When I was in my Family Medicine Residency training, I scheduled a one month clinical rotation in a small town outside of London, England, because I wanted to be see how socialized medicine really worked from the trenches. I was deeply embedded in their system and observed how service was delivered in a country where everyone had equal access to care. I worked in the hospital, on labor and delivery, in the community clinic, and I did home visits with the visiting nurses (and luckily I liked it, because the last week we were there my husband had to have emergency surgery at the hospital I had been working in.) I learned a lot about what worked and what didn’t work during that time but today I want to talk about a different part of that experience.

When you travel in and out of London on their version of the subway, the Tube or Underground, there are signs everywhere that warn passengers to “Mind the Gap.” On floors, the walls, the sides of the trains, the message is everywhere, “Mind the Gap,” a term coined in London decades ago and now copied in countries around the world, warning people of the risk of tripping or falling in the space that is between the train platform and the train, which would result in severe injury or even death.

Today, for a moment, let’s take the danger of the Gap as we see it around the world in the railway system, and apply it to health care in North Carolina. Let’s imagine that the platform, where people safely wait for their train, is Health. It represents people working, parenting, supporting their families, contributing to their communities. Being on the Platform means being Healthy.

On the other hand, there is the Train. The train allows people to get from point A to B, connects them to their loved ones, gets them to work on time, gets their children to school. For the sake of my analogy, the Train in N.C. is the health care system: the doctors, the hospitals, nurses, pharmacists, therapists, dentists. The train is the vehicle that ensures wellness, improves health, treats illness, allows people to return to work and to their families and communities. The train in North Carolina is high quality, robust, and state of the art, with the potential to care for all the people who may need to access it.

And then there is the Gap. The gap in North Carolina, that deadly place between the platform, health, and the train, health care, is wide and deep. The gap in North Carolina holds over half a million people, those low-income, uninsured friends, neighbors and family who are most often the working poor. They are the people in the pews next to you at church, the person who cleans your house, the parent of the child your child plays with, the person who delivers your pizza.

Every day theirs is a fragile existence hanging in the balance, at risk of falling into the gap, with little hope of making it onto the train reliably and safely.

Today I charge North Carolina to “mind the gap.” To allow safe passage to all the people of our fine state. North Carolina has a health care system eager to care for everyone. We have both health care and political leaders who are innovators, experienced, and respected around the country. We all care about the people we represent and serve, the economy, the job force that fuels our industry, the health and well-being of our children, adults and elderly. If health care leaders and policy makers can continue to work together for what is good and has been upheld time and again as constitutional and right, we can close the Gap in North Carolina. Today I urge readers to speak with your senators and representatives, and with your governor, and encourage them to “mind the gap,” to close the deadly coverage gap, and to lead the people of North Carolina to health and safety.

Dowler is a family physician at BRCHS.

Read or Share this story: