What Makes A Healthy Nation?

This question was raised again in my mind by a recent experience traveling in a remote district of northern Uganda (Pader) with some visitors from the UK and USA, where we encountered Jacqueline, lying unconscious by the side of the main dirt road. Her parents were unavailable, being some distance away, working their garden for food to eat. Her brother was around. A local government administrator was also passing by on a motorcycle and acted as our interpreter. Thankfully we also had two doctors on board our vehicle. God had his hand on this girl, with time, place and people coming together in perfect harmony. Eventually, we all agreed that she should be taken unconscious to the nearest medical facility. We reached the best clinic in the town after my twenty minute “ambulance” style drive. It was a newly built, free facility, with an outpatients clinic and one inpatients ward. There were at least two hundred adult outpatients, mostly mothers, with at least a further two hundred young children. There was only one nurse at “triage” and one doctor attending to them all. Both of them stopped their work to attend to our patient. Everyone else waited patiently for their turn to get served – real out-and-out patience. I realized later that we had jumped a seriously long queue – a very non-British practice, but one for which I was thankful to all my Ugandan friends who might still be there waiting. The Doctor said that he had thirteen nurses available but he had given up trying to persuade them to come to work.

We later learned that Jacqueline is deaf and dumb, was suffering from a combination of epilepsy and malaria, and had just experienced a major seizure before we arrived on the scene. They put her on a drip in the ward and she regained consciousness some time after we left. She is now reported to be home again with her family. Where am I going with this story?

I can remember as a boy, loving the biography of Florence Nightingale (1820 – 1910), caring for dying soldiers in the horrific Crimean War, and her example setting the standard and inspiration for the nursing profession, founding St Thomas’ Hospital, London, in 1860. I can remember my mother telling me how this had inspired her to become a nurse. This spirit was further demonstrated to me by historical accounts of self-sacrificing medical missionaries over the last hundred years on the continent, working to eradicate leprosy in Uganda, for example. Considering that Florence and others were volunteers, committed and compassionate, I realize that today’s health workers are motivated by different forces. It is often less of a vocation and more of an employment, providing a means to survival; the by-product being community health, of a fashion. I am generalizing of course and cannot assess the motives of all medical personnel everywhere. Certainly there are some outstanding doctors in Uganda, whom I respect very highly for acting professionally and sacrificially despite extremely limited resources and challenging working conditions.

All the same, you may be aware of many African health workers who have flown away and are employed in the UK and other “developed” nations. Why? Because the stress of caring for so many people at once, the magnitude of the health problems associated with poverty, the unreliability of the wage, the scarse equipment, and the meager medical supplies; all contribute to an exodus from the nations that so badly need their services. The health sector in Africa is so badly in need of people committed to community health and the welfare of their own people. In reality, poor people are often just as concerned with themselves as rich people are, and that includes health workers. Furthermore the health budgets of governments in such countries are highly politicized, being stressed and stretched by many other demands, including education, security, infrastructure, administrative bureaucracy, systemic corruption and stately opulence.

Healthcare in Africa is a complex subject area that I cannot begin to fully address here, but some thoughts I can offer. The good thing about the clinic in Pader was that the services and treatment were free to the local community, being supported by an international medical foundation, who paid the doctor to be present. It is also interesting that Western governments are now recognizing the problem; that their international aid, aimed at assisting primary healthcare might be better invested in assisting personnel to stand in a primary position within their own countries. If Uganda is anything to go by, there is plenty of money to build clinics, but there are just way too few medical personnel available to offer even a basic service to the people that the buildings are supposed to serve. This was confirmed a few days prior when one of our doctors visited an unmanned “clinic” in Padibe; it was like visiting an empty vending machine. Buildings can never make people better. Healing hands can! Local people need professional and compassionate people, speaking the same language, to offer them these vital services. We really need all people in Africa to see their role as meaningful to the development of the nation, from the president, through the local government worker, across to the nurse extracting blood for laboratory testing.

I wish to suggest that Nation Building should be at the heart of all sectors of society, and is the heart of the matter in Africa’s development. I believe this is a foundational principal found in the Bible – nation building. Some of our major biblical heroes were highly commended for building nations outside of Israel’s personal interests. For example, Joseph helped Egypt assist nations outside itself with food supply long before the World Food Program, during a time of severe regional famine affecting at least north Africa and the Near East; Daniel served the interests of the Babylonian kingdom, Israel’s greatest enemy, to advance regional trade and development; and Esther was “born for such a time as this” to save Israel, a minority people, from genocide. We should not forget Jesus Christ, who evidently left the comforts of heaven to enter a poverty stricken world, teaching selfless ethical principals, healing ALL the sick wherever he went, and leaving no-one untouched by his encounters. It takes a sense of calling or vocation, with much grace, but it must be pursued by sincere followers of Christ, at least according to His foundational reference manual – the Bible. We need people who will serve the needs of others and not just be concerned with survival, or self-serving interests. The mindset that poverty creates is a serious health risk to Africa’s people, but “with God all things are possible!”