Hello! I’m writing a story that takes place in a hot, poor, dystopian world. Most civilians and extras don’t really have access to proper medical care, as it’s rare and expensive. My protagonist is a doctor and has been for a while. He runs a makeshift hospital with a biologist and a hit man(neither one of the latter 2 is a doctor but they both know quite a bit about human anatomy, hence why I included them), as well as anyone else who will take orders from him. However, he doesn’t always have the resources to correctly treat people, even when he knows how. How would this affect disabled people who can’t get access to proper meds? For example, ik that amputations from diabetes would likely skyrocket, and people with mental disabilities/mental health issues would have a much harder time functioning in society, to give u an idea of what I’m asking. (I’m sorry if this question is too vague, I’m not really sure how to phrase it).
Hello!
The actual answer depends greatly on the specifics of your world/setting as well as the circumstances of the makeshift hospital.
To put it bluntly: there would be a lot less disabled/mentally ill people.
A lot of medical conditions (especially more severe cases) are managed with medication and, without that medication, can very quickly become fatal. I'm thinking of conditions like epilepsy, asthma, diabetes, even common food allergies.
There's also the fact that a lot of people wouldn't survive long enough to become disabled.
In our world, somebody who survives a severe traumatic brain injury (TBI) may end up with brain damage. Somebody that survives a spinal cord injury may become paralyzed. Somebody who survives a major infected wound may become an amputee.
This is because they survive.
If they don't get the proper medical care in time (or at all), the chances that they survive (and, subsequently, become disabled) are much lower.
Not to mention how many conditions are present at birth that require immediate medical intervention. Or injuries that occur at birth. A broken collarbone, oxygen deprivation, heart complications. These are generally treatable in our world but if they don't have access to proper medical supplies, devices, and training, many of these babies likely wouldn't survive.
Aside from those who'd die, the quality of life for disabled characters would likely be strongly decreased.
This is because of the lack of major aids (such as mobility aids, diapers and other incontinence supplies, feeding tubes, bed lifts, etc.) as well as aids/tools that may seem pretty minor. Things like jar openers, adaptive cutlery, grabber tools, etc. can greatly improve somebody's quality of life and increase their independence.
Without assistive technology and devices, many disabled characters would also require much more assistance. Those who can get by with very little assistance in our world may need a full time caregiver in your setting.
Regarding specific disabilities (or particular types):
People who are immunocompromised would likely be much more isolated and need to be much more careful about interacting with others.
Similarly, those who are more susceptible to injuries (such as those with connective tissue disorders who are at risk of dislocations; those with osteoporosis, osteopetrosis, osteogenesis imperfecta, and similar conditions who are at risk of broken bones, etc.) would be much more limited in what they could safely do.
Those with limited mobility would have a much harder time getting around -- both in general and when it comes to obstacles such as stairs, rough terrain, etc.
Although sign languages would likely remain unaffected, those with communication disorders who rely on other methods of communication (particularly ones that use technology such as text-to-speech [TTS], some augmentative and alternative communication [AAC] boards, etc.) would have more trouble.
People with some types of mental illness would have a lot of trouble. Medication like anti-depressants, anti-psychotics, anti-anxiety meds, etc. have a HUGE impact on somebody's day-to-day life. Without medication, some characters may turn to other, less healthy coping mechanisms such as drinking, drugs, self-harm, etc. I'm very certain that without my own anti-depressants, I wouldn't have survived very long.
There's countless other specific examples I can give but let's speak more generally for a moment and talk about the population as a whole.
There's a lot that many of us take for granted in our world that, without it, could cause issues for people. I'm thinking of medical supplies like disinfectants and bandages but also even just... clean water and food.
Malnutrition or an otherwise improper diet can cause all sorts of diseases, many of which will have lasting effects on somebody. Scurvy, for example, is caused by a vitamin deficiency that generally stems from a lack of fruits/vegetables in the diet and malnutrition can stunt growth (among other things).
In terms of the lack of medical supplies, infection is a HUGE issue for wounds. People get serious infections in our world a lot as it is. Without proper medical care and supplies, that number will skyrocket, as will the severity of the infections. There will be more fatal infections and, at the very least, more amputations as a result of infection.
If they don't have access to safe, clean water, they'd likely see a reemergence of diseases and illnesses that aren't as common in our world. And this isn't even considering things like dehydration -- which is pretty mundane for us but can have lasting consequences in your setting.
This is all pretty bleak and, although I think this is a super interesting topic to explore, it's kinda bumming me out a bit so let's talk about solutions.
The fun thing about working with fictional settings is that you, as the author, get to make the rules.
The not-so-fun thing about reading stories in fictional settings is that most authors decide to eliminate or otherwise ignore disability in their worlds. Which is a shame, because I think there's a lot of potential for some creative solutions and world-building here.
For mobility aids, people may be restricted to lower-tech aids such as manual wheelchairs, canes, crutches, etc. instead of power chairs or similar aids. Characters may also have fewer options available to choose from and may end up using an aid that doesn't fit them properly, which can cause damage or exacerbate pre-existing problems.
This [link] is an older post by @scriptmedic that talks a bit about medicine in a post-apocalyptic setting. I'm not sure how specific it will be to your setting but it's worth a read anyways!
I think the two biggest questions you need to ask about your world are "how do disabled people fit into this society?" and "how does this society treat disabled people?"
Before we answer these questions, we need to know a bit more about your society. Is it a permanent city/town or more of a temporary, camp-like settlement? What do most people do during their days? Do they work regular jobs? Do they hunt/gather, build/improve their settlement, etc.? How big is this settlement?
The answers to these questions will help you answer the next ones.
The first question about disabled people in your society actually encompasses a lot of secondary questions/prompts such as:
Where do they live? Are there supports in place for them to live alone if they choose to? Are the resources there for them to live with a support person if needed?
Speaking of supports and resources: what kind of supports, aids, and resources exist in this world? What does the settlement have access to? Do people ever have to share things like mobility aids? How does this impact the lives of your disabled characters?
What role do they play in the society? Are there jobs that some of them can do? What about the people who can work with limitations? What about people who can't work at all?
What kind of currency does your world (and the settlement in particular) use? Is there money or an equivalent? Is it an exchange of items of value (such as trading food for pillows or blankets)? Is it more of a community, where everyone gets some of everything? If so, how is it divided up? Is it based on equality (everyone getting the same thing) or equity (everyone getting what they need)? Whatever this system is, how does it include disabled people? Particularly those who can't work or can't work as much as others.
These last two questions are already starting to veer into the territory of the second major question so let's look at that in a bit more depth.
The easy, obvious, and (dare I say) lazy solution is for your society to treat disabled people negatively.
Most of the time, these types of stories cast disabled characters out in some sort of warped interpretation of "survival of the fittest". Societies will kick these characters out of the settlement, leave them behind, or otherwise abandon them to fend for themselves. Sometimes the disabled characters even encourage this in some sort of "go on without me" move which is... deeply upsetting and problematic on several counts.
Going in this direction comes with a lot of issues, both ethically and mechanically. The first problem is that it -- quite explicitly -- shows disabled people as being worth less than abled people. It shows us as disposable and says that in order to survive, we have to be able-bodied. More over, it shows us as something to be discarded when we're no longer useful rather than, you know, actual human beings.
There's also the fact that it doesn't really make sense from a plot standpoint, especially since disability (especially acquired disability) would be so much more common in these worlds. Why would a group abandon disabled people when there's a significant chance of them becoming disabled themselves at some point?
Of course, this isn't to say that this can never be a realistic course of action in these stories. People can be incredibly selfish and we see this problem to a degree even in our world. We know that people become less mobile as we get older and we know that a notable percentage of the population is disabled or will become disabled but the accessibility infrastructure in place is severely lacking.
What I'm saying here is that this kind of thing could make for an interesting and realistic story but it needs to be addressed within the story in some way, especially since it comes with a host of plot considerations. Do characters end up hiding wounds/disabilities out of fear of being abandoned? What happens if the leader/the person who decided on this course of action becomes disabled themself?
This could be an excellent opportunity to explore how the rules tend to change when they begin to affect the people in power. It could also be a great commentary on how we define a person's "worth" or "usefulness" in society.
What I'd really like to see more of in settings like this, however, is disabled characters being treated like human beings and actual members of the society in question.
Sure, I'd like to see this on an individual level (disabled characters making friends and forming relationships) but also on a wider, more systemic level.
One of the good things about the world ending is that you can build it back up, better than what it was. Your world could be a more accessible one.
In many places, our current work system is very rigid with strict limits on how many sick days you have, how many hours you work, and what deadlines you have to meet. Maybe your world takes a more flexible approach to accommodate people with disabilities, other responsibilities other than work, and other limitations.
This is a more concrete example but what's more important than the infrastructure and the policies is the attitude.
What I want to see most in these kinds of stories is societies where disabled people are loved and cared for. I want to see a society that acknowledges the worth of its members beyond what they can provide. We, as humans, are at our best when we're forming communities and taking care of each other.
One last thought: I'd encourage you to consider the impact that all this has on your protagonist.
How does he cope with that feeling of helplessness? How does he deal with having the necessary knowledge to save somebody's life but not the necessary resources? How does he deal with losing so many people?
Working in healthcare or any similar fields is already stressful. Add in an incredible lack of resources and a very low ratio of doctors to patients and it would be an incredibly taxing job.
I wouldn't be surprised if your protagonist ends up becoming disabled or mentally ill himself in some way -- whether that be developing depression and/or PTSD from his job or developing some sort of chronic illness from overworking.
I know this is a lot of information and it can look a bit intimidating but just keep in mind that this is your world. It's entirely up to you what happens in it. I've given you a lot of advice and you can take all of it, some of it, or even none of it if you want! It's entirely up to you. :)
Cheers,
~ Mod Icarus
