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Experts debate universal health concerns

Eileen Duffy | Friday, September 15, 2006

The overwhelming global health crisis might not be as complicated as most Americans – Notre Dame students included – think, said three distinguished panelists at the University’s academic forum in the Joyce Center Thursday.

Gwen Ifill of “Washington Week” and “The NewsHour with Jim Lehrer” moderated as humanitarian Dr. Paul Farmer, economist Dr. Jeffrey Sachs and Ugandan Dr. Miriam Opwonya educated the audience, then prodded it to take action.

A thunderous round of applause greeted Farmer, the first to take the stage. Focusing on the results made possible by the United Nations Millennium Project, Farmer laid a fine foundation for Sachs, the director of that initiative.

Farmer said “vertical funding” – that is, money designated for a specific area, like AIDS – can and must be used to treat other diseases like malaria and tuberculosis, since the diseases often coincide.

Farmer, the director of nonprofit international healthcare organization Partners in Health, and his colleagues recently applied that very thinking to an HIV-positive, tuberculosis-afflicted Rwandan man who, in the photograph Farmer flashed, looked like a skeleton.

“He was hungry, as he put it. [Other] physicians might have said he had a consumptive disease, but we knew better; we listened to him… In the corporal works of mercy, there is a radical notion that we ought to treat hunger with food,” Farmer said. “We fed him and gave him antiretrovirals and [tuberculosis] medicine.

“Now look at him.”

A gasp was audible as a Rwandan man with an almost Santa Claus-like belly appeared on the projector, grinning at the audience.

Sachs bowed to Farmer when he stepped onstage, then steered the discussion in a more serious direction. Pummeling the audience with statistics – a result of his self-professed “economist’s love of long division” – Sachs showed just how feasible it is to make the world healthy.

As an economist, Sachs said, he understands market theory. But when countries are so poor and people are so poor that they are struggling just to feed themselves, market theory and globalization concepts are just not applicable.

“People are dying because they lack a dollar [required for clinical treatment],” he said. “Are we trying to prove a textbook theory, or are we trying to make a better world?”

From malaria-stricken children lying comatose in Malawi hospitals – “What conceivable justification could there be for this?” – to African farmers who lack basic fertilizer for their crops, Sachs has seen the problem firsthand.

He’s also seen how ready the African people themselves are to solve it. He spoke at a conference in the mountains of Kenya with thousands of villagers who had walked 20 or 30 miles to attend “a canyon filled with love, in the absolute real sense,” he said. He’s been to town conferences and listened to the locals’ ideas.

“Boy, are they helpful; boy, are they excited; boy, are they pragmatic; but boy, are they are poor,” he said. “They are ready to work, but they need help.”

He offered five practical solutions for the year 2006: help Africans grow more food, control malaria, ensure clinical health services – “Starbucks clinics in Africa: there should be one in every village,” he joked – provide safe water points and provide schooling for all children.

“We have to understand the problem and we have to solve it. It’s urgent,” Sachs said. “Our own survival will depend on it as well.”

Speaking carefully through her thick Ugandan accent, Opwonya engaged in discussion with Ifill on the problem of HIV/AIDS in her country, advocating an equal focus on antiretroviral treatment and behavior education.

The Ugandan government implemented prevention programs in 1989, when the country was at its peak of HIV/AIDS prevalence, with 23 percent infected, she said. Through a combination of television and radio jingles, posters and other methods, the percentage dropped from 23 to six percent.

While antiretrovirals have now become important, Opwonya emphasized the ongoing power of behavioral education.

“Some teens go to high school and their peers have no idea how HIV is transmitted,” she said.

But Americans are unaware in their own right, too.

“A lot of people do not know exactly what is happening in Africa. Knowledge is power … We’ve all been given enough – we should be able to distribute it. I look around…” Opwonya said, gazing at the rafters of the JACC. “I look around and there is nothing in Uganda like this. You people have been given a lot, and you should give back.”

Responding to various questions posed by Ifill, the panelists then explored the issue of corruption in poverty-stricken countries.

“What’s called ‘corruption’ is often simply [the] face of extreme poverty. When you bring in practical solutions, you find, lo and behold, results can happen,” Sachs said, citing the eradication of smallpox – which took the combined efforts of African governments – as proof that corruption in Africa is a myth.

A journalist from a radio station – which Farmer refused to identify, saying only that “it’s national, and it’s public” – asked him about corruption, as well. Farmer echoed Sachs’ idea that corruption is simply “extreme poverty” and said he and his colleagues had succeeded in the middle of rural Haiti, a country with a history of coup d’états.

Asked about what the world should look like in their “wildest dreams” in 2025 (the final year of the Global Millennium Project), Farmer and Opwonya said they hoped to put an end to patients dying because of a lack of treatment or physicians. Sachs simply noted that “they weren’t his wildest dreams – they were his practical calculations.”

Finally, the three panelists fielded questions from two Notre Dame seniors, Michael Dewan and Ailis Tweed Kent; and two alumni, Dr. David Gaus, Class of 1984, and Keri Oxley, Class of 2004.

Responding to Gaus, a former business major, Sachs and Farmer delved into the issue of privatization of health care. Sachs warned against thinking that because the current public health care system is problematic, that private systems would work better – the public system isn’t working because the governments are broke.

Once guaranteed access to health care is secured, he said, then it is possible to apply business logistics and work on depoliticizing health care.

“Business is good at scale, logistics and management,” he said. “Politics is not.”

After Opwonya brought up the issue of mother-to-child transmission of HIV through breast-feeding – a “major problem, but we’re working on it” – Farmer was quick to point out that treating babies who contract HIV through breast milk is not a good goal.

“We will never eradicate HIV among children if our main option is HIV-positive breast milk,” he said. “The goal is that HIV-positive things do not get inside children.”

The four students and alumni closed out the forum. Dewan, who worked in Uganda, said he felt optimistic after the discussion.

“[Studying in Uganda] I was frustrated that there was so much needless suffering and death, from diseases we’ve known the cures for, for over 300 years,” he said. “But it’s exciting for our generation. We know these solutions – they’re right in front of us. Now it’s just a matter of us taking charge.”