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- The
Global Medical Forum, Pontresina,
Switzerland
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- THE
MEANING OF HEALTH CARE
- Statement
by Beat Richner, M.D., Cambodia
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- The Global Medical
Forum, Pontresina, Switzerland
- Opening Session:
Monday, 17 September 2001
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- Mr. Chairman,
Ladies and Gentlemen,
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- Please, let me
discuss this subject from the perspective of a
pediatrician who, over the past nine and a half years,
has had the opportunity to create and direct three
hospitals for sick children in Cambodia. Eighty
percent of Cambodia's children are receiving health
care from these institutions; without the health care
of these hospitals, around 2'600 children would have
to die each month. Thousands more would have to suffer
from their diseases. This is the meaning of health
care for these children and their families. This is
the meaning for those in need.
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- Per year, we now
hospitalise 40'000 severely sick children; we see half
a million outpatients, perform 5'200 surgical
interventions and provide 140'000
vaccinations.
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- In other words, the
three Kantha Bopha Hospitals are preventing a passive
genocide. Yet the experts and functionaries, be they
from the local health ministry, be they members of the
International Community, not only refuse to
acknowledge these institutions but even attack and
confront them, since the hospitals are not part the
official Health System. Health care outside The System
is said to be wrong and not only wrong; it is
discredited as subversion of The System, even as
antagonising the system. Such thoughts are spread by
words and written documents. - Here, however, I want
to say that there is also official recognition,
understanding and even help not only from the King,
but also from the Prime Minister of Cambodia. And
there is, as one knows, consistent financial and moral
support from academic and political representatives as
well as from many, many private sponsors mainly in
Switzerland. At this occasion, I would like to
express, toward all these, my deepest
gratitude.
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- But what means
"outside The System"? And: What means the kind of
"Health Care System" as outlined before which is
implemented and safeguarded by the International
Community?
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- After working at
the original Kantha Bopha Children's Hospital in
1974/75 until the take-over of Phnom Penh by the
"Khmers Rouges", I have been requested by the King
Norodom Sihanouk and the Cambodian government to
accept the task of reconstructing and directing the
hospital. I have been asked to do so as a doctor, not
as an expert or specialist for health care in the
third world. For me as a doctor of children, there has
never been a question about whether or not a Cambodian
child should have the same rights for correct and
efficient medical treatment as a Swiss child.
Therefore it was clear to me that conditions had to be
created in the hospital that would allow to put a
normal medical thinking (i.e. spirit) into daily
practice. Should this normal medical thinking as such
be questioned, sadly even by professional colleagues,
then there will and can be no opportunity for further
discussion; one then deals with apartheid. The success
resulting from the three hospitals however
demonstrates that it is possible to create the
necessary conditions.
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- What are these
conditions? Correct treatment, correct medicine, which
means appropriate as well as just application of
medical care, is possible only without corruption. The
first thing to eliminate is corruption. There is no
corruption in any of the Kantha Bopha hospitals. All
of the one tousand Cambodian coworkers receive a
decent salary allowing for proper survival. No child
and no family has to pay for medical care. 95% of
families are too poor for paying. If they had to pay
(having no money), they wouldn't have access to
correct medicine. No one takes money "under the
table"; no employee is selling medications on the
market instead of using them for patients. Everybody
works three full days and spends the fourth night in
the hospital. Nobody could do this with the salary as
provided by The System, namely 20 US$ per month. They
would starve and be forced to corruption. This is one
crucial difference to The System. Corrruption within
The System is a "necessity". Unfortunately, there is
often complicity with the International
Community.
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- What, beside
corruption, makes the intrinsic quality of The System
is the fundamental idea of the International
Community, especially represented by the WHO and some
other International organisations who may be the last
resorts for the philosophies of Marx and Lenin, that
only little and cheap undertakings can be afforded for
poor people so that there is enough health care for
all. There are little means, especially in poor
countries. Therefore one does so little that not even
the little bit has any efficiency or relevance. One
strives to make justice to the global request for
sustainability "à la mode". Since nothing
results from nothing, and nothing will remain. Let us
call it "the global sustainable innovation for the
developing world".
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- It is said and
written by such people and representatives that Kantha
Bopha is doing luxury medicine. We do have up-to-date
diagnostic means, modern technologies. - There will be
opportunity to discuss this on the Wednesday afternoon
session of this Forum. &endash; Thanks to these means
which, from the perspective of The System, are thought
to be too expensive and too sophisticated for a poor
country such as Combodia, thanks to these means we
discover for instance the following: tuberculosis in
children, generally underestimated and missed until
now, is the alarming problem number one. I will
mention this also on Wednesday. Thanks to correct and
expensive medication (again outside the of "The
System's" protocols) we are able to treat tuberculosis
efficiently. Thanks to the elimination of corruption
and to continuous education of the families, there is
a compliance of 90% over the entire duration of
therapy which runs for six to nine months!
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- So, correct health
care of the child outside the official "Health Care
System" is meaningful for the future of the country.
Never a nation through and through sick with a disease
such as tuberculosis will be able to carry out self
determination. It will remain weak and its destinywill
be at the mercy of the ones in power whatever their
philosophical back ground may be. &endash; At times, I
wonder, whether the powerful neighbors of this country
who have, in part, their links with the powerful ones
of the "global circus", do have an interest at all to
comes to grips with tuberculosis. Correct health care
is also meaningful politically and
economically.
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- Often I get the
impression that the carriers of "The Health Care
System", the International Experts, the Functionaries
in the Health Minstries, even some doctors among them,
do not treat humans but sytems and
folders.
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- At the base of all
medical thinking and, therefore, as a fundament of all
health care is and must be the sick with his
suffering. The basic thinking of so many experts and
functionaries however, is devoted to "The System" and
the money. Only if, within the Health Care Elite,
one-self is at stake, then the valuable ego goes
before "The System". And this, as everybody
understands, is quite human.
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- Our annual budget
is ten million US dollar. The average stay at the
hospital is five days, at a cost of 226.- US$. Without
these admissions, around 80% of children would not
survive. And this, through words and documents by the
Health Experts, is called to be too expensive.
However, if by chance such expert in Cambodia is
molested by some fever, he has himself evacuated to
Singapore or Bangkok immediately. He feels himself
more important than the poor masses, since he has to
decide what is good enough for them. Vis-à-vis
og the global expertship one has to justify the
expense of 226.- US$ for correct medical means
invested to save a child's life or to prevent from
lifelong infirmity.
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- Rather than
representing a true globalisation, this global
handling of health care compares much more to some
"saturnisation". The elite of humanitarian long
distance tourism, the global experts or nomenclatura,
their busy activity seems caught in a rotational
motion of self promoting turns around a distant globe
with no noticeable effect &endash; as do Saturnius'
icy rings. Some (big bang) crushing of the rings must
be expected so that health care is no longer
celebrated in theory but performed in practice. This
is a crucial and decisive question: Is health care to
be available to all mankind? Will all children of any
age have access to it?
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- From this
perspective, correct and, thus, efficient health care
is a true contribution to world peace.
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- In the Kantha Bopha
hospitals the child's fundamental right is being
applied. Every child is entitled to correct and
efficient medical treatment. Diagnostic means do not
fail because they would be prohibited; and therapeutic
measures do not lead to death because they were cheap.
Every single child, disregarding individual "wealth"
or poverty, has his or her own right. After years of
war, genocide and discrimitation peoples' perspective
for active peace which means justice and the right to
live and geting health care is underdeveloped. To
promote such perspectives of a decent life while life
at large is still affected by war and dictatorship is
promoting peace.
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- Back to money. One
must justify the expense of 226.- US$ for a child's
life bending the knee before a wealthy world. Ninty
percent of families who have a sick child in one of
our hospitals could not afford a dollar per night. The
hotel next door to the hospital in Siem Reap Angkor
charges 340 US$ for one night, for customary culture
and fun. Squeezed between the contradictions of need
and wealth, one can only continue to be creative if
there is mutual reconciliation and forgiveness which
is not equal to resignation; with pardoning music
resounding in the spirit. The spirit of reconciliation
may guide this Forum so that it may turn into
creativitiy relevant also for the poor.
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- At this
opportunity, please, let me express a personal
invitation to this Forum for a subsequent reunion next
November 2002 in Siem Reap Angkor where a conference
center, now under construction, will be added to the
Jajavarman VII Hospital. With the spirit of pardon I
would like to intonate for you the Kol Nidrei composed
for cello by Max Bruch, the musical prayer of
forgiveness on Jom Kippur eve.
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- English translation
by Ulrich V. Willi, M.D.
- University
Children's Hospital, Zürich,
Switzerland
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