Published on
July 14, 2009 in
Health.
Tags: Blantyre, civic engagement, conference, Edinburgh, FrontlineSMS:Medic, global, global health, Ken Banks, Malawi, mHealth, Scotland, Scotland Malawi Partnership, Scottish government, slides, speaking engagement.
I presented these slides at the Scotland Malawi Partnership Conference at City Chambers in Edinburgh, Scotland, 2009. If you are interested in the slides, particularly if you were able to attend the conference, I encourage you to contact me with follow up questions.
The short one-day conference was great. A few interesting tid bits I learned: More than half of all international health and development aid from the Scottish government goes to Malawi. Until Malawi began to build its first medical school just a few decades ago, most Malawian doctors were trained in St. Andrews. Blantyre (Malawi’s largest city) was named after Blantyre, Scotland, the birth-place of Dr. David Livingston. Dr. Livingston (of the oft’ quoted question “Dr. Livingston, I presume?”) was a Scottish Doctor who was the first European to explore much of East Africa, and his story is at the root of much of the long relationship between Scotland and Malawi. It was great being at a conference with so many people with extensive experience working in Malawi, and I particularly enjoyed meeting Maeghan Ray and the other conference organizers and speakers.
Since the conference I’ve been as busy as ever, meeting up with Ken Banks in Cambridge, visiting Dutch friends and host family that I hadn’t seen since I was an exchange student in the Netherlands (4 years ago!), and most recently re-launching the FrontlineSMS:Medic website.
A recent post at the change.org global health blog discusses a few global health programs that do not improve global health very much for how much they cost. Examples include Hospital ships and flying patients to the US for medical care. You could say that these programs use resources irrationally, Alanna goes so far as to say that such programs are immoral.
I think a key issue at the heart of some such of programs is the balance between long term effectiveness and the fierce urgency of now. I agree that the programs she describes would play a very small role in an ideal global health care service, but ultimately what we need more than any specific program is for people to give a damn. Some people have excess resources; we need them to care enough that they are willing to share some of those resources with the rest of the human family. If irrational programs will occasionally inspire people, perhaps they are worth the cost.
I’d like to discuss an example. The organization Partners in Health works in Haiti, and will occasionally fly patients to Boston to receive complex treatments that are not available in Haiti. They call it their Right To Health Care program. One recent patient was a young boy who needed to have a hole in his skull repaired. The flight and the procedure were admittedly expensive; the same amount of money might have purchased many bed nets or vaccines. But for the health care providers involved, the issue at stake was whether they were willing to treat this little boy like a beloved family member, whether they were willing to do whatever it would take to help him be healthy. In this instance PIH chose to respond to the fierce urgency of now.
PIH’s difficult work is possible in part because they have attracted very dedicated staff by telling controversial and emotionally charged stories, and following up with stories of hope and healing. Such acts are not purely metaphysical, they shape PIH programs. PIH has incredible, even enviable support in the communities where they work, in part because community members hear about stories like this little boy’s and they think, “wow, these people must really truly care about us an awful lot.” I also know individuals in the USA who have had the course of their lives changed by this brand of irrationally inspiring dedication. I’ve met people who heard a PIH story like this and decided that they were going to donate what they could to PIH every month from that point on – indefinitely. In my own case, I read of such efforts and decided that I too would become a doctor for the poor. I dare say my contributions to humanity will outweigh the cost of flying one needy child to Boston and performing a pro-bono surgery. I cannot emphasize enough how plausible it is that I might not have come to care, that I might have marched though life without being inspired.
Logistically, economically, such decisions do not make sense. They are irrational. And yet, a great many people ache for that kind of leadership, and to emulate such reckless devotion. I am forced to conclude that there are depths of the human soul which I do not yet understand.
Note: Presentation contains mild blood and guts pictures. Seriously.
My friend Evan lost a finger to a barracuda. Observing the entire course of his treatment, from emergency care to reconstructive surgery, was a great opportunity to observe the Cuban health service at work. The experience highlighted the differences between the care tourists experience (competent and lavish by Cuban standards) and the care most Cubans experience (competent but very bare bones).
When I presented this work I discussed most of my research orally and I was hesitant to post photographs here without extensive explanation. I’ve been asked repeatedly though, so here they are.
