IN PRAISE OF FAMOUS MEN
by
George A. O. Alleyne
Director, PAHO
Presented at a Tribute to Sir Cuthbert Sebastian's contribution to Health in St. Kitts, and to celebrate the release of his book St. Kitts - 100 Years of Medicine.
14 August 2002.
(St. Kitts and Nevis)
Your Excellency, Governor-General of St. Kitts and Nevis, Sir Cuthbert Sebastian
Mr. Prime Minister
Mr. Minister of Health
Distinguished guests; ladies and gentlemen
First let me thank the Minister of Health, Dr. Earl Martin, for the invitation to participate in this ceremony, which I am told is being held as a part of this country's celebrations to mark the Centennial of the Pan American Health Organization (PAHO). I also wish to express my thanks and appreciation to the Governor-General for having postponed the ceremony so that I could have the privilege of participating. It is fitting that in the year we celebrate 100 years of the existence of our Organization, we should be recognizing Sir Cuthbert for his book "St. Kitts-100 Years of Medicine." On occasions like these, we must give thanks that there were persons who had the vision 100 years ago to establish the basis of what we do and what we are today. This is as true for PAHO as it is for St. Kitts/Nevis.
In the case of the Pan American Health Organization, which is the oldest international health organization in the world, it was the imagination of a group of wise men who conceived the idea of a small organization that would collect and distribute sanitary information in the Americas. That idea and that vision have prospered, and now we find ourselves 100 years later, spread all over the Region of the Americas and still using to good purpose the instrument of information in our technical cooperation with our countries. We find ourselves striving to live up to the basic ethical credo of Health for All by which we advocate that the inequalities in health that are a manifestation of social injustice should not occur, and are an affront to us all. As an institution we are proud of our commitment to the ideal that our remit must encompass a concern for the health of all the countries of the Americas -the rich and the poor, the small and the large, and we show with pride that many of the examples of good practice in health have no predilection for any single geographical location. Over the course of the years we have focussed more and more on technical cooperation with our Member States. We work with them to put in place the kinds of public health programs that lead to tangible improvement in the health of their people. We increasingly find benefit from promoting technical cooperation among the countries as they develop the kinds of expertise and knowledge that they can share among themselves.
There is no doubt about the improvements in health in the Americas over the past 100 years. The good data that we have for the last half century, for example, show a 35 percent increase in life expectancy and an 80 percent decrease in infant mortality over that period. Some of the preventable diseases have indeed, completely or virtually disappeared, and our countries continue to congratulate themselves on the fact that they have eliminated poliomyelitis and are on the verge of eliminating measles through collective action. The Caribbean has been an intimate part of these advances and in some cases has been in the vanguard. This sub-region of ours was the first to embark on the quest for the elimination of measles and has set the pattern for the rest of the Americas and the world. You have set the stage for the elimination of rubella. Very soon there will be no Caribbean children born to suffer from the congenital rubella syndrome.
I have no doubt that with the firm resolve that has been displayed, and the leadership of your Prime Minister, this Region will also show that the modern day scourge of HIV/AIDS can be confronted and controlled through the pan Caribbean approach of which he is a committed champion. And here let me thank him again for the kind things he had to say about me at the Council on Human and Social Development (COHSOD) meeting in Guyana a few months ago. It is the leadership of such men that we should praise.
But there were other famous Kittitian physicians who preceded your Prime Minister. I recall with exquisite pleasure being entertained royally by Sir Cuthbert on one of my previous visits to this country, when he regaled and fascinated me with the stories of medicine in St. Kitts in the early days. I was, therefore, very pleased to receive a copy of his book earlier this year from Dr. Martin. I read it again before this visit and could not help but marvel once more at the heroic medical feats he describes and the men and women who accomplished them. It made me deeply conscious of the debt we owe to those pioneers and how fortunate we are in having Sir Cuthbert -one of those very pioneers- dig into his treasure trove of memories and speak to us through his book. The accounts that he gives of medicine over the past 100 years do not only titillate us, but also cause us to feel rather humble to know what he and others did with the resources they had.
As I reread the book my thoughts ran to the famous piece from Ecclesiasticus:
Let us now praise famous men,
and our fathers in their generations.
The Lord apportioned to them great glory,
his majesty from the beginning.
There were those who ruled in their kingdoms,
and were men renowned for their power,
giving counsel by their understanding,
and proclaiming prophesies;
leaders of the people in their deliberations
and in understanding of learning for the people.
wise in their words of instruction;
There is no doubt that the physicians of those days -of whom Sir Cuthbert is one, were undoubtedly renowned for their power. This was a power that derived from their ability to give succor to the needy, comfort to the ailing, and sometimes cures to the afflicted. But I must confess that it was the last part of the book that caused me to ponder more deeply and be rash enough to praise Sir Cuthbert as famous for the counsel, the understanding, and the appreciation of some of the essence of the learning that is useful for the people.
He reflects on the nature of the human being, on the ills to which we are heir, and decries the tendency to pursue the Newtonian and Cartesian reductionism that causes many to regard the body as simply another machine -albeit perfect in its parts. He reminds us of the perfection of the parts when he calculates for us that the human heart beats about 37 million times per year-a feat that cannot be matched by anything made by human hands. This concern as to the direction and results of the reductionist approach is very much in my mind today.
We are sometimes rather blasé in thinking about the cell and have long lost the excitement that must have come to the old microscopists like van Leeuwenhoek, who saw this structure for the first time. We now think of the cell as a very gross unit of organization, within which resides a myriad of structures whose nature is being revealed slowly and surely. We now know the details of the transmission of various characteristics by our genes, and the unraveling of the human genome is opening up vistas that were figments of our imagination a few short years ago. But that is not the end. We are plunging rapidly into the age of proteomics in which we will discover the functional expressions of the proteins that are formed by genetic instruction and the results of the interactions between them. This probably is not the ultimate in the reductionism which sees the salvation of the human being in terms of the prevention and cure of disease through the further and more minute dissection of what might be called the very nature of life.
But in his profound reflection on what he has learned in the past 60 years as a physician, Sir Cuthbert brings us back to some of the fundamental questions about medicine and health. Will the predominantly western biomedical reductionist approach be the answer to the majority of our health problems, or should we abjure the arrogance born of recent knowledge and accept that the approaches that are more prevalent in other and more holistic systems of medicine should be taken more seriously? Sometimes I think we take too literally the proclamation in Genesis that we have "dominion over the fish of the sea, and over the fowl of the air, the beasts, and over the earth, and over every creeping thing that creepeth upon the earth." It is perhaps because of that arrogance that we so often despoil the environment and seek to shape nature itself to our own ends. As Sir Cuthbert says, "We must also appreciate that there is an interrelationship between mind, body, and spirit, and the more we successfully seek to find that interrelationship, the nearer we come to the practice of what we now call holistic medicine."
And what of the present and the future? We can say what the present situation is, and no doubt in 100 years there will be some like Sir Cuthbert and your Prime Minister Douglas who will speak of the old days and marvel at the distance that has been traveled. You have traveled a great distance indeed, when we look at traditional health indicators in St. Kitts and Nevis and compare them with the picture painted by Sir Cuthbert.
Your life expectancy at birth is now 71 years with the standard difference between men and women. Women live longer than men. The infant mortality rate is 13.9 infant deaths per 1,000 live births. Almost 100 % of the population has access to drinking water and sanitation services. The childhood immunization coverage is virtually perfect and the expenditure on health at 5.3 % of GDP, is a reflection of the importance your government places on health.
These accomplishments have been the result of a combination of factors. There has been the government's commitment, a high level of literacy and education of the population, and the work of a long line of dedicated health workers. I note the work of that Caribbean giant Philip Boyd who cut his public health eyeteeth here. But we should not only praise famous men, we should also praise famous women, and among them particularly the women of the nursing profession here must receive many of the encomiums. At the risk of being invidious, let me mention first the name of Ms Maria Barker, my friend of 25 years whose selfless dedication and cheerful competence have been an example to all health workers in the Caribbean and beyond. Let me also mention. Mrs. Frances Delaney whom I had the privilege to meet when she worked here and in our Caribbean Epidemiology Center (CAREC). She was Mrs. Immunization personified and she generously shared the knowledge and skills in immunization and public health practice that she had acquired here with the Caribbean as a whole. I am sure that there are many more like these to whom we should pay tribute.
And what of the future? We in PAHO have spent a great deal of time and energy this year thinking about the things that should ensure that we continue to be useful to our Member States. I cannot recount them all here but when Dr. Martin attends the Sanitary Conference in September he will hear the proposals we make for PAHO's work over the next 5 years. Central to them will be a concentration on the kind of vision, mission and values that will guide us. High on that list of values will be one that has been my constant obsession -that of the search for reducing those inequalities between and within countries that are unjust and represent inequity. That quest for equity is one that is worthy of an organization that has existed for 100 years and expects to prosper for another 100 years. I also believe that our continuity will depend on what I have often described as a personal and institutional motto. That is "service without servility." This implies being able to serve our countries while observing all the ethical standards that derive from our historical roots. At the same time we must not fall into the trap of being sycophants that tell governments only what they wish to hear and not provide the critical but respectful analysis of the real problems they face and the solutions that are possible.
In order for you to continue on the road to even better health and follow the "beacon light" that Sir Cuthbert says has been lit by the men and women we now praise, there are many stars that have to be in the proper alignment. You will have to come to terms with the changing epidemiological profile that is upon you and most of your neighbors. You must deal simultaneously with the burden of noncommunicable diseases and of new and emergent communicable diseases. Who would have thought that we would still be struggling to control tuberculosis 50 years after Selman Waksman received the Nobel Prize for the discovery of streptomycin? Who could have imagined 20 years ago that the modern version of the biblical plague would be upon us in the shape of HIV/AIDS? These challenges will call for the involvement and commitment of an educated public which appreciates that the essential response is based on the fundamental principles of health promotion. There will have to be appropriate public policies combined with the personal and community behavior that are synergistic. It will be costly, but every society will have to determine the importance it gives to health and assign the necessary resources. I am not advocating dedicating resources to health to the detriment of the other sectors of society. But I am pleading that the resources be in line with the belief and evidence that properly focused expenditure on the health of the people is critical for the important aspects of their human development.
You will have to come to grips with the results of the demographic changes that result in an increasing number of elderly people among you. The greatest challenge here is not to think of the elderly as posing health problems that are intrinsically any different from those that affect other ages. The last thing you wish to do is to create the type of intergenerational inequity that leads to a large section of the population being disadvantaged in terms of health and other services. Part of the approach is to focus on healthy practices throughout the life cycle. In this case the health sins of the young come back to haunt them when they are old. We can also hope for the continuing of the kind of social arrangement, traditional in our societies, that does not isolate the elderly.
You will have to come to grips with the dilemma of small states whose vulnerability exists not only in terms of the physical and economic environment. Small states are vulnerable to having their space infiltrated by information or propaganda that conditions their people to styles of behavior that are inimical to their health and induces expectations that are outside of the reach of their budgets. The interconnectedness that is a feature of this modern world makes your borders penetrable by a range of human and other vectors that did not pose a threat 100 years ago. No Caribbean island is an island unto itself in terms of health. They are all so bound together by the frequency of popular interaction and intercourse that it makes so much sense for the Caribbean to seek the pan Caribbean approach to HIV/AIDS that I mentioned before, and which is being spearheaded by Prime Minister Douglas.
The size of many of our states means that the unit costs of much of the health infrastructure will be inordinately high and it will call for much creative thinking to overcome these deficiencies. We continue to speak of shared services but, unfortunately, this has been more in rhetoric than in practice. I am pleased to note, however, your efforts to apply the modern technology of telemedicine to overcome some of the critical shortages of key personnel. I believe that this offers tremendous potential and presages the day when communic ation technology will indeed overcome all but a few physical barriers posed by distance.
Mr. Chairman, when one looks at the beautiful photographs that are included at the end of Sir Cuthbert's book, one conjures up images of this place that are nothing short of idyllic. It would be nice to think that these images of beautiful places and people mean that this country will not have problems in advancing along the path to better health. But that is silly and fatuous thinking. What is not silly or fatuous is to believe that you have the will and resources to do so. These resources will be physical, financial, and above everything, human.
Therefore, let me end by quoting one of my favorite verses by A.E Houseman on the celebration of Queen Victoria's jubilee which is perhaps very appropriate, as this is the year of another jubilee.
Oh, God will save her, fear you not,
Be you the men you've been;
Get you the sons your fathers got,
And God will save the queen.
I am not particularly preoccupied today with the salvation of the queen. It is the health of St. Kitts and Nevis that concerns me, but the analogy is apt. Be you the men and women you have been and if you beget sons like Sir Cuthbert, there will be no doubt that the progress of health here will be assured.
I thank you for your attention, and both St. Kitts and Nevis and PAHO should wish each other good health for the next 100 years.
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