Vinoth Ramachandra

Archive for March 2010

The past two weeks have been emotionally fraught. My wife, Karin, was diagnosed to have a malignant tumour in the upper part of her colon.  She had it removed within a week of discovery. She is recovering well from the surgery, but we await the pathologist’s report for her prognosis. It has come as a complete shock to us, as there is no history of cancer in her family and her general health is excellent.

The operation was performed by one of the best surgeons in the field and in one of the best-equipped hospitals in Sri Lanka. Until the 1980s Sri Lanka enjoyed an enviable reputation as a Third World nation with an excellent system of free, high-quality, state-sponsored medical care.  But not any more.  State hospitals have been (intentionally) starved of funds, although they are the only medical services to which the majority poor have access. Medicine has turned into “big business” with corporations building state-of-the art hospitals in the capital. Many doctors who have received a free medical education in the state universities leave the government hospitals to work in these new hospitals and charge fees comparable to those of specialists in the rich world. Middle-class families pull out their entire life savings to pay medical bills.

There are many factors- economic, cultural, political- that account for this shift. One significant factor, however, that is not mentioned in public discussion is the following. As in the West, the influence of Christians in the medical and nursing profession has steadily declined. Until well into the 1960s, the proportion of Christians among doctors and nurses in the Indian continent was far higher than their proportion in the population as a whole. In India the medical care of women, tribals and “low-caste” peoples was pioneered by Christians. Sri Lanka had very few mission hospitals, unlike in India, because many Christians chose to work in the government hospitals. The exodus of Christians in recent decades, largely on account of the war and economic stagnation, has meant that money-making has replaced older ideals of compassionate care and public service. Of course there are individual Buddhists, Hindus and Muslims who practise these ideals admirably (while there are professing Christians who are a disgrace to the name of Christ), but the cultural ethos has shifted hugely. It may well be irreversible.

Middle-class as we are, the only reason we could afford such speedy, good quality and expensive care was because we are relationally rich. The support of friends, emotional and financial, both here and abroad, has been overwhelming. It has placed us in an awkward position: enjoying the privileges of private medicine while continuing to believe passionately in socialised medicine. I don’t think this is hypocrisy. We are not recommending the government system as it stands now. We are victims of an economic system which severely limits choice while proclaiming “freedom of choice”. We shall continue to advocate that the quality of healthcare that people receive should not depend on how much they are able to pay, and especially when it comes to life-threatening situations such as in Karin’s case. If the rich want special clinics for breast enlargements, liposuctions and Botox lips, they can pay for that themselves. But public funds, and perhaps public-private partnerships, should be devoted to providing services that every citizen can enjoy.

Our health depends so much on factors outside our control. Being born into a poor family means that we have poor nourishment, less access to information about health and nutrition,  more exposure to pollutants, less educational skills and job security, lack of political influence, and so on. This is what makes the right-wing rhetoric about “personal responsibility” for health mere hypocritical cant.

Economists limit their discussions of healthcare to the provision of medical services. But healthcare involves much more than good hospitals: concern for social justice in healthcare forces us to look at everything from sanitation, waste disposal, and climate change to the ethics of TV advertisements and food companies, the quality of secondary education and disparities in income and work opportunities. Prevention is far more effective than cures- and prevention mostly requires cash transfers to develop education and infrastructure, whereas curative medicine absorbs real resources.

Most of us non-Americans are naturally nonplussed at the fury that Barak Obama’s health care reform bill has unleashed. It perplexes us that so many suburban American Christians who do not care one iota about a trillion-dollar military budget, and wax eloquently about being zealously ”pro-life”, are now indignant about their state spending public funds to make the poor Americans more equal to them when it comes to receiving medical treatment and enjoying good health! Please, could some Republican party Christian explain these anomalies to the rest of the Body of Christ around the world?

Two massive earthquakes have left a trail of devastation in South America. Haiti suffered an estimated 230,000 dead and 1.2 million homeless, but Chile was relatively unscathed in terms of human casualties (several hundred) despite experiencing a far more severe quake. What accounts for the huge difference? High population density and widespread poverty. The two are connected.

Haiti’s poverty is largely the result of decades of vicious, postcolonial dictatorial rule that replaced colonial exploitation.  The country has never had the infrastructure that only political institutions can create. After the internationally sponsored coup in 2004, a strong UN pacification force was placed in the country. Despite being the nation’s de facto law-enforcement agency, it was not given a mandate to help in poverty alleviation programmes or agrarian development.

As for Haitian Christianity, in both its Roman Catholic and Protestant expressions, it is heavily syncretistic, often barely distinguishable from traditional voodoo religion. While engaging in social welfare, the Church disengaged from critical witness in the political domain, either through fear of repression and reprisals or through a pietistic theology of withdrawal from public life. (Both in its syncretism and quietism, it is little different from Churches in many parts of the so-called ‘developed’ and ‘developing’ worlds).

But rich nations also share responsibility for Haiti’s plight. In March 2008 Stefan Gates from the BBC went to Haiti, known to the world as the poorest country in the Western hemisphere (with 72.1% living on less than $2 a day and two-thirds of its workforce of 3.6 million unemployed), met with locals in the Artibonite Valley. He reported how this valley used to produce nearly enough rice to feed the entire country, but back in the 1980s the IMF and the WB demanded that Haiti drop import tariffs in return for loans. Haiti was soon flooded with cheap and heavily subsidised food from the United States. A local farmer complained, “We can’t compete with imported rice”. Agriculture – one of the few sources of employment in this desperately poor country – effectively collapsed. Rice production halved and imports increased fifty-fold, making Haiti the USA’s fourth-largest market for rice.

After the recent disaster Peter Hallward commented in the British newspaper, The Guardian: “Since the late 1970s, relentless neoliberal assault on Haiti’s agrarian economy has forced tens of thousands of small farmers into overcrowded urban slums…hundreds of thousands of Port-au-Prince residents now live in desperately substandard informal housing.” Hallward quotes Brian Concannon, the director of the Institute for Justice and Democracy in Haiti: “Those people got there because they or their parents were intentionally pushed out of the countryside by aid and trade policies specifically designed to create a large captive and therefore exploitable labour force in the cities; by definition they are people who would not be able to afford to build earthquake resistant houses.”

It is humbling to be reminded again (see my posts of 8 May and 15 May 2009, “The Lives of Others”) how many of us are implicated in the tragedies that befall strangers- either through our apathy or our complicity in global institutions that continue to practise double standards that are biased towards the rich. While churches and international aid agencies now trying to help Haitians rebuild their shattered lives and collapsed homes, who is calling on the IMF and World Bank to apologise publicly and offer restitution? And why is it that, while we raise prayer and money for victims of natural disasters, we do little to educate ourselves and our churches about the histories behind such suffering?

I am reminded of the oft-quoted words of Dom Helder Camara, the late Archbishop of Recife, Brazil: “When I help the poor, people call me a Saint. When I ask, ‘Why are these people poor?’, they call me a Communist.”



March 2010