Reason and Instinct

I am a firm believer in the need to personalise issues such as education and health care. Unless we can see the effects of our decisions, unless we can put ourselves in a position where we share the burden of their costs and the value of their rewards, we are far too susceptible to error.

There is, however, a tension between the moral weight of our decisions and their practical implementation. Simply stated, public medicine is costly, time-consuming and requires significant planning and coordination. Vanuatu as a nation has fared poorly in meeting any of these challenges. Money is limited, skilled professionals are thin on the ground and coordination even inside a single hospital is often the result of improvisation, not planning.

[Originally published in the Vanuatu Daily Post’s Weekender Edition.]

Public health is a human rights issue. Medical services, though, are ultimately ruled by economics. The tension between the two will never be resolved. It will, however, shape our future in ways that are impossible to measure.

This morning over coffee, I received news that the 15 year old daughter of a friend had passed away. She’d been ill for over a month, but a full diagnosis was never made. All anyone knew was that her head ached terribly.

Within an hour of hearing this, I learned of the untimely death of Ture Kailo, MP for TAFEA Outer Islands.

Ture was well known in Vanuatu. During his tenure as DG of the Ministry of Youth Development and Training, he was a consistent champion of youth issues and a friend to many local NGOs. Many took heart when, after his politically motivated ouster from the Ministry, he announced his candidacy for national office. Everyone I spoke to expressed deep regret at his passing, noting that Vanuatu politics has suffered a real and measurable loss.

Cases like these often define the debate over national health care policy. The loss of prominent individuals like Kailo demonstrate in unambiguous terms just how much we stand to lose when we lose a single life.

But what of my friend’s young daughter? The magnitude of her mother’s loss is of course immeasurable. And who can tell what she might have achieved?

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Something I find truly galling in Port Vila is seeing chronic, preventable conditions exacerbating the larger health threats and creating a largely un-measured drag on the national economy. The number of people suffering from boils, skin ulcers and other opportunistic infections is startlingly high. When I visit my adoptive family during the warmer months, inevitably at least one of them is so afflicted. More often than not though, most of them are.

The fevers, pain and loss of sleep brought on by these have cost more than a few days lost to illness. But equally important is their impact on the quality of life.

These afflictions are largely unheard of among those who don’t wander much into Vila’s residential neighbourhoods. That’s because they don’t have to cope with lack of sanitation, dirt floors, mud, overcrowding, inadequate or non-existent drainage, lack of proper screens and countless other shortcomings that the average resident copes with daily.

A note for online readers: As I write this, I am recovering from a systemic fungus infection that covered my entire body with a damnably itchy red rash severe enough that my physician spontaneously exclaimed in surprise when he saw it. Pockets lighter by over twelve thousand vatu (about USD 120), I am now burdened with three different medications and six more weeks of treatment before I have any assurance it won’t recur. My friend Ruth informs me that her entire community is rife with the same condition. I do not, however, have enough money to treat even one of them. They’ll have to content themselves with rubbing their bodies down with bush limes, not a pleasant undertaking, to say the least.

At the same time, my brother’s daughter (and my namesake) has only just recovered from a nasty infestation of boils all over her forehead. I can’t describe the poor child’s misery. Her father has been kept from work for over a week now with one of these nasty putrescences in his armpit. It’s so painful that he’s been walking around with his hand permanently poised against his hip like a lawn jockey. The elderly man he’s hired to look after the family kava bar has one foot rendered nearly useless by chronic infection, and his eldest boy has a permanently misshapen thigh bone, fractured by a subcutaneous abscess that was never properly diagnosed or treated.

The list goes on.

Remediating problems like these is not simply a medical issue. The causes are environmental and infrastructural in nature. There is currently little awareness – and no comprehensive statistical measurement – of the extent of the damage to society by afflictions that are simply not tolerated in developed areas. I say ‘areas’ because such problems are utterly unknown in the wealthier parts of town.

So now you know what motivated me to write the following in this week’s Weekender edition of the Vanuatu Daily Post….

Let any man who thinks humanity resides at the apex of evolution come and live in the tropics for a year or two. It won’t take long for him to realise that in warmer countries, the average human being is nothing more than an elaborately conceived buffet for a multitude of creatures too small to see.

God may love all creatures great and small, but sometimes I’m tempted to believe he likes the small ones better. I could recite a laundry list of different little creatures I’ve played host to in my years here. From tiny viruses, bacteria and single-celled plasmids to fungi and molds on up the chain to mites, ticks and worms, insects without number… I give myself the willies just thinking about them.

I suspect it’s no accident that ‘paradise’ and ‘parasite’ are so easy to mix up on the page.

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A Strong Foundation

The cost to the national economy of abysmally poor housing conditions in Port Vila and Santo is quite literally immeasurable. We simply have no means to determine how many school days are missed by students due to health issues, how many work days lost by their parents, how many futures wasted. Employers suffer too, of course, as yet another source of inefficiency compounds itself with all the other factors to create friction in Vanuatu’s economic machinery.

[Originally published in the Vanuatu Daily Post’s Weekender Edition.]

I’m often asked for rental advice by visiting volunteers and consultants. My default response is to say, “Before you decide on a place, look around you.” With only one or two notable exceptions, relatively rich expat housing developments are surrounded by jerry-built shacks constructed of cast-off lumber and a few sheets of corrugated metal.

Housing in Vanuatu

Experience shows that more break-ins happen in places where the greatest disparities exist between expatriate and ni-Vanuatu housing conditions. But the problem of inadequate housing runs much deeper than that.

The majority of houses in Port Vila and Santo have dirt floors. This is not just a cosmetic problem. Scabies, lice, boils, fungal and bacterial infections resulting in ulcerated sores are all commonplace among children in our municipalities. More common, in fact, than they are in our villages.

In Vanuatu, you have to live with the rich to be poor.

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