In prison, he had exposed himself as being very interested in medical care, whatever that
word means in the apocalyptic world
he was living in.
He had developed an expertise in withdrawing blood
for laboratory investigation and teeth
extraction.
Because of that he was noticed by the people of a Beirut University that had developed here a program for basic health care.
Because of that he was noticed by the people of a Beirut University that had developed here a program for basic health care.
This had began seven years ago, one month after the end of the 2006
Israeli attack on Lebanon that severely hit the vast majority of South
Lebanon’s villages. Immediately after the end of the war, the president of the
university had launched a civic engagement project with an action plan to
help the population, each institution in its area of expertise.
After 18 successful healthcare missions in all the destroyed villages in
South Lebanon, a group of volunteers wanted to continue serving the community
by working with the most vulnerable population segment, namely the inmates in
Lebanese prisons. The hospital and the university administration were very
reluctant to this project; putting students in direct contact with convicted
persons in an unfamiliar environment was sensed as taking a high risk.
But the enthusiasm of volunteers and the positive feedback of the
prison’s authority encouraged the hospital administration to engage in this
project.
Before her
current position as
senior consultant
for a Health Consulting
Group, she was involved in the
prison project.
At first a comprehensive assessment of prisoners’ health was developed.
This included a general check-up as well as activities of screening and
prevention of cardiovascular, dermatological, psychiatric diseases and some
cancers mainly breast and cervical cancers in women.
Missions were performed on a Saturday every 6 to 8 weeks and 100
volunteers on average were involved in each mission.
They were aware that they could not assess the health of all 5500
prisoners in a three year period especially that the missions were performed,
as mentioned before, one Saturday every 6 to 8 weeks.
So they decided to give priority to the 300 women inmates and the 170
minors because they were the most vulnerable and controllable given their
limited number. The second priority went to 4 medium size men prisons not
exceeding 200 inmates each.
Secondly the aim was to create a healthcare system in Lebanese prisons that covered primary, secondary and tertiary healthcare, emergency services, as well
as care documentation through an electronic health record.
In order
to create a sustainable system, an insurance system was set up, sponsored by
NGO money for those who couldn’t afford the yearly 300$ fee.
Randa had just
returned from
an international
conference concerning Advanced Health Decision-Making.
This initiative was
set up 2 years ago by ABIS( the Academy of Business in Society), Rutgers University in
New Brunswick and
the Corporate
Citizenship Trust of the pharmaceutical company Johnson and Johnson.
In May 2011, they had
a first meeting in New Brunswick bringing
together healthcare
managers, policymakers, industrial people, academics,
human ecologists and
other species
that more or less had something to do with healthcare.
The aim was to emerge thoughts and concepts about possible evolutions in healthcare, opportunities
and innovation
in a spirit of openness, trust and collaboration.
Focus moved from traditional health care strategies
and interventions to questions as : "What is
health?" or "Who owns health in a community?"
During a second
meeting in October 2011 in Fontainebleau with the cooperation of Insead, emphasis was put on conditions and leverages of better healthcare
decision making
as management information, technology,
systems innovation, policymaking and knowledge brokers.
In Glasgow in
March 2012, a visit was
set up in an occupational day
center for psychiatric patients
and socially isolated people
who found there a
meeting point
and working
together in
a more or less sheltered environment.
Health of the
population was
significantly decreased
after the closing of much of the ship industry with a huge
unemployment as
a consequence.
A mission statement
was worked out with emphasis on health decision-making
based upon patient and community empowerment, and a comprehensive
model of health including
education, prevention and
social involvement.
Unlikely alliances and partnerships could challenge traditional concepts of health care and facilitate innovation in order to achieve better quality health outcomes for individuals and communities.
Key issue was the extent of responsibility of a person for his own health which could be conceptualized as an invitation more than an obligation not to be captived within the dictatorship of health control as described in the book “Corpus Delicti” of Juli Zeh.
Unlikely alliances and partnerships could challenge traditional concepts of health care and facilitate innovation in order to achieve better quality health outcomes for individuals and communities.
Key issue was the extent of responsibility of a person for his own health which could be conceptualized as an invitation more than an obligation not to be captived within the dictatorship of health control as described in the book “Corpus Delicti” of Juli Zeh.
The journey was oriented to the
Arabic Spring but the meeting in Cairo in December 2012 had
to be canceled because
of the unstable situation.
From 23 to
24 April, an international
bunch of academics, hospital managers, policymakers, consultants, industrial people, entrepreneurs and communication
experts had gathered in Sharjah, the little sister of Abu Dhabi and Dubai.
The territory of
the state is very fragmented
due to the historical alliances between
tribes and the ruling family in the city of Sharjah.
The state has about 600,000 inhabitants
with more than 80% expats and foreigners
mainly from India, the Philippines and other Asian countries.
The luxury hotel
could easily compete with a five-star Hilton in the United States with one critical difference :
alcohol was not available as the consequence of the gratitude of the emir of
Sharjah towards Saudi Arabia who had helped them financially in bad times during
the eighties.
But could we
deny that there was a small change in our perception when we were told it was only a three-star
hotel priced at USD55 a
night, breakfast
included.
Could it have
been an anticipating metaphor for our the congress :
“high-quality low-cost by advanced decision-making”
“high-quality low-cost by advanced decision-making”
“The venue was
the most beautiful university
campus in the world”, Frank said.
"Own child's beautiful
child", one could
have thought but anyway the campus resembled a kind of Arabic royal resort with mosque like buildings, green squares and lots of space
which could only be available in the desert.
The Vice Chancellor
of the Medical College was very proud of their interactive
way of teaching especially the obliged reflective
time that stimulated self
knowledge and
creativity.
It was in
this mixed cultural desert
environment that
the participants
would try to elicit the secrets of good healthcare decision
only a couple of miles away of the highest tower in the world.
The second day
of the congress, the group was supposed to
design and build a vessel to prolong
their journey
not any longer roaming in the
desert but the flag
hoisted and the helm in the right direction
on their way to a goal.
But the first day, the participants had to
prepare calibrating their compass and study the maps
and what could be more facilitating
for this than sharing experiences.
Besides the Lebanon prison
project, a Canadian M.D.
talked about
the added value of lab results for prevention, a German physician
shared her experience working
for the Aga Kahn Foundation in Kenia and a Belgian psychiatrist conceptualized opportunities for innovation in bridging between
economic and
relational dynamics
and between
developed and
developing country strategies.
A British-Indian M.D. draw
attention in
a very convincing way
on her attempts to create primary
healthcare systems
within the low class Indian population.
“I seek for what I want by torturing
venture capitalists and governments”, she provoked, “they give in because they
want to get rid of me”.
Furthermore there ware talks about a
cancer survival program in Kenya, a system that allows consumers to instantly
check whether their medicines are counterfeits and about European and
international health policy planning on diabetes.
Key issue was the sustainability of
the projects : while financing organisms seeked for measurable outcomes, the
added value of such projects was highly influenced by the social and cultural
context and oftenly shifting during the journey of the project itself.
“Experts from all over the world were discussing strategies for a better healthcare decision-making”, she answered hesitating
“and how you can use conceptualization, experimenting and bridging to find the right answers."
"I don't understand", was his predictable reply, “did you really tell these folks there about what is happening in our prison?"
"Well", Randa said " I was very proud to tell the story and regarding the enthusiastic
reaction of
the audience, it must have had something to
do with decision making in
health care."
“Did you tell them that buildings are in a very bad condition, cells
are overcrowded and persons are detained in inhumane conditions and that ach
prisoner has only 1.3 m2 of individual space on average.
Randa’s thoughts went
to the discussions
of Wednesday
where teams
were selected
to work upon themes as health credits, health values, access and
impact of care.
The value of
health was reflected in the eyes of Ahmed, access to health care was given through an opening
in the iron gates, health
credits were enhanced from zero
to an acceptable level, be it for a limited part of the prison population and
the impact could not only be conceived in a set of quality indicators but
was totally
visible in
the regaining of dignity
and hope of a population on
the edge of civilization.
Didn't Pope Franciscus
I make an appeal on moving with the church to the margins of the society realizing that
all reconversion and innovation
starts with
caring for the forgotten ones.
Bright ideas were put forward in the
afternoon sessions,
new concepts
defined and new strategies developed with
the aim that this group in this place at this moment could create something
new, the starting point
of the creation of a better healthcare, a paradigm
shift to your new model of health decision-making.
Freedom of interest, no defined
outcomes, ownership of the group and international and
multicultural focus
where ingredients
that would contribute to the successful creation of the
magic drink.
But aren’t too many cooks spoiling the
broth or how to steer a boat with 10 captains.
Although statements were not always build up as a set of interventions logical following each other and although peoples talks were more like flashes in the audience moving in all directions, participants were enthusiastic about the discussions.
Although statements were not always build up as a set of interventions logical following each other and although peoples talks were more like flashes in the audience moving in all directions, participants were enthusiastic about the discussions.
Not only the high intellectual
level was appreciated but also the commitments and the good
intentions of any
participant combined with respect for each other's opinion.
In the "impact
team", standpoints evolving
from the discussion were synthesized and an agenda and roadmap was set up to start an experimenting project on the opinions of stakeholders
in healthcare
concerning the impact of their the decision-making.
A discussion framework would
be prepared and every participant of the task force would
set up a structured interview with a stakeholder as they were patients, providers, government, universities and companies.
This could be
used as an input for the next meeting in Nairobi within about 200 days and eventually be prolonged in an action research project with cross fertilization of the thinkers (academics) and the workers (the
others).
In the farewell session the core team was congratulated not only
for their hard preparatory work but mainly
for the
respect they kept on showing towards the group and for the ownership
of the process left to the participants as an intended consequence.
Could this be
seen as a leverage for a renewed attitude of each of the participants dealing
with sharing decisions and ownership with their patients and with the
people they were responsible for.
Randa was not present at the farewell dinner in Dubai, at the bottom of the Burj Khalifa, with 828 m by far the highest tower of the
world, reminding the tower of Babel in early history of mankind.
