How can Bangladesh invest in its health care professionals?
I was devastatingly saddened by the sudden demise of Niloufer Manzur, the founder and principal of Sunbeams School, our pioneering educationist. She reminds me of Plato -- the great ancient Greek philosopher, teacher, writer, speaker, and the most brilliant and intelligent of all the students and followers of Socrates.
May I humbly remind our readers that this is not an exercise contemplating comparison but merely citing contextual analog. Plato’s academy was the first organized school in the Western world, and his philosophy forms much of the foundations of the current Western liberal civilization.
Socrates had transformed Plato’s life and was his true mentor, guide, and philosopher, and believed that the only way to improve human intellect was through verbal rational debate. Socrates’s love of wisdom and philosophy was driven by and based on verbal discourse.
Suffice to say that we now know about Socrates because of the fact that his most ardent pupil Plato refined his reasoning, and added that the art of writing arguments down provides the freedom to plan and execute articulation with finesse.
Plato’s philosophical disagreement with his mentor on the use of written words in pedagogy opened the horizon for documentation of the works of his predecessors and through his writings, Socrates’s work became known. Had he not disagreed with Socrates and introduced the novel method of instruction in pedagogy, Socrates and his work may have been lost forever.
A comparable and contentious debate raging through the nascent post-liberation Bangladesh is carved in my vivid memory, as if it happened only yesterday, the younger and over-enthusiastic political leadership who had worked tirelessly for our freedom were homme d’armes, steeled in their resolve in destroying two important building blocks of strengthening the very core of our education system.
One was based on a misconception of elitism, and the other was, what I may describe at best, a tangled perspective in celebrating our affection for our language or at worst, a pretentious affection for our mother tongue for which we were the first nation to have bled and sacrificed life upholding its veneration in our national life.
The first one was the abolition of cadet colleges, and were it not for the subtle but firm intervention by some of the senior members of Bangabandhu’s cabinet and some of the senior defense personnel, Cadet College would have been a failed concept in our distant past.
The other contention was the abolition of English as a medium of instruction in any institution in the country. Because of the emotion associated with Bengali, it was relatively easier to push back the usefulness and demand for English as a medium.
This is where educationists like Niloufer Manzur stood steadfast against all attempts at demonizing English. I sincerely wish that there were many like her, pioneering a system of quality medical care in Bangladesh with intelligent and pragmatic investment in medical and allied education.
The need is felt more than ever now with the present coronavirus pandemic devastating the globe. Patients need good doctors. I keep on emphasizing that good doctors make the care of their patients their first concern.
They must be competent, keep their knowledge and skills up to date, establish and maintain good relationships with patients and colleagues. Good doctors are honest and trustworthy and act with integrity and within the law.
Good doctors treat each patient as an individual, work in partnership with patients, and respect their rights to privacy and dignity. I have also been advocating that the wealthy of the nation must actively and comprehensively partake in the development of quality health care in our own country.
Their probable inability to appreciate fully the very socio-economic concept of the health care of a nation perhaps leads to their disinterest in their participation. It is not unusual for the wealthy to ignore the existing medical care system as they tend to rely heavily on the availability of reasonably good quality health care in the neighbouring countries.
People wealthy or poor, have to perceive that there is a social gradient in health. In plain language, it means everyone below the very top level of wealth has worse health than those above them, the lower the position in the social hierarchy, the worse the health, and the shorter is the life expectancy. As the wealthy are at the top of that gradient they may feel reluctant to agonize so much over the existing medical care in our country.
However, the intricacy in health ensures our ensnarement to the nation irrespective of our social class, creed, and colour, each of us is part of the whole. This intricacy in itself is the overriding reason why the wealthy need active participation in developing and sustaining effective medical care as they would at some stage or other, in an emergency or in a pandemic, be it intentional or situational, become the most unwilling but nonetheless, helpless victim of the country’s health system.
At the pinnacle of the current pandemic, multiple such exigencies are being broadcast on a regular basis in Bangladesh. The self-interest of the moderately rich should make them concerned that their health is not as good as that of the very rich, and so on.
This should be incentive enough for the different socioeconomic groups within a wealthy community to make them concerned that their health lags behind their immediate and other higher strata in the chain.
Social scientists would argue and rightly so that socioeconomic inequalities in health arise from socioeconomic inequalities in society, a phenomenon extremely damaging to the very fabric of society, and cultivates a sense of social injustice and paucity of righteousness.
These adverse emotions may result in a fertile breeding ground for discontent and violence depending on the emotional intelligence of the people belonging to the lower socioeconomic strata, a fundamental feature of inequalities in society.
My polemical argument in favour of building clinical care units (hospitals) incorporating in-built training, and continued professional development of health care professionals (doctors, nurses, midwives, technicians, paramedics) is that human resources are the basic and the single most outstanding component of any quality medical care.
There is a huge scarcity of good quality health care professionals in Bangladesh. Any proposed new medical care venture must incorporate developing its own human resources simultaneously to building a new facility or enhancing the quality of an established one.
The coronavirus pandemic has, without mercy, exposed the truth and weakness of our clinical care -- especially our extreme vulnerability due to the fallacious quality of the care delivery.
It is now the most appropriate time to rethink the strategy and need for wealthy citizens and philanthropists of Bangladesh to forge ahead and step up the pioneering ventures associated with developing good health care facilities with high-quality human resources.
Dr Raqibul Mohammad Anwar is a Specialist Surgeon and Global Health Policy and Planning Expert, Retired Colonel, Royal Army Medical Corps, UK Armed Forces.