Vinoth Ramachandra

Archive for March 26th, 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?



March 2010