Tag Archives: health care

Heavenly Rest:  The UN Pays a Holiday Health Visit, Dr. Robert Zuber

23 Dec

Doctors_and_Nurses_at_War

We are healthy only to the extent that our ideas are humane.  Kurt Vonnegut

Surgeons can cut out everything except cause.  Herbert M. Shelton

Extreme violence has a way of preventing us from seeing the interests it serves.  Naomi Klein

A sad soul can kill you quicker than a germ. John Steinbeck

If you would live long, open your heart.  Bulgarian saying

On the Sunday before Christmas I am staring at my worn and trusted crèche scene, a holy family “guarded” in this instance by replicas of cats and hippos and camels as well as by the more traditional barn animals.  For me, this scene represents a brief respite in a season that seems to have followed our cultures off a cliff of sorts – trading in the expectation of “heavenly rest” for the expectation that what “really matters” will magically appear at our front door or under a decorated tree.

Except that magic is at a premium.  I walked for over a mile yesterday down Broadway between rendezvous with good friends, past the high-end stores north of Canal Street before turning east towards the vegetable markets that line several of the streets of Chinatown.  The streets were packed.  The winds were howling. The car horns were blaring.  Children were in the midst of emotional meltdowns. The looks on the faces of most of the people I passed stretched beyond the usual wary impatience that characterizes so many in this city so much of the time.  This was stress of a different order, or so it seemed, the stress that accompanies the determination to make Christmas “matter” for someone at least, to make one last push through the crowded streets, through the racks of clothes and toy bins, through the long check-out lines, to satisfy an opaque longing that has everything to do with advertisers and virtually nothing to do with the message in the manger.

People in this city really do seem unhappy much of the time –and I would often add myself to their numbers– but especially so in this “joyous holiday season.”  It is though we have lifted a bandage covering the wounds of the year only to discover that the infection is worse than we imagined, that we are less healthy in mind, body and spirit than we ourselves, and our bartenders, therapists, pharmacists and yoga teachers, have allowed us to believe.

One verse of a well-known Christmas Carol ends with “sleep in heavenly peace.”  For too many of us, sleep in any form has become a virtual luxury, a deficit that directly and at times severely impacts the quality of our lives including the depth of our compassionate and active engagement with the world.  Our stressful societies have created for us a kind of double-whammy – distractions by day and restlessness by night.  We have become addicted to bombardment from outside ourselves and increasingly oblivious to the toll this is taking on our inner resources.

Regardless of our political affiliations or religious dispositions, we know that things are not right.  Too many of us work too hard to sustain lives that yield too few joys.  Too many of us cover our sorrows and anxieties with substances and diversions that are about as effective as painting a bathtub with watercolor. We fret about the “state of the world,” even lament the blood that occasionally appears on our collective hands, but soldier on as though the contents of the next smiley Amazon Box will heal what ails us, will restore our serially damaged relationship between longing and gratitude.

Institutions such as the United Nations have actually begun to take health issues a bit more seriously.   Here in New York, the UN has done important policy work on preparing for pandemic outbreaks as well as identifying remedial options for addressing the “non-communicable diseases” and even road hazards that continue to ravage communities and shorten life-spans.   Even the Security Council has gotten in on this act.   Just this past Friday, as one of its final contributions as an elected Council member, Sweden convened an excellent Arria Formula discussion focused on the most immediate implications of health for peace and security – issues of access to medical care in conflict zones as well as the growing danger to medical practitioners operating in such zones, persons and facilities increasingly targeted by state forces and non-state armed groups in fundamental violation of international law.

These are matters crucial to any and all efforts to preserve and promote the peace.  It’s bad enough that we aren’t more successful in preventing conflicts, in part through a clearer examination of the “interests they serve,” but to actively prevent persons already-devastated by armed violence from receiving the modicum of care available to them in conflict zones is beyond reprehensible.  Wars have rules, we are told, most of which are related to the treatment of non-combatants, but these rules are constantly in various states of violation.  As Swedish Ambassador Skoog put it, the gaps between “what is said and what is done” on health care access and the safety of health care workers continue to be large.  In this instance as in others, our “humane ideas” must come attached to more humane practices and, as France noted during the session, greater accountability for perpetrators of abuses.

Fulfilling this “sacred responsibility” to conflict-related casualties requires, as Peru’s Ambassador noted, a “homogenous approach to protection” with uniform standards that are both upheld and guaranteed by the Security Council and other UN member states.   Such guarantees are frustratingly hard to come by in this current phase of human existence.  As we were reminded by a panelist from South Sudan, the degree of difficult in field surgery is sent through the roof once the bombs resume falling.  Surgeons, it appears, “can cut out everything except the cause.”

We must, as many speakers noted, be more attentive to the needs and resources of those who make such sacrifices to bind together those who have been maimed by violence in its many facets.  But genuine healing is even more comprehensive than the bombs we prevent, the destruction averted, the injuries avoided, even by eliminating the trauma that impacts confidence in life, including the confidence to seek out treatment.  It is also a function of getting our institutions right, of making certain that we are doing what we can to optimize our performance in the world, in part by insisting on more healthfully engaged colleagues. The UN itself still has things to learn in this regard.

We must take our collective health more seriously, in all its dimensions.  Our “sad souls” and the things we do to cover that sadness are collectively doing us in, making us more “cranky” than we need to be, isolating us socially and spiritually, but also shutting down our practical empathy for others – the needy in our immediate midst, the migrants at our borders, the victims of our thoughtless policy choices, those whose bodies have been mangled and psyches traumatized courtesy of our overly politicized and militarized international engagements.  We don’t need to be this way; we don’t need to bury our own wounds while simultaneously inflicting wounds on others.  Whatever you understand “human nature” to be, this isn’t an example.  This isn’t inevitable.

The call to the deeper health advocated here is not satisfied by going to the gym or swallowing our meds.  And it is not satisfied through pious calls to “take care of ourselves,” as though most of us actually know what that means. The health we would do well to seek instead, that indeed this season calls for, is a collective and comprehensive endeavor – a commitment to maintain and share in what Wendell Berry once called “the feast of creation,” a feast fully open for a time only to the few while impeded for the many by the artifacts of our often thoughtless predation.

Whether particularly religious or not, I wish each of you a portion of “heavenly rest” this season, a time of uninterrupted sleep, inspirational dreams, successful self-reflection and ultimately a renewed commitment to the health and well-being of others.  Rest assured that we will all sleep more soundly in a world of greater hospitality for refugees, an end to threats against health and humanitarian workers, the cessation of bombing raids and all indiscriminate killing –especially in the places where children live and learn –and far fewer, less intrusive, external distractions of all kinds.

May this soon come to pass

Advertisements

Vaccination Nations:  Elevating Health Care Access for Peaceful, Inclusive Societies, Dr. Robert Zuber

11 Mar

Pills

Happiness is nothing more than good health and a bad memory. Albert Schweitzer

If Patents are for Patients then Patients will be for Patents. Kalyan Kankanala

Healing is a matter of time, but it is sometimes also a matter of opportunity. Hippocrates

It is the first morning of daylight savings time in New York which has caused some to miss Sunday appointments but many to hope that spring weather will soon make a lasting appearance.

The winter in the northern hemisphere, here and in many other parts of the planet, has been characterized by a range of health-related problems.  Severe flu outbreaks here have brought tragic death to some children and thrown many millions off their game.  I know personally of several people – most at least enjoying sufficient access to medical care – who have had to stay in bed for many days, with weeks of only semi-functional, partial recovery to follow.   You see such people in half-recovery every morning on the subways of New York, avoiding the many coughers, refusing to hold on to the poles in crowded cars with bare hands, trying to figure out in their heads how they are going to make up for lost work time when they are still only half-whole.

As has been stated so often by so many, health is something we take too much for granted until we lose it.  Then, and sometimes only then, do we recognize how much of our lives – including fulfilling our responsibilities to our jobs, families and communities – is predicated on “feeling up to it.”   And even when we don’t, there are times when we must “soldier on” perhaps because of the non-negotiable responsibilities to work and family that beckon, perhaps because of access-to-healthcare issues, including the seemingly ever-increasing costs.

These impediments of time, opportunity and expense are far more than annoyances, but undermine well-being in ways that impact our ability to participate fully in the affairs of the world and help others to participate also.

At the UN, health care quality and access are thankfully occupying a more prominent place on our collective agenda, in part because far too many people in this world lack sufficient opportunity and access to health resources that can improve the quality of their own lives and their productive service to others; also in part because of a growing understanding of how important personal and community health are to the often-challenging promotion and achievement of “peaceful and inclusive societies.”

In the Sustainable Development Goals (SDGs), target 3.8 directs us to “achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.”  This represents a noble aspiration and, as with other SDG goals and targets, naming it is only the first step to full and fair implementation.

It is hoped that the Commission on the Status of Women, convening this Monday on the theme “Challenges and opportunities in achieving gender equality and the empowerment of rural women and girls,” can also make substantive contributions to greater health care access and awareness.  In areas of the world in which Global Action has cultivated program partnerships, including in Cameroon and El Salvador, access barriers to vaccinations and other health care often drag down women simultaneously discharging family and community responsibilities while seeking pathways  to greater levels of economic and political participation for themselves and others.  It is exhausting just to witness the multiple tasks that many rural women juggle, even more so considering how many of these women must juggle while battling illnesses and injuries that often go untreated and which, in some instances, are a consequence of diseases that have received too-little attention from the scientists and pharmaceutical companies that drive so many medical innovations (and the patents to protect them).   The CSW can hopefully focus some of its formidable policy attention and recommendations on improving health access for rural women (and their families) that can help them achieve both access to markets and increased levels of political and social participation.

Thankfully, health issues seem to be getting tracton across the UN agenda – specifically in terms of preventing and responding to pandemics, addressing antibiotic resistance (and the current lack of pharmaceutical interest in creating viable alternatives), and encouraging shifts in diet and lifestyles that can lower thresholds for non-communicable diseases (from cigarette smoking, opioid addictions, etc.) .  All of these (and related) interventions, as noted, have important implications for peaceful and inclusive societies, as well as for elevating levels of health-related access.

Last Tuesday, the World Health Organization and other UN partners convened a session devoted to “Promoting Innovation and Access to Health Technologies,” which was intended in part as a follow up to the 2016 report by the Secretary-General’s High Level Panel on Access to Medicines.  Despite acknowledged limitations in its mandate, the report deftly outlines impediments to access and suggests trade and finance reforms to ease obstacles.  The report acknowledges the need to fund more research on diseases and related health needs endemic to developing countries — including more resistance-free antibiotics – while ensuring fair protection and compensation for those whose investment risks made new medicines and medical technologies possible.  The report highlights most of the often-systemic, critical barriers to access that must be addressed by the international community, including “inequalities within and between countries,” poor health education, a lack of trained medical personnel, health-related stigmas, lack of access to health insurance, and what it calls “exclusive marketing rights.”  And of course it cites the matter of health-related costs which in some instances (including for insulin, as noted by the WHO on Tuesday) are still rising.

What the report did not take up are the health and human rights implications of “bio-piracy,” research that exploits potential remedies from fields and forests to produce medicines which are then patented and marketed in ways that render them often well beyond the reach of the very people who inhabit the environments of origin.

Nor did the report take up the health access barriers that are created and exacerbated by armed violence, the refugees struggling with severe physical constraints on their long and treacherous journeys, the families under siege who find their clinics and hospitals reduced to rubble.  The nefarious “stripping” of long-awaited relief convoys containing medical supplies headed for besieged areas of Syria (even after a Security Council-authorized cessation of hostilities) is a special case but sadly not a unique one. We can’t seem to stop the bombing — perhaps our primary UN responsibility– but beyond that we can’t even guarantee minimal access by victims to the medicines and equipment that could give them a “punchers chance” for survival and renewal.  Apparently even the most abusive state and non-state actors understand that healthier and more able people are better able to contribute to stabilizing damaged local communities; but on a larger level are also better able to resist the intimidation of bombs and sieges, to more effectively demand cleaner water, lower levels of state corruption, less discrimination and abuse, fairer access to education for their children and energy for their dwellings.  Even abusers recognize that health care access is not a side-show on the path to more peaceful and inclusive societies, but is elemental to their ultimate success.

As one recent TV advertisement in the US seeks to remind us, moms and dads “don’t take sick days.”  But as the Dutch Ambassador to the US intimated during her statement at Tuesday’s event, the world is full of too many people for whom a “sick day” is an indulgence that threatens the basic well-being of families and communities.  It is the obligation of all of us, as the Thailand Ambassador and others noted – health professionals, scientists, parents, the private sector and the global policy community — to ensure a “better balance” of interests between those who develop vaccines, other medicines and medical equipment and those for whom access to context-appropriate health care is literally a lifeline.  We cannot meaningfully propose strategies for the full inclusion and participation of persons who can barely lift their heads to attend to their daily responsibilities in domiciles, fields and markets.

(Desperately Seeking) Health Without Safe Water: A Reflection by Leah Caudell-Feagan

5 Aug

Editor’s Note:  The following (with very slight modifications) was written by Leah Caudell-Feagan currrently serving as a Peace Corps Volunteer in the Dominican Republic. I came across this Blog the morning after the UN adopted the outcome document which recommends a new and ambitious set of Sustainable Development Goals to Heads of State who will gather at the UN in September.   One of those goals (#6) is expressly devoted to achieving universal access to safe and affordable drinking water by 2030.  Diplomats could hardly make a better case for such a commitment than Leah has here.

Health Without Safe Water

It simply can’t exist.

This is a fact that we all know. A woman from Gambia walked in the Paris marathon this year to show the lengths to which some people in the world have to go to obtain potable water. Matt Damon and other celebrities star in videos gone viral that try to shock us into understanding how crucial water is, and how big of a problem it is for so many.

A lack of water is a global issue, affecting too many people worldwide, though celebrities, activists, and normal citizens alike understand this problem mostly in a theoretical sense. I also had some awareness of this problem, even to the extent that I felt guilty when I took showers that were luxuriously long, or when I left the tap running while brushing my teeth. However, it was not until my Peace Corps service that I truly began to understand how critical water is to health.

After becoming intimately acquainted with life sans potable water, I can tell you from personal experience that a lack of water makes life harder in many ways, but none more taxing than losing control over your health. During my Peace Corps service I have constantly gone back to Maslow’s hierarchy of needs because it has become relevant for me in ways I never imagined it would.

2000px-Maslow's_Hierarchy_of_Needs.svg

For the first time in my life, I became stuck in the first tier, not being able to climb past physiological needs to general safety. Maslow said it well–without water, there is no security of body or health. Following that truth, without security of body and health it becomes increasingly difficult to find footholds in the higher, more complicated needs and aspirations. Such a lack negatively impacts your esteem, and halts your ability to find time and energy for creativity and those things that truly make life feel exciting and stimulating. In simpler terms, if you are stuck in your house having diarrhea every 30 minutes, investing time in your friendships, feeling great about yourself, and thinking of ways to develop yourself and rise out of conditions of poverty all become pretty daunting if not completely impossible.

I realize that I am absolutely oversimplifying a complicated thought experiment and issue. I am speaking from what I have seen and my personal experiences of living without water and struggling with my health. My immune system and I were never the best of friends, and I’m not saying that I was the healthiest person before making a home in OjedaHowever, after multiple amoebas, Chinkungunya, more UTIs that I can count, multiple bacterial infections, pink eye, and a skin rash that despite being seen by doctors 4 different times still has no name, I definitely think that I can prove correlation between the lack of safe water and the health decline I experienced during my service. And those health issues don’t include the digestive irregularity that becomes a baseline for PCVs, the food poisoning that attacks frequently, and viruses that take over the community every few months. As my flight back to the states approaches, people keep asking me what I am most excited for. Before they can even finish asking the question I always blurt out “TO BE HEALTHY!”. What I’ve realized recently is that what I really am most excited for is water. Beautiful, running water that has no creatures swimming in it. Filtered water that needs only to be appreciated.

Living without water means the house is not clean. It means that the plates you eat off of and the food that is prepared are not as clean as they should be. It means that no matter how hard you try, you physically are not clean, because even if you go to the river twice a day to bathe, you are bathing with animals and the hoards of community members who are there beside you.  A lack of water means that even the most basic steps to staying healthy become impossible. Washing your hands is one of the surest ways to protect yourself against illness. I know this better than anyone here–I teach it. However, when I have one bucket of water to last me today and possibly tomorrow too, washing hands becomes another thing in the long list of activities to prioritize.

Health is a human right, and water is one as well. These shouldn’t be things that anyone in this world has to prioritize around or worry so much about.

My mom is constantly telling me about the guilt that she feels for having water when I, and all of my community members in the Dominican Republic, do not.. I definitely do not want anyone reading this to feel guilty. But she also tells me how grateful she is for every glass of water she fills up out of the tap to drink, and how much she appreciates the water that pours out of the shower heads and taps all over our house. That- the appreciation and gratitude- is what I want you to feel. I appreciate all of the people all over the world who are working towards ensuring that all human beings have access to water and all of those who donate their time, money and energy to this cause. And when I am eventually back in the land of free flowing, filtered water, I am positive that I will never again fail to feel grateful.