A paradigm shift in medical care and plight of the poor

December 30, 2015, 8:44 am 

State-run Hospitals in Sri Lanka are chock-a-block with patients desperately seeking medical help for afflictions ranging from the trivial to those that are life-threatening. How can we account for this seemingly explosive increase in those seeking institutional aid?

Its roots are as much social as medical. Traditionally, the sick were treated at home with Native Practitioners administering nostrums based on Ayurvedic folklore. Interventions of the kind seen in modern hospitals were rare or non-existent. Invalids recovered serendipitously, or died peacefully at home, with near and dear ones around the deathbed. Often a monk was called in to assure a good passage to the next world.

The great medico-sociological revolution that has overrun our rural populations is the acceptance of the Western notion that the body is a machine that must be regularly serviced and repaired by specialists. This means that illness is no more the malfunctioning ‘machine’ that must be put right by a kind of specialist medical engineering that necessarily entails experts – and ‘workshops’ called hospitals. There is no need to belabor the point that the new philosophy involved in this management of the sick and the feeble is not only hugely expensive – it is unsustainable as a long-term strategy of health-care, except for those with wealth and privilege.

There is also the fact that true medical care is not all science and technology. The ancients spoke of the ‘healing touch’ or the ‘laying on of hands’ to betoken a spiritual side to medicine – the power to heal depending on the personal ‘magnetism’ of the healer in his encounter with the invalid, and his immediate circle of near and dear ones. That the new system of hospital medicine reduces to naught the ambiences of mystery and spirituality to the healing process will not be denied by any except the incorrigibly skeptical.

Until recent times, prayer was supposed to be an essential part of the care of the sick. This expulsion of mystery in matters of life and death is a regrettable cultural regression of the modern world. Is there a solution? There is one - albeit partial in its scope. Let us recall that before the rise of hospital-based scientific medicine, there was a class of healers called ‘General Practitioners’ who served a community or neighbourhood from within – that is as an accepted member who played a role as comforter and adviser to patients who were socially bonded to him and viewed him as an elder and a friend.

Naturally, this was possible only in closely-knit communities of a kind that have largely been replaced by anonymous urban sprawls. Sadly, high science and the latest in medical technology did not penetrate the GP brotherhood, and they have gone the way that cars have replaced buggy-carts. This forced extinction of GPs is one of the prime reasons for the rise of Hospital Medicine, and the loss of that intimacy between patient and doctor that made medical care different from the repair of machinery. While it seems impractical and even anomalous in this day and age of Mega-cities and high science, would it not be possible to introduce itinerant or ‘barefoot doctors’ as an arm of the state-run social services to advise (clinical counselling) and provide a basic health care network for the less fortunate? It should be emphasized that such ‘barefoot doctors’ ought to be seen as community-based friends and helpers – not ‘inspectors’ of the kind notorious today, in connection with the Anti-Dengue campaign launched by the State.

The problem facing mankind as a whole is the unbearable rise in the cost and sophistication of medical care, while wealth is increasingly accumulated asymmetrically with the rich getting richer while poverty shows no sign of easing its historic dominance as the most pressing problem we face as mortal beings.

Let us conclude by reflecting on a similar social ’paradigm shift’ in the field of ‘human locomotion’. Through most of history, people walked –often great distances – without the danger of lethal impacts from road machines. Today the car is a dire need as public roads are not meant for walking. This ‘paradigm shift’ in styles of public locomotion is killing the planet, according to some respected authorities. The shift to Hospital Medicine is clearly not so calamitous, but the cumulative social cost can be so great as to be unsustainable in the long term. Mankind has to develop not only new medicines, but also new and enlightened ways to deal with the sickness and death that stalks us all.

R. Chandrasoma