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| Year : 1984 | Volume
: 30
| Issue : 2 | Page : 65-8 |
White/might has rights : apartheid and health.
Kothari ML, Mehta LA
How to cite this article:
Kothari M L, Mehta L A. White/might has rights : apartheid and health. J Postgrad Med 1984;30:65 |
We are, world over, trapped in the tyranny of topsyturvy priorities. This unenviable state grips medicine too, so that our 5-star hospitals have patients who have money but no disease and the roadsides and the rural sides have patients who have disease/s but no money. There is an apart-hood that divides the rich from the poor. In Africa, this apart-hood divides the whites from the not-so-whites through the notorious apartheid meaning apart hood. This article is about Apartheid. and Health, as it is found in South Africa, in India and elsewhere.
South Africa represents the epitome of what a powerful parasitic minority can do to a helpless majority: Relentless exploitation of the able-bodied non-whites to the point of disabling them, coupled with an intelligently executed denial of family hood, food, sanitation, education and medical care to the whole non-white population. The wants of the whites are pampered; the needs of the non-whites are denied. The Carrellian[4] et Bronowskian[2] idea that while all humans are equal the whites are more equal in evolution and in The Ascent of Man,[2] has an unmistakable ring of arrogance that finds its brazen acme in South Africa.
Apartheid and Health[1] is a 1983 WHO publication comprising Part I Report of an International Conference held at Brazzaville, People's Republic of the Congo, 16-20 November 1981' and Part II The Health Implications of Racial Discrimination and Social Inequality: An Analytical Report to the Conference.' The 258 pages are a testimony to good printing, text and tables. Sleekly bound in soft, the `book' has a wealth of information and ideas useful for any country, and any system of medicine.
Watt,[8] the professor of international history, University of London, has succinctly defined apartheid: "Afrikaans word meaning `apartness' or segregation, applied since 1948 by the dominant Afrikaaner Nationalist Party in South Africa to policies governing relations between white and non-white (African, Indian, or mixed-race) inhabitants of South Africa. Apartheid implies the total separation of races socially, economically, and in the last resort territorially, but its full realization runs contrary to the economic need for a large labouring population in white inhabited areas and the refusal of whites to perform menial duties. In practice, therefore, it requires Africans living in urban areas as aliens of temporary residence, identifiable by passes, strictly limited in freedom and virtually without rights, e.g. subject to arbitrary arrest and imprisonment." The book under review amplifies the foregoing, drawing the reader's attention particularly to migrant labour, mining, and maldistribution of health, wealth, housing and food. The unprivileged black herded into neowastelands that cannot sustain him and family, must migrate for menial jobs and mining where, underpaid and overworked, he must fall victim to loneliness, illness, psychic and sexual aberrations, a syndrome that would equally afflict his parents, wife and children at home, may be, for different reasons. "A detailed recent assessment of the effects of migrant labour on the rural periphery of South Africa has pointed out that 'virtually every adult male in the Bantustans is faced with the contradiction that his absence is a condition of his family's survival. But his absence also undermines the conjugal stability from which his family derives its identity.' By the 1940s there was already a volume of well-developed anthropological literature drawing attention to the consequences of migrant labour for family life. Postponed and broken marriages and the distorted sex ratios were even then leading to high rates of illegitimacy. The lengthy absence of husbands and fathers created problems in the socialization of children, as well as high rates of marital breakdown, desertion and widowhood in the periphery. The preferential access to higher paid jobs for the younger men led to a breakdown in the authority of the elderly".[1] Mining-gold, diamond, metals-meant mining the able bodied of their good health and then dispatching them, off to the countryside as vectors of tuberculosis, malaria, syphilis, psychosis, and alcoholism. Maldistribution of nutritional resources can be gleaned from one glaring fact-while South Africa produces surplus calories per capita, "being one of the richest countries", a black child dies of malnutrition every 20 minutes. What is true of food is true of medical care-the white have heart transplants, the black have some token medical care. "For strangers to South Africa it is the symbolic notice, `Slegs vir Blankes' (`For Whites Only')-a manifestation of the overtly racist laws-which first catches the eye."[1] The whites have all the rights; the blacks, all the blights. In Chile, Argentina, and India, the situation is slightly different; the mighty, the well-to-do, the rich minority enjoy the medical best cum latest; the rest, the vaster majority, are denied elemental medical care. It is an aparthood that is as demeaning as it is in South Africa.
The aparthood on our home front may not seem obvious, but is as pervasive. The urbanization cum industrialization has begotten and sustained the migrant labour system-cities bursting beyond their seams with lonely, desperate, homeless males, and villages breaking down through fragmentation of families, neglect, and urban-biased exploitation of all natural resources. Diseases of the underprivileged-tuberculosis, leprosy, malaria, all water-borne and food-borne infestations-have by now assumed endemic form, an urban achievement that merits an analysis: The migrant labour force in the city so works and so lives that the microbial diseases naturally slated to disappear from among men, is made to linger on, nay, prosper. "Tuberculosis, a disease virtually unknown in South Africa in the period preceding industrial development, is today a condition which dominates the disease pattern among blacks in both town and countryside. Never in history has the social stratification of tuberculosis been as marked as it is today in South Africa, where Africans are about 80 times more at risk from this disease than whites."[1] What is true of South Africa is equally true of India, Egypt or Thailand. Mankind was coming to terms with the tuberculosis bacillus by 1875 by exhibiting increasing resistance which had peaked to the maximum by 1925. Then came industrialization et urbanization with all its attendent quality-of-life-destroying cascade of consequences. And thus we have tuberculosis to stay with us, and the ceaseless scramble for potent antituberculosis drugs and our impotent `Victory over Tuberculosis' campaigns. You move in Bombay, or Rajkot, and in the midst of the consumeristic splendor, the stench in the air fills up your nose, and chokes your alveoli. What price GNP? The consumeristic apartheid holds the wants of man as enjoying a state superior to the needs of man and the dictates of nature.
And, then, there is in our country and elsewhere fiscally-fostered medical apartheid, seen nowhere better than in the bastion of democracy and the Mecca of modern medicine-the USA. Those who can pay, are treated, those who cannot are connived at, elbowed out, or as a leading medical journal put it, "skimmed off." It. is significant that the motto of the AMA-the most powerful medical association in the world-is fee-for-service. USA has the distinction of rechristening medical profession as the Health-care Industry run by the Medical-Industrial Complex with the same ruthless efficiency as the Military-Industrial Complex. India has not lagged behind in importing this moneymaking spirit. The 5-star-hospitalsyndrome, pioneered by the Jaslok Hospital, is now gripping India like an epidemic. The common man, the general practitioner and the consultant have started equating the quality of medical care with the quantity of fees demanded. Such a monetary equation is satisfiable only by the elite of India-an utopian state for the miniscule against a state of despair, for the rest. In USA, it is better to die than be diseased. India is fast attaining that unenviable goal. The obsession Health for all by 2000 AD inevitably pushes our society towards creating more medical schools; more doctors, more ICCUs, more gadgets most of them imported, manufacturing more drugs and phobias, all these at the expense of a simple formula-edible bread and potable water for all by 2000 AD. Failing the latter practicable goal, all we shall achieve is Hell for all by 2000 AD. In the ultimate analysis, apartheid is the intelligent man's penchant for foisting the patently wrong as right, a trait born out of what Dante called, the use of reason to foster unreason.
The world-wide illusion that in the USA, the best bulwark against fiscal bankruptcy because of medical bills is provided by the Blue Cross, Blue Shield and the like is belied by the singular fact that over 20% of individual bankruptcies in America are caused by medical bills. Ubell[7] reviewing Starr's eye-opening book "The Social Transformation of American Medicine", concludes: "The contemporary message of Starr's book is clear and stark: the advent of corporations into medicine will undoubtedly further aggravate inequality in access to health care. 'Profit-making enterprises are not interested in treating those who can not pay ... the two-class (the apartheid that separates those who can pay from those who can not) in medical care is likely to become only more conspicuous'."
Thomas McKeown,[6] after surveying the global scene of medical practice and research came to the sobering, conclusion that the doctor's supreme role is to help/assist the three basic functions of birth, growing and dying. High-flaunted research to cure cancer/heart attack/diabetes, etc. has a la Burnet[3] as much relevance as a dust storm in a distant galaxy. The apartheid of pampering sophisticated medical research institutes and programmes at the cost of India's solvable problems lies at the root of whatever the mighty USA is experiencing, as detailed in "Doing Better and Feeling Worse: Health in the United States"[5] a Rockefeller Foundation publication. Medical profession, cure thyself of apartheid!
| 1. | "Apartheid and Health.": World Health Organization, Geneva, 1983.  |
| 2. | Bronowski, J.: "The Ascent of Man." British Broadcasting Corporation, London, 1973. |
| 3. | Burnet, M.: "Genes, Dreams and Realities." MTP, Bucks, 1971. |
| 4. | Carrel, A.: "Man, the Unknown." Maefadden Publications, New York, 19S1. |
| 5. | Knowles, J. H. (Ed.): "Doing Better and Feeling Worse: Health in the United States." W. W. Norton & Co., New York, 1977. |
| 6. | McKeown, T.: "The Role of Medicine: Dream, Mirage or Nemesis?" Nuffield Provincial Hospital Trust, London, 1976. |
| 7. | Ubell, R.: Book review: "The Social Transformation of American Medicine" by Starr, P., Harper and Row, 1983. In, Nature, 304: 667-668, 1983. |
| 8. | Watt, D. C.: Apartheid. In, "The Harper Dictionary of Modern Thought." (Ed. A. Bullock, and .O. Stallybrass). Harper and Row, New York, 1977, p. 30. |
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