Tuesday 22 March 2016

Celebrations and health equity in Ghent


Can we justify the kind of celebrations accompanying an honorary doctorate? Putting on funny gowns and hats, having bands and choirs, and walking through the streets in procession? Not to mention the lectures and dinners that accompany such an occasion. We can indeed. Not for the first time this year – see Bangkok – I have had occasion to reflect that such celebrations are a wonderful testament to scholarship. They take us out of the everyday political concerns of austerity and cuts, the human concerns of war and refugees, the economic concerns of global slow downs and market uncertainty and allow space to reflect on what universities can contribute to our civilisation. Five of us received honorary doctorates from Gent University – it has no “h” in Flemish, but seems to have gained one in English – a statistician from Sydney, an expert in fire safety now in Brisbane, an animal physiologist from Pennsylvania, a Belgian choreographer and me.

The diversity made the occasion even more special. I can illustrate. Several years ago a visiting American colleague gave me a copy of A Civil Action by Jonathan Harr. When my guest left I glanced at the book. Then something happened that has only one or two precedents in my life – I read through the night, literally. (If I recall, TS Eliot read through the night and went south in winter. I stayed put with the book.) It is a story of a small cluster of childhood leukaemia cases in a town north of Boston. A local factory was pumping so much chemical into the water that it was coloured. The question was whether the chemical was causing the leukaemia. Difficult scientific question. Reading the book, riveted by the book, I was convinced that a legal process is not the best way to settle scientific questions of cause and effect. Louise Ryan, now a statistics professor back in her native Australia, had had some involvement in this fascinating question while at Harvard. In case you are wondering, the legal case did not resolve it satisfactorily.

Next up, I remembered a typical long article in the New Yorker. A man in Texas was executed for murdering his children. There had been a fire in his house, the children died and he was accused of arson and hence murder. A fire expert said that the pattern of the fire was typical of arson and that clinched the man’s guilt, despite his repeated professions of innocence. Later expertise, too late, questioned the conventional wisdom and showed it to be false. It turned out that the pattern of the fire was NOT typical of arson and should not have been incriminating. Professor Jose Torrero from the School of Engineering in Brisbane had been important in bringing real science to the question and revising understanding.

My ‘promotor’ was Jan de Maeseneer who built up the Department of Family Medicine and Primary Health Care of Universiteit Gent. They had been part of the knowledge network on health systems of the Commission on Social Determinants of Health. Now, under Professor Sara Willems, social determinants of health is an important theme of their department. To that end they take students out into the community to experience the reality of people’s lives and encourage their feelings of empathy and their understanding of social determinants of health.

Another theme running through each of the honorary doctorates is the importance of networks and human relations in academic life. Though their countries of work are spread,  each of the honorary graduands, now graduates, had close intellectual and personal links with their promotor at Gent. There is a global community contributing to knowledge and understanding. That surely is ample reason to have a day of celebration.



Wednesday 16 March 2016

Treating people with dignity not as instruments



I began my book, The Health Gap, with the line: What good does it do to treat people and send them back to the conditions that made them sick. I did not have in mind the current crisis of mass refugees in Europe, but it brings home the question in a starkly tragic way.

Some politicians take the view that if refugees are treated well, it will only encourage others to follow. My response to that is twofold. First, you would have to treat refugees particularly badly to make things worse than the conditions in Syria, for example, from which the refugees fled; quite apart from the hazards of the journey. Ghastly idea.


Second, and more fundamentally, medicine can lead by example in the ethical treatment of refugees. Doctors treat individuals who need care regardless of who they are and what made them sick. Each individual has the right to be treated with dignity. It is a core ethical concern for doctors. If someone is lying in the gutter with a broken head, the doctor does not say: I smell alcohol, I won’t treat him. The doctor delivers the best care (s)he can. So should it be with refugees. Treating people badly so as to discourage others from coming means that people have become instruments of political policy. It goes against the core ethical principles of medicine. To repeat, individuals have a right to be treated with dignity not as an instrument of someone else’s policy.


We should extend this ethical approach to the conditions in which refugees are eking out an existence: apply the social determinants of health principle. Treat the sick and be advocates for dealing with the conditions that made them sick. And that means addressing the appalling conditions in which refugees find themselves, as well as doctors speaking up for peace in the areas of conflict.


All this came to mind at the conference on War, Migration and Health, convened by the Turkish Medical Association and the World Medical Association in Istanbul, 25-27 Feb, 2016. The Turkish Medical Association had prepared an excellent report on the Turkish experience. Official figures suggest that there are between 2.5 and 3 million Syrian refugees in Turkey. The real figures are probably higher. Such numbers put enormous strain on a country’s resources – economic, social and political.


In Turkey’s case it comes with the background of the long-standing tension between the government and the Kurds and tensions over degrees of Islamisation. The Turkish Medical Association stands tall. By delivering medical care to all it has earned the opprobrium of government, but they have strong support from the World Medical Association. The declaration from the conference states this clearly.


My frustration at visiting cities and seeing little was eased by being shown something of Istanbul by our hosts. One has the feeling that the bridge over The Bosporus is the link between secular, modern, Europeanised Istanbul and traditional, more Muslim, conservative Asia. It is a tension that is playing out on the larger political stage. The secular republic of Ataturk is being challenged by the present government.