Reason and Instinct

[Originally published in the Vanuatu Daily Post’s Weekender Edition.]

Public health is a human rights issue. Medical services, though, are ultimately ruled by economics. The tension between the two will never be resolved. It will, however, shape our future in ways that are impossible to measure.

This morning over coffee, I received news that the 15 year old daughter of a friend had passed away. She’d been ill for over a month, but a full diagnosis was never made. All anyone knew was that her head ached terribly.

Within an hour of hearing this, I learned of the untimely death of Ture Kailo, MP for TAFEA Outer Islands.

Ture was well known in Vanuatu. During his tenure as DG of the Ministry of Youth Development and Training, he was a consistent champion of youth issues and a friend to many local NGOs. Many took heart when, after his politically motivated ouster from the Ministry, he announced his candidacy for national office. Everyone I spoke to expressed deep regret at his passing, noting that Vanuatu politics has suffered a real and measurable loss.

Cases like these often define the debate over national health care policy. The loss of prominent individuals like Kailo demonstrate in unambiguous terms just how much we stand to lose when we lose a single life.

But what of my friend’s young daughter? The magnitude of her mother’s loss is of course immeasurable. And who can tell what she might have achieved?

I am a firm believer in the need to personalise issues such as education and health care. Unless we can see the effects of our decisions, unless we can put ourselves in a position where we share the burden of their costs and the value of their rewards, we are far too susceptible to error.

There is, however, a tension between the moral weight of our decisions and their practical implementation. Simply stated, public medicine is costly, time-consuming and requires significant planning and coordination. Vanuatu as a nation has fared poorly in meeting any of these challenges. Money is limited, skilled professionals are thin on the ground and coordination even inside a single hospital is often the result of improvisation, not planning.

It’s tempting to see the death of these two individuals (and the countless others who might have been saved, had circumstances been different) in a tragic light. The young woman had been complaining of terrible pain in her head for over a month. Her initial visit to the doctor produced no result. It’s quite likely that, with better facilities, equipment and training, they might not have failed in that regard.

But Kailo’s tragic loss tells us too that sometimes, even with world-class medical facilities available, fate conspires against us. Having been hospitalised in Sydney myself for an emergency surgical procedure, I can attest to the quality and professionalism of the Australian medical system. Their best efforts did not suffice to save this man’s life.

We have to admit the possibility that even if we had been able to diagnose this young woman’s condition, we might still have been powerless to save her.

The emerging dialogue around health as a human right was questioned recently in an article in the Financial Times. William Easterly, a professor of economics and co-director of the Development research Institute, claims that the application of generic moral arguments is indeed persuasive, but sometimes in the wrong ways. He compares the respective budgets of HIV/AIDS campaigns and those combating tuberculosis and malaria. Each kills about the same number of people every year in southern Africa, but, “Aids accounted for 57 per cent of World Bank projects on communicable diseases from 1997 to 2006, compared with 3 per cent for malaria and 2 per cent for TB.”

Others pointed out that Easterly complaint should be against the implementation of medical programmes, not their inspiration.

Those who argue for health as a human right deal at length with participation as the key to successful achievement of “the highest attainable standard of physical and mental health, without discrimination of any kind.” Here, particularly, is an area where Vanuatu has a very long way yet to go.

When my friend’s daughter first showed signs of illness, she was not taken to the doctor. Instead, she was treated with kastom medicine, to no avail. As is far too often the case, by the time doctor’s at Vila Central Hospital finally saw her, her condition was well advanced.

People might get more out of public health services if they expected more from them. But by treating western medicine as a last resort, by treating hospitals as a place where we’re born and where we die, we deny ourselves any other possibility.

Many would argue that our medical services are treated that way because that’s all they are. Resources are so limited that, besides the occasional perfunctory dose of antibiotics, our hospitals are only geared to basic lifesaving interventions.

And that brings us full circle. Until we can re-imagine public health as something that affects us all – and that consists of more than medical intervention after the fact – we will continually find ourselves stuck in the same quagmire of overstretched, overburdened resources, fighting a losing intervention against cruel fate.

Health is a human right. And that right starts with participation. And participation starts at home.

Education, prevention, awareness and healthy living might not be enough to save the lives of the two we lost today. But they do save lives. The problem is, our economists will never know it. They cannot measure the effectiveness of medical outcomes because if all goes right there won’t be any.

Health policy should be personal; it has to matter to us all. But the resources available are finite. That does not mean, however, that the outcomes are. Listening to both instinct and reason at once is a tenuous task. But that is precisely what all of us, politicians and public alike, will have to do if we want public health to improve in Vanuatu.