Papua New Guinea’s Health Minister has flown recently to Cuba to seek assistance from the Government of Cuba. There are many Papua New Guineans who pray that the Cubans will come and heal their sorrows. And indeed the clinical practice of these doctors will be of great value to the people.
But what many do not know is that Cuban doctors and Cuban Healthcare is driven by ideology. It is a social contract between the people and their government. And it is upon that relationship between State and Society that the Social Medicine is practiced.
The concept of Social Medicine stems from this maxim of a late 19th Century German Physician Rudolf Virchow. Virchow said:
“Do we not always find the diseases of the populace traceable to defects in society”?
Virchow saw the obvious disparities in health between the classes of 19th Century Europe and conceptualized the relationships between societal existence and Health. His views were shared by another physician later in the 20th Century.
Ernesto Che Guevara was an Argentine physician who later on became a leader of the Cuban Revolution. As a young Medical Student, Che travelled between 1950 and 1951 throughout South America and became radicalized by the social injustice that was prevalent throughout the continent. Also known as El Che, this physician, author, intellectual, diplomat and military theorist believed that politics was a form of Medical Practice. Echoing Virchow, Che said:
“[T]he revolution’s task—the task of training and nourishing the children, the task of educating the army, the task the lands of the old absentee landlords among those who sweated every day on that same land without reaping greatest work of social medicine that has been done in Cuba.”
Exciting opportunities present themselves, with the prospect of the arrival of Cuban doctors on Papua New Guinea soil. Indeed, the nation has been looking the wrong direction all throughout its short history when many solutions to our problems lie in the South American continent.
In terms of Healthcare, there has to be a shift towards Social Medicine. Communities need a greater say and participation in the delivery of Health Services.
The Model of Medical Education; although Clinically-Sound, is based upon training of doctors for a Western Health-care system that does not exist in this nation.
Doctors are not trained to function with-in this health system so they get frustrated over the lack of support they receive to practice Medicine.
Indeed, Medical training is heavily focused on Medical Sciences and Clinical medicine, which is fine, but that is based on the assumption that the other determinants of Health will be catered for by someone. For example, a medical student in Australia does not have to worry so much about the politics and administration of Healthcare because the systems in place take care of that and support the work of that student when he/she becomes a clinician. In Papua New Guinea, politics is very relevant to a medical student along with anthropology and sociology because these factors play a significant role in either facilitating or impeding the work of a doctor.
The work of many doctors is interfered with by factors such as politics, crime, administrative incompetence, society’s attitudes towards illness, and the lack of other enabling mechanisms such as equipment and infrastructure. In Medical School, students are not taught to manage these complex issues or very little time is allocated. The result is that failures elsewhere are unfairly judged by the community as ‘clinical incompetence’ of a doctor.
Medical Education in Papua New Guinea is supported by Australian International Development Assistance (AusAID). The models for the Problem-Based-Learning (PBL) form of medical education are thus imported from Australia. What this means is that the country produces good doctors who can work in Australia but will have difficulty handling the needs of Social Medicine in PNG.
The influence of organizations such as AusAID and World Bank has thus been very detrimental to Healthcare in Papua New Guinea.
A recent report by the Ministerial Task force on Maternal Mortality found that user fees charged by hospitals were a deterrent to pregnant women seeking medical assistance. This user pay system was introduced as part of the World Bank initiated, Structural Adjustment Program.
The Cuban Health system does not depend on AusAID or the World Bank and is indeed better than the American Health system. In bringing in the Cuban doctors, we should also be asking ourselves why the Cuban Health System is on par or even better than most developed countries. And in doing so, reform the Health system accordingly.
What aspects of Social Medicine are applicable to Papua New Guinea? What is the most appropriate model of medical education and by the same token, what is the right model of development for Papua New Guinea? The answers to these questions lie in the Americas.