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Magazine
HEALTH ISSUES
Doctors of the world, unite
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Reaching medicare to those who have little or no access to it is one of the primary goals of healthcare professionals today. KAVERY NAMBISAN comments on a medical conference held in Hull recently.
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A MEDICAL conference with the theme "East Meets West" was organised from June 24-26 this year in Hull, a small town in Yorkshire, U.K.
It was a platform where doctors from different parts of the world could meet and share ideas, not just technicalities. This was a platform for a debate on ethics, which affect not only our profession but also the world we live in. The conference was held at the 1,000-bedded Royal Infirmary, a hospital with exceptional facilities and staff to cater to every medical need.
The organiser, a consultant paediatrician in Intensive Care, Dr. Hilary Klonin was a slightly built, energetic, infectiously outgoing lady with the habit of speaking in breathless long sentences. She conveyed in 30 minutes the larger purpose of the conference.
We Indians are a strange people: We pride ourselves on our eastern heritage but follow the western precepts of progress.
In medicine, we have imported technology, built mega-hospitals and succeeded in catering to the rich. And, of course, we are proud that a large number of our best doctors have "made it big" in the West. Yet, only 15 per cent of our population have benefited from our frenetic advance in medicine, and millions still die of curable diseases.
Many doctors have begun to look at progress with a clearer, if more suspicious, gaze. And they find that it does not hold up so well in the light of reason and justice. West is not always the Best. The rift between the advantaged and the disadvantaged has never been so vast.
At such a time, it is worthwhile for us in India to look at another picture — of individuals and teams who have tried to bridge the gap.
Jackie Smithson is a consultant physician in Hull. She has been involved in a teaching programme in Mbrara, Uganda organised by the medical staff of Hull Infirmary. In Uganda, where the AIDS epidemic has reduced life expectancy to 43 years and where infant mortality is 11 per cent, doctors are scarce.
The team from Hull visits Mbrara to train physicians. Given the funds, it would have been easy for the team to start a medical school based on the western model. Instead they had the temperance to perceive that community-based teaching was better than classes in lecture rooms. "The people on the ground know best," explained Dr. Smithson.
Dr. Nicholas Maurice is a general practitioner in Wiltshire, U.K. where six generations of his family have practised medicine. In 1982, he set up a link between the town of Marlborough and a Muslim fishing village in the small West African nation of Gambia.
It is based on the exchange of people — 700 to date — to bring better understanding between communities, which would otherwise remain ignorant of each other. This has led to the setting up of an integrated development programme in Gambia.
Dr. Maurice who is the Director of UK-One-World Linking Association works towards spreading this concept of connecting people.
Bringing help to those who suffer.
Wali Wardak has worked to improve the mental health of refugee children in Afganistan, Iran, Iraq and Pakistan. In a school for refugees in Peshawar, the children were asked to draw self-portraits of what they were as a result of war and what they would like to be.
Bush, Blair and, indeed, all our "statesmen" need to hang these portraits in their office and bedroom, to see how the simple needs of children have been taken away by the cruelty of war.
Some speakers chose to touch upon issues beyond the scope of professional work.
Dr. David Southall is the medical director of Child Advocacy International. He is also a consultant paediatrician in London — a controversial figure, known for his fearless exposé of child abuse in the U.K. His talk about "Children and the Arms Trade" was a searing account of how the arms trade affects the health of the world's children. Most major conflicts after World War II have taken place in poor countries; wars which leave them with little or no funds for health care. The maternal and infant mortality in these countries is an index of the injustice foisted upon them.
Mozambique suffers from a scarcity of health resources in the rural areas. Amelia Cumbi described their experiment in training health professionals for the villages. They are taught simple methods of treatment including minor emergency surgery and normal deliveries.
Despite the important role played by these health workers they have met with difficulties. The powerful medical lobby has seen with dissatisfaction the growth of an alternate team of health providers. Remy Toko is a smiling, burly paediatrician who now works in South Africa. Some years ago he left his hometown of Kinshasa in Congo, when the hospital where he worked started to be targeted by soldiers. He showed grim pictures of a country savaged by war and described the plight of ordinary people, especially children.
A senior military official once visited his hospital, accompanied by no less than 14 security guards. Most of the guards were around that many years in age.
While the official was busy with his work, some of these child soldiers ran into the front yard of his house. They put down their AK-47s and played like normal kids. Killing was part of their job and they "felt nothing" afterwards. Most are habituated drug users from an early age. Countless children run away to the jungles to escape being soldiers. Schools have been closed down.
Dr. Subash Daga, associate professor of paediatrics from Grant Medical College, Mumbai, lets his work speak for him. He presented a simple and effective protocol for treating prolonged fevers in children.
Doctors often rely on a host of investigations, which require hospital stay and cause discomfort to the child. In the end, there is a substantial bill to cope with. Poor families can ill afford more than a few rupees.
Over the years, Dr. Daga has evolved a step-by-step treatment, which involves few tests and uses medicines costing much less than the high antibiotics routinely used by doctors in their haste to "cure" fevers.
Dr. Nicholas Hart is a consultant plastic surgeon in Hull. Once a year, he visits Pakistan with a small team of volunteers and operates on children with cleft lip and palate. This was made possible because of the cooperation between doctors and staff in Pakistan and Hull; and because of the generosity of people who care about children in another part of the world. On an average they do 100 cases in a week before flying back to Hull.
This kind of work is impressive not because it is medically advanced but because it is compassionate and imaginative. It makes one wonder whether the linear form of progress, which is to keep improving upon what you have or what you are, is always the best way.
In medicine, we have been taught to believe that linear progress is inevitable and essential. But there is another form of progress, which is concentric. It moves forward but never loses touch with the beginning, or the past. It is not competitive but quietly dynamic.
There were more such examples: Dr. Deepak Upadhyay who now works in Hull has helped set up low-cost intensive care units in his country, Nepal; Dr. Barbara Wallace of the U.S. takes AIDS awareness to disadvantaged countries; Dr. Louise Miles uses tele-medicine in Winnipeg, Canada, to reach patients living thousands of miles away.
My own contribution to the conference was a description of the scope of surgery in rural India.
The Association of Rural Surgeons of India, which was formed 10 years ago, still has less than 500 members. This, in a country where 70 per cent of the people live in villages.
In any society doctors are a strong, influential and, often, pampered minority. Their role extends beyond clinics and hospitals, towards ensuring that health reaches everyone. At the conference, there was a good indication of this happening in many places.
Every speaker, in some way, underscored the need for doctors to unite, especially in protest against atrocities, which lead to suffering. In these days of hypocritical politics and greed which is fast destroying the sanity of mankind, what we need is not an eastern or a western philosophy but a refinement of both; a society which accepts that a life saved in Mbrara or Dera Ismail Khan or Hudikeri is as important as a life saved in Miami, Darwin or Hull.
The wasteful use of resources in one part of the world is directly responsible for the loss of lives in another. In Hull I met doctors trying to work towards a humaneness that could, one day, bring real help to those who suffer.
The writer is a surgeon and novelist. E-mail: wallden@eth.net
For further information check www.eastwestconference.co.uk
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