Sunday, August 4, 2013

GLOBAL GOVERNANCE FOR HEALTH AT UP MANILA

Joseph Paguio
MSSR-IPPNW

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Transitions in Global Governance for Health: Perspectives from Young People was a forum held at Paz Mendoza 104, University of the Philippines College of Medicine, Ermita, Manila, last 15 July 2013. Usman Mushtaq, IFMSA Vice-President for External Affairs was the guest speaker and Renzo Guinto, IFMSA Liaison Officer to the World Health Organization, was the facilitator of the discussion. The event was hosted by MSSR-IPPNW Philippines and headed by Jim Paulo Sarsagat, AMSA-Philippines Liaison Officer to IFMSA and MSSR-IPPNW Vice-President for Externals. At least 30 medical students from MSSR-IPPNW Philippines, AMSA-FEU-NRMF, AMSA-UST, and AMSA-Jonelta participated in the forum. Official photos of the event may be found at http://tinyurl.com/mssr-1314-tggh

UP MANILA was extraordinarily dreary that Monday afternoon. School had just ended, yet it seemed that all life extant from seven to five had already been sucked dry. Lecture rooms, hallways, roads, eateries, and gazebos were deserted when they would usually be bursting with after-school activity. Even the color was dully gray: the ominous sky, dirty pavements, half-lit halls, shadowed foliage, and residual puddles. Above, the clouds grew heavy and dark, dissuading even the happy-go-lucky students from gallivanting around the grounds. A light drizzle consummated the gloominess by concealing the campus behind a curtain of mist.
           
 Deep inside this spectacle of lifelessness brewed an ardent gathering of students from different medical schools. Unlike the surrounding backdrop, the meeting’s room––in all its cramped and dilapidated greatness––had a vibrant aura radiating from the students themselves who, despite looking fatigued, were earnestly and excitedly waiting for the speakers.
           
The awaited arrived on time. Renzo Guinto entered first with his beaming grin, so akin and naturally like those of celebrities and politicians. Despite his short stature, he had a large presence which filled the room, making it seem as if it wasn’t already fully occupied prior to his arrival. He released a string of conversational greetings to most members of the audience whom one would have thought he had already befriended. All eyes were on him while he was setting up, conversing, smiling, and even sitting. The admiration his neighbors had for him were clearly seen in their focused attention and liberated anticipation.
             
Usman Ahmad Mushtaq came in next. Like Renzo, he entered smiling but in a more subdued manner and easily captured attention without intimidation, for he looked and acted as if he had already been acquainted with the audience whom he had never seen before. He had a polished European voice with very little vestiges of his native accent. He’s Norwegian of Pakistani descent.
           
Usman was introduced as an avid participant and advocate of international medical student conferences. He was well-travelled, one who had the luxury to count the countries he had never visited without falling asleep. Having taken top-brass positions in local and international medical student organizations, he represented his country and these institutions in meetings of the United Nations and the World Health Organization. In such a young age, he had already concerned himself with global issues and top-to-bottom advocacies, which are overwhelming and sometimes overly idealistic to most of his peers.
             
Given his extensive knowledge on global issues, probably gleaned from his participations in the primary institutions that tackle them, it was surprising that he started his talk with such a basic question.
            
“What is health?”
            
There was a confounding silence from the audience. Usman laughed, as he probably expected that the simplicity of the question would bewilder the listeners. Students reluctantly replied with fragments of text-book definitions stored in the attic of their memories. Some extracted answers from their personal experiences in the hospital. A few declared the WHO’s version verbatim. He lightheartedly accepted all these suggestions, carefully pointing out each point’s precision.
           
Health is simply the overall welfare of a person in all facets of his life, not merely the absence of disease. This was the core of Usman’s definition of health.
             
From this core, he introduced the concept of Global Governance for Health, which recognizes and attempts to govern health’s multisectoral influences. He highlighted the “interplay” of multiple sectors, countries, environments, and cultures as they directly or indirectly affect health. He gave examples such as the effects of free-trade agreements and intellectual property rights on the prices of medicines in less developed countries and how the government structure can dictate how much of his or her healthcare expenses a citizen will have to shoulder. Having attended one of the largest environmental conventions, he did not forget to mention climate change as a globally encompassing detriment to health. A locally relevant topic he touched on was the migration of the health workforce and how this labor force has become vulnerable to diseases because of the lack of healthcare support.
             
Usman then showed the various conferences and conventions he had attended. He pointed out the field’s leaders and pioneers, with whom he had worked. Among them were the Director-General of the WHO and the Dean of the Harvard School of Public Health.
             
He concluded his talk with a picture that said, “BLA BLA BLA... ACT NOW!” He meant to emphasize that the most important aspect of Global Governance for Health was the execution that followed the planning. Students need not be present in the assemblies he attended to participate in them. Likewise, he emphasized how local involvement is just as important as international involvement. One only needs to be concerned and to act to become part of this movement.
             
The open forum was presided over by Renzo Guinto who shared no less credentials as Usman. He reviewed the students on the WHO’s definition of health and the Millennium Development Goals, which are specific achievements which all nations belonging to the United Nations wish to attain by 2015. Like a lecturer, Renzo wittily quizzed the students.
            
 “How many of the eight development goals concern health?”
            
Many were quick and confident to answer, “Three!” True enough, these were the reduction of child mortality rates, improvement of maternal health, and the combat against HIV/AIDS. To this, Renzo replied,
             
“No. All!”
             
Renzo was able to underscore the majority’s constricted perception of health. Though the three aforementioned goals are popular in medical parlance, they are not the only ones which actually involve health, as Usman said. The others, though political, environmental, and economic are just as conducive when achieved and obstructive when forgotten in the attainment of the world’s health.
             
This generalist approach to global health was the main thesis of Usman’s and Renzo’s talk. To limit medicine’s scope to the confines of the hospital or the ability of the physician is already obsolete. Our evolving knowledge of health and its contenders has urged the advent of a new movement of doctors who boldly transcend traditional and conventional constructs and enable themselves to, simply, look at the bigger picture. Just as how patients must be knowledgeable enough to consult multiple specialists when faced with an undiagnosed condition, doctors, in their pursuit to cure patients, must recognize the different “non-medical” fields which could possibly influence their patients’ overall health. When physicians have done this, they realize that their patients are not merely the ones situated in front of them, directly asking for their aid. Rather, their grasp widens to encompass nearly the entire society who is under an influential system, whether political, economic, or social. Usman and Renzo consider themselves such physicians.
             
Usman and Renzo do not see themselves as regular doctors. Regular doctors are those whose ultimate question is, “Was the patient cured or not?” Their success or failure is immediate, dictated by the answer to that question. However, when a doctor has to detach himself from the ill of the present and make studied decisions for the ill of the present and the future––whether that decision is to be made inside the session hall or an international convention on climate change––he indefinitely lingers in a state of uneasiness. He cannot help but be oblivious to the exact outcomes of his decisions firstly because, he does  not know his patients, and secondly because the effects of his decision are subject to such a large period of time. Usman and Renzo are doctors who may never know whether they have cured their patients or not, but know that what they do is so essential that they must do something.
             
Global Governance for Health, therefore, is an enormous responsibility. It is public service at its finest, catering to the lives of the present and the future. It is not mere articles fancily synthesized in massive international symposiums. It is the sacrifice of never surely knowing what your actions account for. But above all, it is an essential obligation, which, if neglected, leaves the population vulnerable to plagues.
             
It is an obligation, which we medical students must learn to accept, for we now know that the lives of our patients are not merely dependent on how we employ the stethoscope or wield the scalpel. As those who have committed themselves to the pursuit of all our patients’ health, we realize that everyone becomes our patient and therefore must pursue everyone’s health. Renzo illustrated this thought by quoting Robert Vurchow, a German medical philosopher who said,
            
“The physicians are the natural attorneys of the poor, and social problems fall to a large extent within their jurisdiction.”

It is ironic that such zealous talk was held in the confinement of a dreary, lifeless, dilapidated setting. It is also ironic how, in a country where the effects of political turmoil, economic deprivation, and social instability cannot be divorced from the health of its citizens, the amount of concern for the governance of health is relatively minute.
            
 Usman’s and Renzo’s talk on the Global Governance for Health only had one aim. And that was to eradicate this irony.

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