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Sustainable Healthcare For Those Most Poor



Doctor, come quickly!” The nurse’s voice carried a tone of urgency that matched his message. I rose rapidly and entered the chilly night air. Moments later, in the children’s ward at Angola’s Kalukembe Hospital, I met a distraught father carrying Maria, his five-year old daughter. “She’s coughed for days,” he explained with distress. Still in his arms, I unwrapped the blanket surrounding his girl. But too late. She took her final gasps and fell limp.


Early death is an inconsolable fact of life. In the world’s poorest nations, like Angola from where I’m writing now, a quarter of children like Maria die before reaching school age, and adults can hardly expect to live much beyond age forty. Such disturbing truths motivate many healthcare professionals to do something bold on behalf of the world’s most disadvantaged people, whether in the safety net clinics of North America’s urban centers, or in the humblest healthcare posts dispersed throughout the developing world.


Despite enormous efforts, such healthcare initiatives are in danger of being swept away, threatening both the good intentions of providers and the last hopes of those like Maria’s father – swept away for lack of resources, chiefly the anchors of personnel and money necessary to support these upstanding efforts. A disturbing number of facilities serving the most poor have closed over the last decade, primarily in communities where they are most essential. A growing number of us ponder the vexing question, How can we assure sustainable healthcare for those who are most poor?


Some suggestions, like focused prevention efforts, are thoughtful and constructive, yet fail to address the most fundamental issue: poverty itself. If healthcare is so difficult to sustain for those who are most poor, why not direct our effort toward alleviating poverty? In his provocative book The End Of Poverty, Columbia University professor Jeffrey D. Sachs brilliantly illustrates how economic growth in the poorest nations – those where people live on less than one dollar per day – has brought with it unprecedented progress in physical health. In Bangladesh, for instance, per capita income has doubled since 1971, while life expectancy has increased from forty-four to sixty-two and infant mortality has fallen from fourteen percent to five percent. How does economic growth foster physical health? Through improvements in housing, nutrition, vector control, water and sanitation, general education, industrial safety, medical care, and incentives to reduce fertility.


Healthcare professionals must illuminate the importance of economic development, encouraging and collaborating whenever possible. As Dr. Sachs points out, increasing international trade, currency stabilization, debt forgiveness, and progress towards the Millennium Development Goals are imperative for the poorest nations to climb from their insufficiency. On a smaller scale, Heifer International is providing sustainable food and income for marginalized communities through animal husbandry. And here in distant Angola, innovative projects are underway to provide low-cost roofing materials to families who would otherwise have only thatch for protection from the heavy rains.


Professionals like you and I must be on duty when a father brings his sick daughter for our attention. But we must also be eager to champion those economic development efforts that would ultimately mitigate the chance of little Maria ever becoming ill: improvements in her nutrition, her education, her house, her water supply, and even the speed of transport that night she arrived just minutes too late.

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