But when the hospital’s finance office estimated that the hospital charges would run another $65,000, not including the surgeon’s fee, he knew he had to think outside the box, and outside the country."

" [...] he ultimately chose to have his hip replaced in 2007 at a private hospital outside Brussels for $13,660. That price included not only a hip joint, made by Warsaw-based Zimmer Holdings, but also all doctors’ fees, operating room charges, crutches, medicine, a hospital room for five days, a week in rehab and a round-trip ticket from America. "

"The Belgian hospital paid about $4,000 for Mr. Shopenn’s high-end Zimmer implant at a time when American hospitals were paying an average of over $8,000 for the same model."

I actually collaborated with the Evangelical chaplaincy in that hospital for a few years, when I lived at that city. I knew Paulo and we became friends, but I have not kept in contact since I first left São Paulo and got married. When I did return to the city for a few years, I had a child and had a nervous breakdown, so I feared the traffic to reach the hospital.

Paulo and Eliana live at the Hospital das clínicas. It is the school‐hospital (or whatever you call that in English) of Brazil’s biggest, oldest, most influential university, the University de São Paulo. It is also Brazil’s biggest hospital, which makes it probably the biggest at least in South America. Quite naturally, it is the reference hospital for the whole of South America.

I never knew of family involvement in maintaining them. As mentioned, he lost his mother even before contracting polio; I do not know if his father is still alive, or if he has any other family. Same for Eliana.

It would have been quite natural for the Medicine school of USP to care for them as case studios, as polio was once prevalent and a mutant outbreak is still to be feared. But I suspect that, more than that, being a state‐run hospital no one ever thought of ceasing care or returning them to their families, if these are still available. It is not that expensive, as they share a section with other patients — they do have their own room — and need quite common medical equipment. Many doctors and other caregivers, such as chaplains — both are practising Christians, he Evangelical and she Romanist — volunteer time, and a few persons do brave the city’s insane traffic jams (usually measured in peak rush hours kilometers of jams; anything over 100km gets in the news, and that is not rare at all; going over 200km is rare) to visit them in the restricted alloted visit times.

This does not mean we have ‘great national healthcare coverage’. Just that these two were blessed by being referred to the Hospital das clínicas de São Paulo. As the cliché goes, it is a country of contrasts, an euphemism for inequality, often cutting in ways that some foreigners have difficulty in grasping.

Polio doesn't always leave visible long-term side-effects. My father had it and was partially paralyzed for a couple of years as a child, but is normal now. He got lucky! One can only hope that, when we're so close to the final goal, people continue supporting vaccination efforts to finally put an end to this disease.

I just wanted to add some more information to your comment. The long-term side-effects are called Post Polio Syndrome and there's a International Polio Network at http://www.post-polio.org/

The more obvious long term side effect is nerve damage/paralysis, as in the case of the article, which is distinct from post-polio syndrome.

This jumped out at me:

"The danger of infection means that they have to live in hospital."

Isn't a hospital like the worst possible place in regards to infection?

I believe the author refers to the danger of infecting others.

Is polio really contagious 50 years later?

No, it is not. They do not "have" polio now, they were paralyzed by the disease and the paralysis remains after the disease is gone. My mother had polio as a child and is crippled in one leg, but otherwise of normal health. I'm not sure what the infection worry is - it might be something to do with the paralysis/use of the iron lung?

They do live in a controlled environment. And this is a reference hospital for infection control. I know a nurse who was once one in charge of infection control in the child’s ward — actually, a smaller hospital of its own in the main hospital grounds; the whole thing is huge — and she was quite competent, as are most of the medical staff there. They usually go to conferences in the US and Europe and all that.

One short article that was equal parts inspiring, heart-rending and heart-warming.

I look forwards to the animation.

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