On my last visit to my grandmas house she presented me with an article written about my great grandfather in the 1950’s. He was an eye surgeon and my grandma had pulled it aside after I had told her about the global health pathway @ BU. The article was written after a then recent medical mission trip to Pakistan to perform cataract operations on hundreds of patients in the mountains in the northern part of the country for a few weeks.
I was excited to read the article, accompanied by an unrelated picture, she reported, of my great grandfather with Indira Gandhi, shaking hands. The texture of the paper was soft, as aged newspaper is, with the creases well formed conveying a permanence that modern electronic text doesn’t. The color resembled the tea he probably enjoyed in the afternoons after numerous surgeries. The advertisements reflected a different professional landscape in middle America in the 50s, a part of the country I I have never visited. The article served as an odd information piece on “the new state of Pakistan”, complete with information regarding the history of the country, and some local cultural norms among other things.
The underlying attitude of the article was quite paternalistic regarding the approach to providing care – ‘colonial medicine’ in more than name. It was a bit bizarre and kind of uncomfortable to read – ultimately in line, however, with the expectation of the medical missionaries at that time when “just as (medical) missionaries were frequently the first point of contact between Europeans and non-Western peoples, the news and writings of the missionaries sent back home were commonly Europeans main source of information about the colonies”. Similarly, the style of writing also exemplified the beliefs that many of the time expressed towards the former colonies of the European countries – indigenous social systems were “backward, immoral and unclean”.
The article suggests the physician in the 50s was to be accommodated, especially in another country. It contrasts starkly to the relationships we have with our patients now and the approach we take to global health. There were significant struggles documented in the article but they concerned the physicians struggles as much as the patients. We were to pity the patients of the time, not empathize. More importantly, the role of the physician was limited- the approach to health was concerned the medical intervention that could be applied rather than a more holistic approach global health takes now.
While it would be easy to find further significant disparities between attitudes and care then and now, the more striking issues were the ones we continue to deal with as physicians, especially in the context of global health. The subject writes, “Since the principle observed was to give to the greatest possible number, sufficient vision to get around without having to be led by another person, many critical observations that could be made die unuttered” and as most of the people face “a short life expectancy and a grievous burden if left blind, it seems to me that it is better to give 1000 of them each year sufficient vision for their every essential need than perhaps only 500 of them if a more elaborate surgical technique, prolonged post op care…” were used. We struggle with resource allocation in resource limited and replete environments, a reflection of the inequality in both distribution and access to care.
Simple interventions can make a significant impact on health…should priorities allow – an issue that continues to be applicable across all oceans. We’ve made tremendous strides in the preventative care people across this planet receive since the 50’s and I’m optimistic we will continue to see significant improvement in the future.