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Do we have the will to make poverty history?

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By Dr. B. M. Hegde, India [ Published Date: July 16, 2010 ]

"We, who have so much, must do more to help those in need. And most of all, we must live simply, so that others may simply live." -- Ed Begley, Jr.

This week the British Medical Journal’s main editorial is on poverty and diseases. I am excited as it is for the first time that a main line western journal admits that poverty is at the root of all our ills in society-illness, ignorance, illiteracy, precocious mortality, crime and what have you. I have been writing to let the world know that the poor pay for their poverty with their lives to convince the powers that be all over the world for them to see the naked truth. Who cares? Some of my writings have even been published in the same British Medical Journal. Now that the establishment has admitted that poverty is the cause of all ills, I thought it fit to write the following response.  In fact, one of the contributors, a previous editor of the BMJ, Professor Richard Smith, himself wrote in his blog in the journal that recently he has  learnt about this naked truth after he started working with poor country medical systems. He had given a  list of ten lessons that he had  learnt. I have added one more lesson that probably is at the root of all our misdemeanors in all areas of human endeavour.

We have lost our sense of proportion in patient care, both in the rich and the poor countries, thanks to the claptrap around disease care which, in addition to adding tons of money to the kitties of the different stake holders in the business, has caught the imagination of the common man, thanks to the media, both print and electronic. The latter are heavily influenced (lured) by the industry to spread the false message as far and wide as is possible. One can not practise sensible clinical medicine, which has been shown to be 100% perfect by triple blind controlled studies using even the PET scan, as every patient thinks that there is a pill or surgery for every ill. Little do they realise that there certainly is waiting an ill following every pill; in the case of some pain killers it could hit one even after a gap of five years!

In my own experience even the poorest Indian patient demands expensive unnecessary investigations before you advice him/her! The defensive medicine practiced in the US has found its way to many poor countries through the media and everyone thinks that a transplant surgery can make any non functioning organ come back to life again and keep one here forever! They have not heeded the advice of George Bernard Shaw when he wrote in his Doctors Dilemma that one should not try to live here forever as one would not succeed. We only medicalised death; just as we have tried to medicalise the whole population through mass screening methods. 90% of the US hospital incomes come from trying to keep the dying (half dead) patients alive during the last ten days of their lives in the ICU’s. Today’s ICUs are just one way thoroughfares to heaven. Reminds me of the "hospitalism" in the nineteenth century England where a patient went to hospital  en route to heaven or hell, as the case may be, never to go back home alive.

Properly screened every one becomes a patient as we only have a statistical definition of normality. Disease mongering is a fashion these days. How can we make medicine cheaper if we continue to follow the present disease care system? Our only hope is to popularize the "wellness concept" that I had put forward years ago. Each human being could hope to remain healthy as long as one lives if only one could keep the immune guard at its best. There are hurdles on the way but we have to devise ways and means to do just that at a very small fraction of the present disease care cost. We need to popularize my idea of health expectancy in place of the conventional life expectancy. I defined health expectancy as the number of years a new born child could hope to live without the help of medicines and doctors. My hunch is that health expectancy is the longest in rural India where there are even centenarians who have never seen a doctor or a hospital.

Richard, may I humbly submit an eleventh lesson, please? At the root of our problem is our exclusive educational system right from day one in school. Most doctors come from those strata of society, even in poorer countries, which are relatively affluent for that society. Thus educated in high end schools and colleges and then trained in five star type of teaching hospitals where the poorest of the poor who bear the brunt of illnesses are rarely seen. Even when they are there the students, far removed from the reality of the depth of poverty in their own backyard, find it hard to empathise with such hapless poor patients, leave alone trying to understand their true malady! Such students are not even comfortable communicating with the poorest of the poor as they are not used to that experience.

Professor William Deresiewicz, from Yale University, in his paper on the disadvantages of elite education has this to say: "The first disadvantage of an elite education, as I learned in my kitchen that day, is that it makes you incapable of talking to people who aren’t like you. Elite schools pride themselves on their diversity, but that diversity is almost entirely a matter of ethnicity and race."

Unfortunately, poverty is increasing by leaps and bounds as seen in this recent UNPD report for India which is now considered a rich enough country if one went by the number of billionaires, thanks to our skewed economic policies of globalisation.  "An analysis by MPI creators reveals that there are more 'MPI poor' people in eight Indian states (421 million in Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Orissa, Rajasthan, Uttar Pradesh, and West Bengal) than in the 26 poorest African countries combined (410 million).The new poverty measure that gives a multidimensional picture of people living in poverty, and is expected to help target development resources more effectively." This is the recent UNDP report.

Therefore, my eleventh lesson is the need to first deschool medical students and make them comfortable talking and understanding their unequals. Then as a second step we need to deschool society about the false propaganda that only the five star modern medicine could keep them alive for ever and that every ill does not necessarily have a pill or surgery to fix it. God save mankind!

" Wealth and poverty: the one is the parent of luxury and indolence, and the other of meanness and viciousness, and both of discontent " --  Plato.

Dr. B. M. Hegde MD, FRCP, FRCPE, FRCPG, FRCPI, FACC, FAMS, is editor-in-chief of The Journal of the Science of Healing Outcomes; chairman, State Health Society’s Expert Committee, Govt. of Bihar, India, Visiting Prof. Cardiology at The Middlesex Hospital Medical School - University of London, Affiliate Prof. of Human Health - Northern Colorado University, Visiting Prof. Indian Institute of Advanced Studies - Shimla,  Retd.  Vice Chancellor, MAHE University - Manipal. Prof Hedge regularly gives talks on AIR, Doordarshan, BBC and Zee TV, London. 

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Roshan, Qatar:
Dear sir
This Article is so nice for the New Generation & it is so Reality of the life.
i like it and i will expect form your side keep more achievemnt.............
G.N.Bangera, Oman:
If people like Warren Buffet & Bill Gate charity done by the rich there will be health for poor, this people need little care from best health care system after 63 years of freedom look at our people with rag shunty naked please do help our innocent human of MAHA BHARATH GREAT INDIA good house school road clean water little food please bring smile on the face of poor
A.S.Mathew, USA :
Mr. K. Shenoy: you are a great person to
mention that you had to undergo suffering in the early part of life. " Greatness of a person is based on his meekness" Richard Nixon. Only the meet at heart will remember their old days of suffering, and also appreciate greatly their blessings of life.

Andrew Carnegie, who was a billionaire
(there were only five billionaries in the world at that time, including the Nizam of Hyderabad) had to suffer poverty in his younger days, and he said " poverty in early part of life is an indirect blessing of life".

We can appreciate life more while passing through the valley experience of life and easily relate the pain of other suffering people.

Carnegie Hall, Carnegie Mellon Univeristy, and several Universities in the U.S. were part of his generous heart of giving.
SHENOY R, India :
watch that movie 'life stinks' by mel brooks.-K Shenoy

I will try to get the DVD and see it.

There was one more movie based on true life story starring Will Smith about a man who made himself against all the odds. That story appeared in Reader's digest as well. I forgot the title. It is about an American black who goes through severe difficulties including going to prison.

I notice that you have mentioned about some difficult times in your own life. I hope you will not have any bitterness about that. One needs to make the most of what the life offers. It is the ability to over come the challenges and adversity that matters at the end. I remember the movie 'Gharonda' where Dr Sriram Lagoo tells Amol Palekar' meine bhi garibi dekhi hai lekin mein garibi ka medal lagaa ke nahin ghoomtaa'. I guess that has some powerful message. I must congratulate you on your frankness and honesty on this forum. Definitely I would consider it a privilege to sit with you some time and have a cup of tea, God willing.
K Shenoy, India :

while i salute you for your excellent article touching the most sensitive subject that today's india is facing, may i appeal to you and all other wealthy people to channelise some part of your wealth and look after the needy in terms of food shelter and education?

may be you are already doing that, but let's not have that guilt sitting in big bungalows and driving big limousines while we speak about poverty.

shenoy maam, watch that movie 'life stinks' by mel brooks. it's easy to dream or feel sad sitting at home, but it is real hell when we face life like that.

i have had a taste of it for some time in my early life.
elias, India :
Good artcle by Dr. hegde. Now we can see India ito 4 parts. One is north India minus Delhi, Hariyana and panjab. Second North east. Third Western India e.i Gujarath and Maharastra. fourth the south India. Northeastern staes are well educated. They see INDIA is a different country. North India mostly Hindi belt eight states little bother about education. Those who are illiterate get their children marry before the age of 22. If they do not get maried by that age fellow people think that there is some physical deficiency. Hence they get marry fast and have children so the populations triples in 60 years in these mentioned states. In western Maharasthra and south India people give more attention to education and they get married latter say age of 28 the population by this redusued by 1/3rd compare to north hindi belt. HENCE EDUCATION ONLY way to REDUCE THIS POVERTY.
A.S.Mathew, USA :
Dr. Hegde, you have revealed a spiritual lesson and a dire call to get involved with the crying masses of India.

As you have stated, majority of the Doctors are coming from affluent families, and they don't know the pain of hunger and lack in life. So, most of them are totally alien to compassion and empathy.

If every individual will take a course of action to be content with less
material things of the world, and share
their abundance with the suffering people across the street, that can wipe away the tears of the hungry and sick human beings.

We are faced with this worldwide economic crisis due to excessive greed. While the Wall street players blow $ 150.00 or more for a lunch, they can see people across the street searching food in the street to get something from the strangers. We may have a tendency to judge them as
lazy and hopeless people, but perhaps majority of them might are ended up there due to many other reasons.

When I got a chance to participate in a medical camp at a Delhi slum, I could feel the reality of pain and sickness. It has competely transformed my life. How many
blindness could have been averted, had we given vitamin A to the children?

Dr. Hegde, thank you for writing this
touching article.

Mr. Shenoy R: Your narration of the story in Mayura is still the routine of life, and that was a very touching challenge and inspiration. Thank you for that illustration.

Readers, please don't misunderstand me
as self-righteous. I have seen that many poor people come to attend marriages and picking up food waste when they are thrown out. Dogs and human beings will fight for the waste, and it broke my heart.

When I got married 36 years back, my family didn't allow anybody to touch the waste food, but put them inside the marriage hall and I myself served the food to them, until they were fully satisfied. Also, gave them food
to take home. That act of compassion gave me more joy than visiting any sacred place in the world. If we don't have compassion for the human beings created in our own image, our prayers and worships are fruitless
and void before the Creator. Let us show compassion to the crying world of human beings.
SHENOY R, India :
Thanks for this very thought provoking article Prof Hegde. Poverty indeed is the biggest illness.

I remember reading a story in Mayura at least 3 decades ago. A poor street urchin is happy because a rich man's daughter is getting married. Why? He thinks that he will get some nice wholesome lunch that day including laddoo. He waits outside the wedding hall compund hopeful that some kind soul will take notice and offer lunch. But no. Time goes by. All the big ups and their satellites come flashing their sarees, gold, smiles and eating a little from their plates and leaving the rest. [Undu jaasti tinniyera aapunde?] This poor man is eyeing all that. The security guard asks him not to stand there. He suggests go away and come back when the function is over and the guests leave. Even after waiting till evening he does not get any thing. He goes back hungry only to meet a fellow street character who gives him a piece of dosa he has in his hand.
I have only given the essence of the story and the complete story and narration had really touched my heart. I felt uneasy and sad after reading that. Truth hits harder than any thing else in this world. You have spoken the most important truth in your write up Prof.
Kadengodlu Shankara Bhat, Kazakhstan:
I liked this master-piece very much.
Thanks to Dr. BM Hegde &
It's an eye opener both for the elite in India & in developed countries.
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