Fe­lipe Noguera

"In life, health is the great­est wealth."While the re­cent con­tro­ver­sy which re­sult­ed in the change of lead­er­ship at the South West Re­gion­al Health Au­thor­i­ty re­flects some as­pects of the con­di­tion of the pub­lic health sec­tor in Trinidad and To­ba­go, in many ways it di­verts at­ten­tion from the ex­i­gency of pro­vid­ing qual­i­ty health care ser­vices to the peo­ple of the na­tion. The na­tion­al dis­cus­sion and de­bate on pub­lic health has not been en­gaged be­yond the in­dus­tri­al re­la­tions ten­sions be­tween med­ical pro­fes­sion­als and the Min­istry of Health or news re­ports of pre­ventable deaths from al­leged mal­prac­tice and im­prop­er use of phar­ma­ceu­ti­cals.

Unit­ed States Pres­i­dent Barack Oba­ma has staked the pres­tige of his pres­i­den­cy try­ing to re­form the health sec­tor of his coun­try which has been large­ly shaped by the in­ter­ests of the health in­sur­ance and phar­ma­ceu­ti­cal in­dus­tries. In the Caribbean and Trinidad and To­ba­go, the phi­los­o­phy of health care pro­vi­sion is large­ly con­ven­tion­al, 'Al­lo­path­ic' or West­ern. The prac­tice of health care de­liv­ery how­ev­er, is ex­treme­ly var­ied, ac­cord­ing to polls which in­di­cate up to 30 per cent of the pop­u­la­tion seek 'com­pli­men­ta­ry and in­te­gra­tive' health care so­lu­tions.

Chi­ro­prac­tors, body ad­justers, Home­o­path­ic and Ayuvedic doc­tors of­fer ser­vices to peo­ple in Trinidad and To­ba­go who seek health care out­side of the ­pub­lic health sys­tem ad­min­is­tered by the Min­istry of Health. Is reg­u­la­tion of com­pli­men­ta­ry and in­te­gra­tive health (cim) care-an­cient Chi­nese med­i­cine, in­clud­ing acupunc­ture, mas­sage, herbal and 'root­i­cal' treat­ments and en­er­getic heal­ing a new area for pol­i­cy con­sid­er­a­tion by the Min­istry of Health? To en­ter­tain the ques­tion would be to open to de­bate the is­sue of achiev­ing and keep­ing good health and hap­pi­ness in the pop­u­la­tion.

Once the door of pub­lic pol­i­cy dis­cus­sion is opened and rather than con­tro­ver­sy, peo­ple can fo­cus on the type of health care sys­tem they would like to see, a gen­uine na­tion­al con­sul­ta­tion on health can oc­cur and pro­duce worth­while re­sults. This must in­volve ed­u­cat­ing the pub­lic about how to pre­vent the spread of dis­ease, pro­vide cures for ex­ist­ing dis­eases and make the pop­u­la­tion hale and hearty.

Pro­mo­tion of well­ness, phys­i­cal ex­er­cise, nu­tri­tion, and hy­giene aware­ness, ed­u­ca­tion to pre­vent the spread of HIV and oth­er STDs and an­timi­cro­bial re­sis­tance con­scious­ness are all el­e­ments of a pub­lic aware­ness and com­mu­ni­ca­tions strat­e­gy nec­es­sary to pos­i­tive­ly trans­form the health ser­vice. To do so, to pre­vent the spread of 'su­per bugs' re­sis­tant to an­tibi­otics which will in­crease treat­ment costs, World Health Day 2011 has been ded­i­cat­ed to com­bat­ing drug re­sis­tance, in­sist­ing that no ac­tion to­day means no cure to­mor­row.

In­te­grat­ed med­i­cine, which at­tends to the pa­tients' body, mind and spir­it adds an­oth­er di­men­sion to the pub­lic health pol­i­cy de­bate in Trinidad and To­ba­go as the health con­di­tions of the poor must be ur­gent­ly ad­dressed. Doc­tors must be com­pas­sion­ate and con­sid­er­ate to­wards the poor, many of whom can­not af­ford cost­ly, pri­vate treat­ment. This means that pub­lic fa­cil­i­ties must be com­pa­ra­ble, or bet­ter than pri­vate since all our tax dol­lars pay for them.Must qual­i­ty health care be pri­vate­ly ad­min­is­tered? Can the mas­sive re­sources of the state al­ready in­vest­ed in the pub­lic health care sys­tem not be more ef­fi­cient­ly ad­min­is­tered to em­brace natur­o­path­ic health care providers as well? At the hemi­spher­ic lev­el, the Pan Amer­i­can Health Or­ga­ni­za­tion is fo­cused on in­fluen­za vac­ci­na­tion cam­paigns, the ef­fi­ca­cy of which in epi­demi­o­log­i­cal con­trol has been called in­creas­ing­ly in­to ques­tion.

The April 2011, Sur­veil­lance Re­port of the Caribbean Epi­demi­o­log­i­cal Cen­tre in­di­cates an in­crease in com­mu­ni­ca­ble dis­eases in the re­gion of dengue virus, mumps, in­fluen­za and oth­er res­pi­ra­to­ry dis­eases. The rise in vac­cine pro­duc­tion has been matched by po­lit­i­cal lob­by­ing to min­imise or es­cape li­a­bil­i­ty for the man­u­fac­ture and de­ploy­ment of in­creas­ing num­bers of vac­cines. This un­der­scores the ris­ing cor­po­rate mo­men­tum pre­dom­i­nat­ing over prop­er pub­lic health sci­ence and pop­u­la­tion best in­ter­est.This begs the ques­tion of the phi­los­o­phy and pri­or­i­ties for pub­lic health pol­i­cy that are be­ing for­mu­lat­ed and im­ple­ment­ed by the Peo­ples Part­ner­ship Gov­ern­ment. For the de­mo­c­ra­t­ic so­ci­ety of Trinidad and To­ba­go to make any mean­ing­ful con­tri­bu­tion to the health de­bate, the pop­u­la­tion needs sub­stan­tive in­for­ma­tion and analy­sis which will help them to act in ways that al­low us to im­prove our health as a so­ci­ety.

Apart from the many chal­lenges and ob­sta­cles we con­front on the road to be­com­ing a healthy na­tion, there are count­less peo­ple-both with­in and out­side the Min­istry of Health that are mak­ing a pos­i­tive dif­fer­ence. Doc­tors, nurs­es, tra­di­tion­al heal­ers all need two in­gre­di­ents for suc­cess in cul­ti­vat­ing health. These are the co­op­er­a­tion of the pa­tient and the pop­u­la­tion be­fore they be­come pa­tients and the grace of God, with­out which there is nei­ther life nor health.

On East­er Sun­day a world spir­i­tu­al leader and teacher, who mil­lions recog­nise as an Avatar, Sri Sathya Sai Ba­ba left the mor­tal coil. His pass­ing is of rel­e­vance as we con­sid­er how to ex­pand the par­a­digm of pub­lic health in Trinidad and To­ba­go. This is be­cause Sai Ba­ba not on­ly built uni­ver­si­ties and slaked the thirst of mil­lions in Chen­nai, In­dia, who on­ly a few years ago were threat­ened by ty­phoid for lack of clean wa­ter. He al­so built hos­pi­tals as pure tem­ples of heal­ing, which com­bine both con­ven­tion­al West­ern and tra­di­tion­al Ayurvedic ap­proach­es to med­i­cine. The ser­vices of these are of­fered with no charge to the re­cip­i­ents.Ba­ba brought qual­i­ty health care to the poor, putting them at the cen­tre of health and heal­ing. That is an ex­am­ple we can all fol­low. So we close this evening with Sai Ba­ba's most fa­mous words to ex­pand the health par­a­digm-"Love all, serve all," and "help ever, hurt nev­er".