health in a global world - my personal journey€¦ · malnutrition/retarded growth poverty and...
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Elizabeth Blackwell Annual Public Lecture
Health in a Global World: my personal journey
Dame Parveen Kumar DBEProfessor of Medicine and Education Barts and The London School of Medicineand DentistryQueen Mary University of London
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Introduction by
Professor John Iredale,Pro Vice-Chancellor for Health
Professor Rachael Gooberman-Hill, Director of the Elizabeth Blackwell Institute for Health Research
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Housekeeping• Fire alarm: no test expected• Assembly point: between Wills Memorial
Building and Merchant Venturers Building (exit left out of main entrance)
• Toilets: on the ground floor • Inclusive and accessible toilet• Hearing loop: avoid the edges of room and
upper balcony• Quiet room: room 1.5 opposite the Great
Hall • First Aid: please let a staff member know • Please keep bags and coats off the floor • EBI staff and student volunteers wearing
light blue badges• Drinks Reception in Reception Room
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Health in a Global World - a personal journey
Parveen J Kumar DBEProfessor of Medicine and Education
Physician and gastroenterologist
The 5th Annual Elizabeth Blackwell LectureOctober 22nd 2018
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Elizabeth Blackwell
1821-1910
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Bristol
Professor Ken Heaton
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• Global health ....the stark facts
• Devastating effects of wars
• Women in a global context
• Climate change
• Doctors and society
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Some unacceptable issues in GH
• 17 children <5 years old die every minute -70% of these are preventable
• MMR approaches 1000 per 100,000 in some LMICs
• 10 countries in Sub-Saharan Africa have <3 doctors per 100,000 population
• Government health spending in SE Asia 2.5% that in Europe
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Sanitation and water ( world population)
• 1 in 5 defaecate in open
• 61% have some improved sanitation at home
• 13% live where water is collected from distant unprotected sources.
• Improved sanitation leads to less diarrhoeal disease by 32-37%
Mahatma Gandhi 1923:
‘Sanitation is more importance than independence’
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Downloaded from: StudentConsult (on 25 October 2005 12:28 PM)
© 2005 Elsevier
Diarrhoea – 2.25m die yearly
Infectious diseasesMalnutrition/retarded growthPoverty and War
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Save the children
SACORE
NHS Acute hospital Trust Board
Chair-Medicines Commission UK
NHS for 43yr
NICEEducational rolesU/G, Post Grad, CPD.Chaired committeesStarted MSc ingastroenterology
Global health
Research-small bowel
President
President
President
Vice -President
President
Roles that I have had the privilege to hold
Council. Trustee
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Global health chapter
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Teaching, examining (MBBS,MRCP, Local examinations) and lecturingSACORE, THET, Royal Society of Medicine – started Global health programme Merlin/Save the Children
RCP, RSM, BMATHET, SACOREClinical Medicine – used by most medical schools around the world ( Not USA)- Huge privilege of being invited
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Teaching - Different culture, ways of teaching. Diseases -same but different in quantity ,
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2016: A year of major crisis for Global Health
• Conflicts remain the biggest threat to human development– Biggest refugee crisis since WWII
• By late 2014, 60 million people forced to abandon homes
– Destruction of infrastructure
• Other challenges:– Big gaps between poor and rich , rural and urban areas
– Gender inequality persists
– Climate change and environmental degradation undermine progress achieved and poor people suffer the most
– Millions of poor people still live in poverty and hunger without access to basic services
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Liberia
• Highest infant and maternal death rates
• 14 yr internal civil war
• Infra structure destroyed – roads, electricity, houses, food sources
• Killings, rape, mutilation, child soldiers –drugged, plunder
• People left devastated, demoralised,
• 40% malnutrition in children – in fertile land
• Female genital mutilation 70-85%
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A fertile land ……yet malnutrition
……Local cultures, taboos
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Cerebral malariaBurns ( open fires in huts)
Ante and post-natal wardHIV TB, diarrhoea, (tetanus)
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Merlin run hospital in Buchanan
Empty dispensary ….but computer! Crowded wards – few facilities
• Hospital - 80+ patients (women, children, men) • 1 doctor• NO Xrays• Lab – Smear for malaria only• 3 treatments – analgesic, 1 antibiotic, anti-malariaWonderful committed medical, nursing and ancillary staff
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Madam Ellen Sirleaf JohnsonPresident of Liberia
2011 Nobel Peace Prize
Leymah Gbowee of Liberia and Tawakel Karma of Yemen
Non-violent struggle for the safety of women and for women’s rights to full participation in peace-building work.
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Pre-partition - Lahore India
Family history
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Escaped in an army convoy
Partition
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PARTITION 1947The very painful division – riots, migration, looting. Killing, bombing
Google images
Evacuated in an army convoy
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The Family united in Nanking (now Nanjing), China
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A lunch hosted by my parents at our home. Indian Ambassador, SirdarPannikar, is at the back (4th From left). Others are dignitaries from the UN and Government of China.
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Chinese civil war 1927-37
1946-50Sino- Japanese war in between
Fled back to new INDIA- Lived in tents
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Boarding school
The Lawrence School SanawarSimla Hills
School moto : Never give in
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Travels of the family – Left India for the UK by boat (Batory)
Training doctors for the world
3 weeks on a ship
By air on a clipper
evacuated in an army convoy
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New Young Doctors at Bart’s Hospital 1967
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Women– in a global context
• Most important - for family survival
• If mother dies - child is unlikely to survive
• Educate women
• Raise their status in communities
• Simple healthcare/nutrition/cleanliness
.........however
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Elizabeth Blackwell
“A blank wall of social and professional antagonism faces the woman physician that forms a situation of singular and painful loneliness, leaving her without support or professional counsel”
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Every Minute...
Maternal Death Watch
• 380 women become pregnant
• 190 women face unplanned or unwanted pregnancy
• 40 women have an unsafe abortion
• 1 woman dies from a pregnancy-related complication
Courtesy of Prof LRegan
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Levels of Maternal Mortality
Courtesy of Prof L.Regan
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‘Women are not dying of diseases we cannot treat.
They are dying because societies have yet to decide that their lives are worth saving.’
Professor Mahmoud Fatallah
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Elizabeth Blackwell
‘If society will not admit of woman's free
Development, then society must be remodeled’
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Ethiopia
• 12 new medical schools with European curriculum
• Taught about modern medicine but ....no modern equipment/therapies
• Young leading with little experience of medicine
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Ethiopia
Impossible decisionsNo imagingShot by husband …multiple fractures. Very poor prognosis.
Husband goes free.
Student ward roundAfrica ..but Western medical textbooks
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From www.gajit.com
Global warming
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64
36
20
80
Percentage change in yields to 2050
-50 -20 0 +20 +50 +100
UN Development Programme, 2009
Plus climate-related:• Flood/storm/fire damage• Droughts – range, severity• Pests (climate-sensitive)• Infectious diseases (ditto)
CLIMATE CHANGEPoor Countries Projected to Fare Worst
MODELLED CHANGES IN CEREAL GRAIN YIELDS TO 2050
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The “Cuban paradox”The power of public health
How can a country in economic crisis for 20 years
• achieve first world health statistics?
• send >30,000 trained health professionals to poorer countries?
At 1959 revolution:• IMR 65/1000 live births, life expectancy 58 years• 50% of the 6,000 Cuban doctors fled the country
B. Sethia
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Health inequalities stem from social inequalities
Where people are born, grow, live, work and age
• The poor tend to be unhealthy
• Significant social gradient in health
- the lower the persons social position
the worse his or her health
Best health + life expectancy in university educated
Michael Marmot
UK Marmot Review - Fair Society : Healthy Lives 2010
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Lives on the Line
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The Jugaard principle- frugal innovation
6 principles:
• Seek opportunity in adversity – use problems to create innovation
• Do more with less – be frugal
• Think and act flexibly- improvise, adapt
• Keep it simple- simple to make, use, repair
• Include the margin – use marginalised market
• Follow your heart- solve a problem
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Learning from LMICs
Improving health and well-being at lower cost
• Technology
• Innovation
• THINKING DIFFERENTLY
– Task shifting
Google picture
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MEDICINEAND THE
MEDICAL PROFESSION TODAY
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A ‘changing’ profession
The doctor and his patientCompassion, empathy, altruism
Advanced technology +
Patient involvement
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Pool of Bethesda Barts Great Hall William Hogarth 1697-1764
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Lancet 1999
‘Medicine used to be simple, ineffective and relatively safe. It is now complex, effective and potentially dangerous’
Doctors have a greater capacity to do good
but .....their capacity to do harm is greater than ever
Sir Cyril Chandler - Editorial
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Number of Doctors, Nurses and Midwives per 10 million population (WHO data)
Crisp N, Chen L NEJM 2014; 370: 950-7
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Summary
• Human rights for all
• The devastation of wars and conflict
• Educate women – best for survival of the family
• Innovate. Think of simple ways of doing things –Jugaard
• Medicine is getting complicated but a lot can be done in low income countries with collaborationbetween countries
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Books for backgroundGlobal Health: bringing new thinking
to the NHS
2007 2010 Lord Nigel Crisp
Written by 127 medicalstudents from
all around the word.
Proceeds to Global health Student projects
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Never give up!
• ‘Courage is going from failure to failure without losing enthusiasm ‘
Winston Churchill
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Final remarks by
Professor Rachael Gooberman-Hill, Director of the Elizabeth Blackwell Institute for Health Research
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Thank you for attending
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