NOTES HEALTH, FOR A MANIFESTO: THE MOST PRECIOUS GAIN

One of the most quoted references of Gautama Buddha’s teachings on wellbeing is the 204th verse of the Dhammapada, contained in the Sukhavagga or the Discourses on Happiness: Arōgā paramā lābhā san tutthi paramam dhanan vis āsa paramā nāthi Nibbānan paramam sukhan Acharya Buddharakkitha translates it as follows: “Health is the most precious gain and contentment the greatest wealth; a trustworthy person is the best kinsman and Nibbana the highest bliss.”

Health, contentment, kin and Nibbana can each be elaborated, but this is no thesis on Buddhism. What we need to draw is the importance of good health as being a condition that surpasses all else in terms of the tangibles one can obtain in life. A healthy nation can therefore be considered a kind of bedrock for all other improvements. Obtaining it is not easy. It is not that our leaders have been oblivious to the subject of health. For decades we’ve trotted out laudable numbers pertaining to importance indicators of good health, mostly flowing from an excellent public health system complemented by equally excellent awareness programs.

The question that’s often being asked is whether it is sustainable. In other words, there are doubts that a country with an economy such as ours can afford to subsidize to the extent it does. Perhaps it is not about blanket subsidies but intelligent support from the state. The discussion on the sector in recent times have been caricatured into a private vs public debate. Within it, there’s mention of a national policy on drugs, price formulas for private hospitals and of course the controversy over private medical schools.

In all this, there has been a concerted effort to dub the Government Medical Officers’ Association (GMOA) as the villain of the piece. They, unlike other professionals, are not supposed to have grievances. They earn enough, we are told (as though only those who earn less than some magical figure have grievances and therefore have the privilege to protest). That vilification extends to the services provided. State hospitals are not plush entities like private hospitals, it is lamented. There is over-crowding and a general unkempt appearance (which does not mean it’s unhygienic, note).

In all this, there’s a lot missing. Nothing about the fact that hospitals are understaffed in almost all categories, that those who have to work do the work of several (unlike in private hospitals), that even today the state hospitals provide the best services across the board (a hospital is not a resort hotel, note) and offer the kind of medical surveillance a private hospital just does not.

It must be noted that there are excellently maintained state facilities in certain parts of the country, which clearly says that meagre though the resources may be, they can be intelligently used. And yet, any medical mishap in any state hospital is inflated in the media whereas negligence in private hospitals is swept under the carpet (if indeed it is even known!).

That said, the solution is not to have a policy of destroying one or the other, but to figure out a system where anyone has access to medical care that is affordable. Insurance has been offered as a solution, but the system introduced recently for school children essentially gets the taxpayer to fatten insurance companies and private hospitals.

As mentioned, it is not about the services but also about the drugs. Here too there is the public vs private matter being debated. Drug companies are villains, some say. The State Pharmaceuticals Corporation just can’t deliver, others say. The default option so far has been to let multinational pharmaceutical companies to do as they please. There is very little talk about private-public partnerships or supporting the development of a local pharmaceutical industry.

Time was when regular work in the household and community provided all the exercise necessary. That community and that household has been all but destroyed. Now we have walkways, gymnasiums, spas and expensive hospitals. Somewhere, somehow, the basics seem to have been forgotten. For example, the General Practitioner is almost a dying breed. Patients have taken over that role. If one has seen a skin specialist, then one is qualified to recommend that specialist to someone suffering the same or similar ailment. Where’s the debate on nutrition? Where’s the debate on preventive measures? Where’s community medicine? Where’s awareness creation? Where’s the debate on enabling environments? Why are these not part of the overall discourse on development? Development has destroyed a lot of things. When forests go, so do a vast treasury of genes that has the potential to cure. A culture of untrammelled consumption of which junk food and all kinds of unhealthy substances are touted as being essential parts of ‘the good life’ have severely compromised the general health of the population. Remember that all this was attended by a deliberate and concerted vilification of all things indigenous — foods, medicine and medical practices included. Indigenous medical practitioners and practices are vilified as indulgence in mumbo-jumbo, but faith-healers protected in the name of religious freedom.

Let’s leave Nibbana aside. ‘Contentment’ has been codified in terms of material things. There are no kin; there are only partners in all kinds of profit-making operations. Can we truly say that ‘health’ in Sri Lanka is thought of as the most precious gain? If not, why not?

Over to you, M/s Nagananda Kodituwakku, Rohan Pallewatte, Gotabhaya Rajapaksa, Patali Champika Ranawaka, Ranil Wickremesinghe, Maithripala Sirisena and any other individual entertaining hopes of becoming the next President of Sri Lanka.

Author is a political analyst and freelance writer can be contacted on malindasenevi@gmail.com. or by visiting www.malindwords.blogspot.com

The question that’s often being asked is whether it is sustainable. In other words, there are doubts that a country with an economy such as ours can afford to subsidize to the extent it does

As mentioned, it is not about the services but also about the drugs. Here too there is the public vs private matter being debated. Drug companies are villains, some say