vrijdag 7 maart 2014

Health as an Asset in Edinburgh

The Royal College of Surgery is located in the center of Edinburgh behind the pillars of a Roman temple.

Once you enter the building you witness a transformation from the South to the North of Europe, from two millennia ago to about the last century.
The corridors, the library and the museum breathed classical Scottish grandeur, custodied by impressing portraits of surgeons everywhere at the walls of the building. 

There could be a similarity between Roman emperors and surgeons although we must admit that the president of the Royal College didn't seem to fit in with this prototype.
He was not corpulent, not arrogant, polite and he entered a discussion about general practitioners without contempt.

When it was said that the representative of the American Medical Association had pointed out that relational skills and compassion of medical students impaired during their education, he even agreed that something had to change in the Faculties of Medicine.

Perhaps he was overwhelmed by the aim of the international conference on "Health Decision Making" and the journey it succeeded from New Brunswick to Paris, Glasgow, Sharjah and now Edinburgh.
Hospital managers, healthcare politicians, scientists, information specialists and drug company executives from all over the world had gathered in the perspective of seeking for innovation and development of healthcare worldwide : looking for Blue Ocean…

When the initiative started with the emphasis on Advanced Healthcare Decision-Making and its impact, focus had recently moved to a mission centered around the concept "Health as an Asset"
One could consider to what purpose the asset had to serve and whether there was a possibility to measure the value.
From the point of view of one who wants to commit suicide or has taken the decision for euthanasia, value was rather negative so it became clear that the value of health was not absolute in its self-reference but had to be related to something as happiness or the meaning of life.
Because it was never the aim of the conference to deal with existential or religious issues, this part of the discussion could be sequestered if Harry Burns, the CEO of Scotland, hadn't emphasized on the relationship between health from one hand and a meaningful and inspiring driver from people's life on the other hand.
If emphasis had to be moved from curation to prevention and if health was related to social, economic and existential issues, then the conference had to change the world in two days.

We had to admit that changing the world had more probably to come from the Asian or African continent and so the audience had great expectations on the presentations and discussion of Kim Tan and Kash.

Kim Tan, son of a Chinese migrant in Malaysia, founded SpringHill Biotech Ventures, Malaysia’s first biotech venture-capital fund. He chairs the NCI Cancer Hospital in Malaysia and serves on the board of the Asia Pacific Economic Cooperation (APEC)
Tan is also the co-founder and trustee for the Transformational Business Network (TBN), which empowers developing world entrepreneurs by connecting them to mentors, resources and capital. TBN’s current outreach includes 60 businesses in 22 countries worldwide with around $40 million of direct or indirect investments.

Kash is a Congolese MD, working for Belgian NGO’s in Congo (Kivu), Burundi, and Ruanda. In this so called “Region of the Great Lakes”, he’s the local coordinator for Medics Without Vacation, a Flemish organization that organizes volunteer missions with nurses and doctors to African hospitals.

"Development starts with an enterprise", Kim opened the debate : "Charity can be useful in some specific circumstances but its impact is temporary and not sustainable. Count the number of charity money that went to sub-Saharan Africa during the last decades and see how that GDP has evolved.
Compare this with the Asian growing economies and you will get my point."

"It's a quick conclusion to presume causal relationship between charity money and GDP evolution”, Kash answered : "the colonization by European countries in Asia in the age before was more limited and from a completely other kind than what happened in Africa during the same period.
It passes the complexity of for example South Africa and Namibia where political control is democratically given to the black majority but the economy is mainly steered by the European originated white minority."

Tan replied : "Good example! To be sustainable, health and education have to be related to economic activity not only as a financial spinoff but also to elicit dignity and ownership of the local population determining their own destiny. Indeed that’s the problem of the black communities in South Africa.
When we come into a country and provide a whole load of aid in the form of grant money that a small country just can’t absorb, that has a whole load of unintended consequences to its economy. Or when we bring in goods that are manufactured here in the West, and unfortunately then that creates a real problem for local manufacturers and producers. It affects them in terms of their economics. So these are some of the unintended consequences of charity.”

"So no charity!”, Kash replied slightly irritated, “ How do you create for example work perspective in the slums?"

Kim told about his “toilet project”.
“There is a huge lack of toilets in most of the slums as you can imagine.
Nevertheless in one case we discovered that toilets were produced as a craftwork by local inhabitants. Most people think of slums as poor communities without money. But if thousands of people survive and have a more or less reasonable living with houses, food and markets for trade, there is a kind of mostly informal economy where things can be bought and sold, where small entrepreneurs can develop some business.
In the case of the toilets we developed a business model for thousands of toilets produced in mass production with the consequence that prices could be diminished and a couple of hundred people of the slums could be employed
Of course there was a need of starting capital but also an thorough exploration of the community of the slums where entrepreneurs were identified and educated to create a professional working force.
At the end the slums were much cleaner, a few hundred inhabitants were employed and we made a profit out of it.
And be sure, we don’t have to think only about financial return on investment but also in terms of a social return, a spiritual return, and an environmental return.”

“Making things done by the local community itself”, Kash replied : “I only can agree on this.
Half a year ago we launched a management education program for hospital directors in East Congo
A team of Belgian volunteer hospital managers were sent by an NGO to organize a seminar for the executives of nine regional hospitals.
In the first week they visited these hospitals to be sure matching western management concepts with local healthcare issues and environmental factors (for example lack of electricity, water and internet).
Most of the learning was introduced by cases from the hospitals themselves and the main knowledge exchange was rather horizontally between the African hospital managers themselves, only facilitated by the volunteer team of Belgium.
It needed no venture capital, there was no supplementary employment, it was not proven that the level of healthcare would enhance, surely in that region, and there was not a profit but the cost carried by the NGO who is mainly financed by government and donations.
Indeed the Gross National Product of Congo will not have a boost by this initiative, even more these kind of initiatives are an excuse for the government not investing in healthcare because it's taken care of by charity organizations.
Should we stop this kind of initiatives because they are contra-productive and sustain abandonment and corruption by the state?”.

“The environment of Goma and Bukavu is a war region for decades”, Kim replied : “You need stability and peace to develop an initiative in a sustainable way.
The paradox is that this is one of the richest regions in the world in terms of minerals (especially gold- and coltan mines) ; there is a huge amount of capital but it doesn't get to the needs of the population”.

The debate was moving from curative healthcare to prevention to the link with economic development and employment up to charity which seemed to be the only leverage of hope in a region of war.
“Healthcare as an asset” : … To do what?

The Roman pillars of the Scottish College of Surgeons revealed the thinking of so many generations of people dealing with these questions and of all the different participants coming here from all over the world to discuss the future of international healthcare.
The answers were hidden behind an iron closed door.

The next day, the conference would focus on implementation pathways for these emerging strategies.
The center of Edinburgh woke up in her robin red morning dress.

Maybe they will make a difference, Edinburgh mumbled.

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