Rapid Responses to:

EDITORIALS: Ellen Verheul and Mike Rowson Poverty reduction strategy papers BMJ 2001; 323: 120-121 [Full text]

Rapid Responses: Submit a response to this article

Rapid Responses published:

Palliating Poverty: A global malignancy

Rakesh Biswas   (22 August 2001)

Palliating Poverty: A global malignancy 22 August 2001
Rakesh Biswas, Lecturer,Medicine Manipal teaching hospital,Pokhara,Nepal Send response to journal: Re: Palliating Poverty: A global malignancy	Poverty was a young boy of four who met me in the streets of a busy city in India begging for money. I, too nearly the same age, peered at him once and then took a guilty look at my ice cream, all from the security of my parent’s feathers. Many years have passed hence and I learnt the trick of gulping ice creams in my own world without batting an eyelid while a million such children of an impoverished nation looked on with eyes, gleaming desire. In my medical career poverty has been a constant observer jeering at me from the seats of an otherwise empty stadium. In a country without an NHS, I had to see young people without financial prospects of renal transplant dying in front of our eyes because the hospital policies throughout premier institutes of India dictated dialysis only for those with transplant prospects. The rest were to be sent outside for dialysis and not all were able to afford it. Some did try to arrange finances by selling off their property. Later when the end came they realized they were left only with the satisfaction of having tried. After coming to a more remote hospital, in Nepal, I was introduced to a different kind of poverty, that of information and expression. It has been curbed partly by web sites like that of BMJ which promise to turn the information desert into a garden. It is also apt that the same editors have addressed the important phenomenon of poverty that is so very much a part of our lives. In my voyage through developing (a terminology coined by the developed) countries a few glimpses of human behavior pointed to a very alarming trend of events, which may have accounted for the birth of this social evil. Imagine a trek to a place that is completely cut off from civilization. Lush green forests amidst steep mountains, a self-sustaining economy that grows only as much necessary for their own consumption. It is a life of hardships, no doubt with all the lugging water daily, the work in the fields and cutting grass for the single cow in the family. The out- door defecation, the abominable access to health care, the nearest center being a two- three day trek with the victim/patient on one’s shoulder. For an outside observer it may be a ridiculous existence, so much so that his heart reaches out to embrace these unfortunate people and he attempts to reform them. Suddenly a person who was happy tilling his land for his bare necessities realizes how POOR he is. There are so many goodies waiting for him out there in a world full of city lights attempting to shut out the dark ages once and for all. That was the birth of poverty, which stems from desire, which is most often relative. Even famines have been shown to be man made mostly due to maldistribution of food by people who start hoarding grain in the fear that they have to protect their own in difficult times. It is a peculiar perception of wealth as having what most of us desire to have, which gives rise to poverty. We continue to coin abusive terms, developing world, socially disadvantaged, little realizing that it was our development, which resulted in their relative poverty. We… who do not reside in a remote village cut off from a world that we term civilized are victims as well as perpetrators of poverty. A civilized world…which is soon engulfing the last such village and the last man to get afflicted by this disease of the new world might as well better start counting his days. (1-2) In these remote villages we have education, which unlike ours teaches wisdom. It teaches us to gather and grow food and to cook it if necessary. It teaches us to live harmoniously with nature and not plunder it to the hilt, a glowering testimony of which today, is our cities we proudly display. Concrete jungles of human misery, a coexistence of the rich in high rises and others in slums…people who couldn’t make it to the top. This is development and we want the developing world to reach similar status. These villages have a system of health care where witch doctors attempt to scare diseases by their various antics. Sometimes it works in various illnesses but if not, death is an equally viable option. Their health care system helps them to embrace death with dignity and equanimity. If by chance some of them reach the world of our hospital, which lies across steep-mountain passes they are subjected to a lot of investigations that rapidly drain their resources until they are forced to hold on to their last penny to trek back to their village. We were only trying to help, we wonder, how much more can we do for them. The students in this hospital have opened a Poor patients fund. It is one of the best things to have happened here and for this everyone, doctors and patients alike are grateful. We realize this fund is mainly for the treatment of a global cancer of poverty, which has engulfed all of us cut off from that remote village. A village, which we hope still exists, somewhere replete with lush green forests and inaccessible mountain passes warding off people…who cut forests to build roads and lay the foundation for a gradual infiltration…of more people from our world which is already struck by the disease. A disease…born in our patronizing outlook, that gave us the license to meddle with the affairs, of the first self-sufficient village our predecessors destroyed with their reformist attitude. Whether the treatment we can achieve will be at best a palliation or Poverty reduction strategy papers shall deliver the wonder cure, only time will tell. Acknowledgements: 1) To that man of a remotely accessible village in Nepal who still survives inspite of all odds. 2) To some of my medical students who were there till 16 years of age without having seen a bus or a paved road but did see an aero plane and a run down air strip, who could come here as they had access to a Western education, who told me about their village and who will carry the West with them back to their village for better of for worse only time can tell but I wish them all the best. References: 1) Biswas R, Hep B story, http://www.meditune.com/articles/medicine/hepb.html 2) Biswas R, Evolution of life and disease a viral perspective- 2, (http://www.healthobserver.net/pages/leisure.html