The Satisfied And The Suffering

“But tell me, this physician of whom you were just speaking, is he a money-maker, an earner of fees, or a healer of the sick?” –Plato, the Republic

"If I define my neighbor as the one I must go out to look for, on the highways and byways, in the factories and slums, on the farms and in the mines – then my world changes. This is what is happening with the “option of the poor,” for in the gospel it is the poor person who is the neighbor par excellence…But the poor person does not exist as an inescapable fact of destiny. His or her existence is not politically neutral, and it is not ethically innocent. The poor are a by-product of the system in which we live and for which we are responsible. They are marginalized by our social and cultural world. They are the oppressed, exploited proletariat, robbed of the fruit of their labor and despoiled of their humanity. Hence the poverty of the poor is not a call to generous relief action, but a demand that we go and build a different social order."  -Gustavo Gutierrez

I recently finished reading a book, called “Pathologies of Power”, that has made me take a long hard look at myself, and the unjust, oppressive social structures that make up our world today. The author, Paul Farmer, is a man who’s work actually got me interested in the field of global public health. In the book, Farmer discusses health care, human rights and “the war against the poor”. As a physician-anthropologist who has served the poor in many different countries, Farmer has experienced the stark contrast in health care in elite hospitals in Boston and that in rural village clinics in Haiti. He brings to light the statement “health care is a human right” and asks the question “when will ‘everybody’ really mean ‘everybody’?” 

                                                                                                                            

This past week I travelled to the southern coast to visit St. Luke’s Mission Hospital in Kaloleni. During my short visit, I got to experience patient-care and hospital management. (Unfortunately, I ended up leaving my camera in Nairobi for this trip so I borrowed two photos from google.) Interacting with the patients and nurses reignited my love for medicine that had been muffled over the past few months by my excitement for learning about public health. 

With a change in management, the hospital has reached new milestones like a new OR and a well-stocked pharmacy. The number of deaths has also significantly reduced from 10 per month to 3 in seven months. 

Despite these achievements, there are still many areas that need attention. The maternity ward has so few beds that unless a woman has had severe problems during delivery, she must go home with her newborn as soon as she delivers – usually this means walking. There is only one doctor. The patients who come to the mission hospital are usually the vulnerable and poor to whom the word ‘insurance’ is foreign. They often wait till the last minute to come to the hospital for fear of the hospital bill. And although they are not charged much, many patients have to stay at the hospital after they are discharged until they are able to pay off the hospital bill. This is a common theme throughout Kenya.

I don’t question or blame the hospital for the challenges it has. I am aware that serving in such an impoverished area means a struggle in finances and have seen the hard work of the staff. But I do question the larger systems and structures that allow, as Farmer puts it, a “cynical calculus by which some lives are considered more valuable and others expendable.” 

“When will ‘everybody’ really mean ‘everybody’? I don’t think equity means efficiency. Jesus didn’t call us to be efficient. And yet, here we are living in a world where medicine has become a business and efficiency is the desired goal. We live in world where the very people who are most vulnerable to sickness and disease are barred from treatment that could cure them because it is not considered “cost-effective”.  We live in a world where, despite plugging into the full promise of science and technology, there are thousands of people dying of malnutrition and TB.

I pray we don’t forget that we, both the satisfied and the suffering, all live in the same world.

“Is not this the kind of fasting I have chosen: to loose the chains of injustice and untie the cords of the yoke, to set the oppressed free and break every yoke? Is it not to share your food with the hungry and to provide the poor wanderer with shelter – when you see the naked, to clothe him, and not to turn away from your own flesh and blood?” –Isaiah 58:6-7

*Tomorrow, I am headed off to Uganda! I will be accompanying Nema for 2 weeks to help with community-based training on designing a behavioral change framework. I’m excited to share the new adventures and experiences that I will face in Uganda!