Notes for a Manifesto: Health, the most precious gain

One  of the most quoted references of Gautama Buddha’s teachings on well-being  is the 204th verse of the Dhammapada, contained in the Sukhavagga or the  Discourses on Happiness:

Arōgā paramā lābhā
san tutthi paramam dhanan
vis āsa paramā nāthi
Nibbānan paramam sukhan
Acharya  Buddharakkitha

translates it as follows: “Health is the most precious  gain and contentment the greatest wealth; a trustworthy person is the  best kinsman and Nibbana the highest bliss.”

Health,  contentment, kin and Nibbana can each be elaborated, but this is no  thesis on Buddhism. What we need to draw is the importance of good  health as being a condition that surpasses all else in terms of the  tangibles one can obtain in life. A  healthy nation can therefore be considered a kind of bedrock for all  other improvements. Obtaining it is not easy. It is not that our leaders  have been oblivious to the subject of health. For decades we’ve trotted  out laudable numbers pertaining to importance indicators of good  health, mostly flowing from an excellent public health system  complemented by equally excellent awareness programs.  

The  question that’s often being asked is whether it is sustainable. In other  words, there are doubts that a country with an economy such as ours can  afford to subsidize to the extent it does

The  question that’s often being asked is whether it is sustainable. In other  words, there are doubts that a country with an economy such as ours can  afford to subsidize to the extent it does. Perhaps it is not about  blanket subsidies but intelligent support from the state. The  discussion on the sector in recent times have been caricatured into a  private vs public debate. Within it, there’s mention of a national  policy on drugs, price formulas for private hospitals and of course the  controversy over private medical schools. 

In  all this, there has been a concerted effort to dub the Government  Medical Officers’ Association (GMOA) as the villain of the piece.  They,  unlike other professionals, are not supposed to have grievances. They  earn enough, we are told (as though only those who earn less than some  magical figure have grievances and therefore have the privilege to  protest). That vilification extends to the services provided. State  hospitals are not plush entities like private hospitals, it is lamented.  There is over-crowding and a general unkempt appearance (which does not  mean it’s unhygienic, note). 

In  all this, there’s a lot missing. Nothing about the fact that hospitals  are understaffed in almost all categories, that those who have to work  do the work of several (unlike in private hospitals), that even today  the state hospitals provide the best services across the board (a  hospital is not a resort hotel, note) and offer the kind of medical  surveillance a private hospital just does not.  It  must be noted that there are excellently maintained state facilities in  certain parts of the country, which clearly says that meagre though the  resources may be, they can be intelligently used.  And  yet, any medical mishap in any state hospital is inflated in the media  whereas negligence in private hospitals is swept under the carpet (if  indeed it is even known!). 

That  said, the solution is not to have a policy of destroying one or the  other, but to figure out a system where anyone has access to medical  care that is affordable. Insurance has been offered as a solution, but  the system introduced recently for school children essentially gets the  tax-payer to fatten insurance companies and private hospitals. 

As  mentioned, it is not about the services but also about the drugs. Here  too there is the public vs private matter being debated. Drug companies  are villains, some say. The State Pharmaceuticals Corporation just can’t  deliver, others say. The default option so far has been to let  multinational pharmaceutical companies to do as they please. There is  very little talk about private-public partnerships or supporting the  development of a local pharmaceutical industry. 

Time  was when regular work in the household and community provided all the  exercise necessary. That community and that household has been all but  destroyed. Now we have walkways, gymnasiums, spas and expensive  hospitals. Somewhere,  somehow, the basics seem to have been forgotten. For example, the  General Practitioner is almost a dying breed. Patients have taken over  that role. If one has seen a skin specialist, then one is qualified to  recommend that specialist to someone suffering the same or similar  ailment. Where’s the debate on nutrition? Where’s the debate on  preventive measures? Where’s community medicine? Where’s awareness  creation?  Where’s the debate on enabling environments?  Why are these not part of the overall discourse on development?  

As mentioned, it is not about the services but also about the drugs. Here  too there is the public vs private matter being debated. Drug companies  are villains, some say

Development  has destroyed a lot of things. When forests go, so do a vast treasury  of genes that has the potential to cure. A culture of untrammelled  consumption of which junk food and all kinds of unhealthy substances are  touted as being essential parts of ‘the good life’ have severely  compromised the general health of the population. Remember that all this  was attended by a deliberate and concerted vilification of all things  indigenous — foods, medicine and medical practices included. Indigenous  medical practitioners and practices are vilified as indulgence in  mumbo-jumbo, but faith-healers protected in the name of religious  freedom.  

Let’s  leave Nibbana aside. ‘Contentment’ has been codified in terms of  material things. There are no kin; there are only partners in all kinds  of profit-making operations. Can we truly say that ‘health’ in Sri Lanka  is thought of as the most precious gain?  If not, why not? 

Over  to you, M/s Nagananda Kodituwakku, Rohan Pallewatte, Gotabhaya  Rajapaksa, Patali Champika Ranawaka, Ranil Wickremesinghe, Maithripala  Sirisena and any other individual entertaining hopes of becoming the  next President of Sri Lanka.

Author is a political analyst and freelance writer can be contacted on [email protected]. or by visiting www.malindwords.blogspot.com