I wrote this short piece for a discussion in a forum on ethics and international affairs. It is not related to conflict resolution per se but is an important issue for me as someone who is temporarily working "in the field", as many conflict resolution practitioners do, which is why I decided to cross-post it here.
While sick people of all ages faced with the desolate
Liberian health system stay alive only by God’s grace, as they say here, the elderly
and sick who wish they could leave the hospitals in Germany to just die in
peace, are kept alive with the newest technology and enormous amounts of
resources over months or even years, prolonging their suffering.
When I entered the office this Monday morning I expected the
usual cheers of “Good morning!”, “How are you?” and “You had a nice weekend?”
that greet me when I come in but instead there was complete silence and I
looked into faces marked with shock. It was the sort of silence that is in fact
incredibly tense and almost loud as if crying out. “Have you heard? John died this morning,” my colleague told me. John was the head driver and an
extremely lovely and humble man. Working for an international NGO and being as
generous as he was, he took in most of his nieces and nephews and provided for
all of them in addition to his own wife and children with his moderate salary.
Why did John die? Nobody knows exactly but it seems that he suffered from
undiagnosed diabetes, then got malaria and the malaria treatment at the
hospital made his sugar levels spike, which ultimately caused his death within
only a few days. The first hospital where he stayed did not have any doctors on
duty; the second hospital did not have doctors capable of correctly diagnosing
his diseases.
After talking to my colleagues, I opened my laptop to check
my email. The inbox showed a new message from my mother: She had just come back
from visiting her 80-year-old uncle who has been sick with diabetes for as long
as I have known him. He has been in and out of the hospital for more than a
year now and just wishes to die at this point. He lies in a hospital bed,
unable to move, unwilling to eat, and, although not having suffered from
dementia before, literally losing his mind. Yet, although his condition is
slowly deteriorating, the dialysis, a pacemaker and an array of other machines
and pills keep him from dying. His wife, my great aunt, has in the meantime suffered
a stroke due to the burden of caring for him. Now both are in the hospital.
While my great uncle wants the doctors to stop treating him, yet they won’t,
John’s family tried to find someone who could treat him and prevent his death,
yet they couldn’t.
Death is an inherent part of life. In countries privileged
with good health care, we are quick to forget that despite all our resources
and skills, our lives will eventually end with death. We can sometimes be blind
to the relief that death can provide for very sick people because we have
learned to avoid and fight death as much as we can. And as our health care
system is so good at keeping people alive, it will do so to the point where it
might do more harm than good. How much effort and how many resources are
invested every day into keeping people alive who wish nothing more than being
discharged and allowed to die?
At the same time, health care in much of the global South is
not even good enough to successfully treat diseases as common as malaria or to diagnose
a broken leg. After being hit by a car, one of my colleagues was driven from
one hospital in Monrovia to the next, looking for an x-ray machine and someone
capable of handling it. She couldn’t find any and now simply hopes that her
pain stems only from bruises and not from broken bones. Resources, equipment,
knowledge, skills – all of it is lacking. “Only the grace of God keeps you
alive in Liberia,” is what my colleagues say over and over.
Clearly, any solution to this paradox of unnecessary
suffering in the North because of health care systems that are too good at what
they’re doing and the South because of health care systems that are
dysfunctional, must be much more complex than simply redistributing resources.
The reasons for both are more deeply rooted in the respective political, social
and even cultural contexts. And yet, the inequality that I experience here is
so outrageous it is hard for me to simply “feel lucky” about where I happened
to be born, give John’s family some financial support for his funeral and
otherwise conclude that the reasons for global inequalities are too complex to
be effectively tackled. Just how?
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