I am a strong believer that every interaction we have in our lives adds a layer of tint to the lenses we see the world through. Mine are forever etched with the experience of working as a clinician in South Africa for 3 years. There are many strokes of bright colours – of miraculous recovery, of the resilience of our patients despite overwhelming suffering, and with the laughter and care of patients and colleagues. But my lenses are also tainted with the pain of watching children suffer from malnutrition in the 21st century, of watching communities ravaged by HIV, TB and violence. Dark stains that reveal that ill health is a social entity consisting of poverty, inequality and inadequate resources and infrastructure.
The 2019 Rhodes Healthcare Forum’s theme was ‘From Surviving to Thriving’, and I found that each session I attended was shaded by my previous experiences of working in an imperfect system created by an unjust society. I could not help but wonder if we were being ignorant in our claim that we had reached a state of ‘surviving’, given the immense inequality and struggles to access health care so many still face. But the message we emerged with was a far more hopeful one – a message emphasising immense health gains over the last two centuries, and an overall trend towards better health.
There are two intertwined stories that stood out for me that I would like to briefly touch on and share some lessons learned:
Partners in Health (PIH) is a healthcare NPO founded in 1987 by a group of friends. It was initiated by a young man who had visited Haiti before starting medical school, and who was confronted with a community ravaged by tuberculosis with very little access to healthcare. The group of friends could not turn a blind eye to the suffering of the community, and as a result were driven to lead the way in providing access to healthcare and social interventions, their approach spearheading the use of community health workers. Over many years, the organisation became an important advocate for access to life-saving and sustaining treatment including antiretrovirals, treatment for drug-resistant TB, advocating for more affordable treatment and addressing the social contributors to disease and suffering. The journey of the organisation is a remarkable one which I cannot do justice to, but it highlights that at our core, we have a shared humanity which transcends borders, both across countries and across oceans.
PIH’s story became intertwined with that of Rwanda’s Health System. Through consulting PIH, Rwanda ascended from the ravages of genocide to a state in which they could begin to rebuild their healthcare system. Rwanda’s emergence from what many saw as a desperate situation, is a testament to the forward thinking leadership of those who valued community engagement and public service. The most striking principle employed in the rebuilding was that no-one would be left behind. It was this inclusiveness that began the process of building trust – both between neighbours, and between communities and their government. The Rwandan Ministry of Health set up systems of community involvement targeting accountability and sustainability. This was achieved through mobile network reporting systems of both community members and healthcare workers regarding the state of service delivery, the training of health workers, and collaboration with international organisations. Importantly, every external influence involved was required to adhere to the model set out by the government, and in this way, Rwanda was able to govern its own transition, instead of having its path dictated by external funders.
The key message from these stories is epitomised by one of my favourite quotes: “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has.” (Margaret Mead). It is easy for us, as healthcare workers, policy makers or anyone involved in public service, to be overwhelmed by suffering and inequality. Yet, we are reminded that even one person can have an immense impact on changing the trajectory of global health.
A small group of American students changed the landscape of healthcare in rural Haiti. They then went on to advocate for affordable access to antiretrovirals and tuberculosis treatment. Their actions had a profound effect on healthcare provision across the world, and particularly in my home country, South Africa.
The community health workers that PIH employed in their projects in Haiti played an integral role in training the local community health workers as Rwanda built its healthcare system. Indeed, a small group of people can have a profound effect.
So how do we transition from surviving to thriving (or even just surviving a bit better, as is still the case for many)? Perhaps the best guiding principle is what Rwanda has taught us – no-one should be left behind.
Over the course of the weekend, we had a chance the engage with how health systems often ignore or discriminate against the vulnerable. We had discussions on indigenous health in New Zealand, Australia and Canada; Gypsy and Traveller communities in the UK; those living with disabilities; mental healthcare; and other marginalised groups. It was emphasised that without building trust in the communities in which we work in, we cannot fully address their needs. Without collaboration, whether it be with public/private partnerships, academia or with other like-minded people, we cannot begin to empower our communities and health systems and see them thrive.
In South Africa, there is a Nguni word/philosophy of Ubuntu –“I am because you are”. It recognises that we all have a common humanity that should unite, not divide us. It is this humanity that should oblige us to stand up for justice and equity. It is often debated whether universal healthcare is feasible or ‘economically justified’ but in my opinion, the debate surpasses all issues of funding and sustainability, and is simply a moral imperative.
I am because we are.
Bronwyn Gavine (South Africa-at-Large & University 2018) is currently studying for her MSc in Neuroscience at the University of Oxford.