Wednesday, April 18, 2018

WHAT HEALTH, WHOSE HEALTH

I have been a field worker in the field of health for years without ever seriously having to ask myself what health work really is.

What is it? First of all it is my bread and butter. I am a travelling operator for the great firm of global Health Industries unlimited. I have been trained in the use of its techniques and materials. 

I may work for public sector, or private sector, or a purely personal sector. I have something to sell: There are customers: The proceeds support my life. Consequences follow: Investments: returns: measures to break down customer resistance - propaganda, advertisements etc. 

The process whereby health has become a 'commodity' and the consequences thereof have been most clearly brought out by Ivan Illich in his book - Medical Nemesis, the most challenging work of the century.

Now, all human life is commerce; all life is commerce - a mutually beneficial (or harmful) transaction of energies between the organism and the environment. This simple transaction has become increasingly complex with the evolution of new forms.

The tiger is hungry. It kills a buffalo and eats it. But it certainly cannot make ten tigers kill a thousand buffaloes: make ten other tigers skin and cut up the buffaloes and store the meant in coolers in order to sell the meat to tigers who have no mea in exchange for refrigerators to store meat and television sets for lonely and lame tigers to watch distant buffaloes. The tiger, then, delivers a public talk on how it is doing its best to save future generations of tigers from dying from lack of buffalo meat.


Purshi, from Wikimedia Commons
It is said that a certain boy wanted to be a monk. As he was too young he was refused. Thereupon, it is said, that the Buddha himself asked the lad some questions, the first of which was 'What do men live by?' and the boy answered food. The Buddha accepted the boy as a disciple, for the boy learnt to recognise fundamental truths, without recourse to specious rhetoric. Ramakrishna also says that the whole of this civilisation is an extension of the stomach. It does not mean that Buddha or Ramakrishna recommended this state of affairs. Only , when the root or reality is grasped, the dissatisfaction with this reality and the search for another reality begins.

"Ramakrishna trance 1879" by Keshab Chandra Sen - Scan from The Gospel of Sri Ramakrishna. Licensed under Public Domain via Commons 

The health industry and its personnel differ from other industries in one important respect. In the other enterprises like engineering, the persons concerned have not much difficulty in confessing to themselves or owning it to others that they are working in order to get food and/or its sublimated forms - fame, name etc.

The Health Industry and Health personnel rarely, seriously confront themselves with the basic truth that they are working for their stomach and its cortical equivalents, and more rarely own it up to the public except as a platitude or joke, expecting it to be hotly denied by the audience. Even when they go on strike for increased pay, rarely does a patient (in India at least) think his doctor as any other than the selfless mouthpiece of Aswins, the twin gods of health.
The doctor himself seems to firmly believe this.

There is not a single house where one or the other member of the family does not refer to some pronouncement from the Holy Health order or advice on what to eat, how to breathe, how to be lean or fat, how not to smell of sweat, how to sleep, what disasters occur if you don't take vit X, why though you think you are a picture of health you may be harbouring cancer or high blood pressure or diabetes , and how you can easily go to the nearest parish chapter of health and get your fears of cancer replaced by fear of the less dangerous possibility of Asiatic flu, or you look healthy, but are you sure you don't have a hole in your tooth and so on. Despite the schisms in the Holy Health order and despite the fact that their pronouncements are always modern, latest and up to date , in  the sense that their pronouncements vary and change, these pronouncements are by and large swallowed, and by and large enforced. The orders are never questioned, for have not the priests offered a million sacrifices in their laboratories ensuring themselves greater assurance than the oracles of Delphi or the Tantric priests of Kali?

It is not only the literate customers that are caught. The cinema, the TV, and the satellites are roped in so that the edicts of the order may reach the humblest villages, who hence forward may sit at the primary health centre with a temperature of 99 degrees Fahrenheit, playing cards with fellow sufferers under electric lights of the rural department, waiting for the visiting health unit to exclude all possible causes of diseases and death tabulated by the Holy Health order.

Unlike in other industries, the Health Industry invades the whole of human social fabric - food, clothing, housing and schools and what not.

If food is one foot of reality of present human existence, their fear of death is the other foot. The Health Religion provides an admirable array of profitable palliatives for this universal pursuit for immortality. 

It is not only Western medicine that constitutes this Health Order. Others are already in or desperately trying to get into the band wagon: Ayurveda, Homeopaths, Naturopaths, Hatha Yoga and so on.

The common denominator seems to be fear of death on the part of the customer and availability of glossy talismans with the sellers. Both hardly seem to consider why the writer of the book on how to live a hundred died at 60 years or ask any other similar question. Such questions are raised as platitudes and rarely is the serious import explored. Those who explored became gods or freaks or martyrs in the hands of the vast multitude who do not expect their questions seriously tackled.

At this point, for all practical purposes, health may be defined as 'Health is what the Holy Health order decides it to be and a healthy man is one who does not, or is not likely to suffer from or be prone to any of the illnesses listed in the Holy catalogue of diseases, and who directly or indirectly buys at the health depots all that is claimed to save the customer from all danger of falling into the proscribed list of diseases. If even then the buyer succumbs, it is because he has transgressed the holy writ or he had not had the benefit of the latest revelation made at a bigger depot.

If any medicine man feels that he works for the health of the public he is most welcome to verify for himself that if there are no patients at his clinic for a week, his wife and himself would be at the nearest temple offering coconuts to Hanuman requesting him to send patients. The great harm, or even the root of disaster is not that the doctor works for food, but that he believes that all he does is solely in the interests of the patient's health. The patient shares this belief.

The doctor's belief that he is saving a person from disease and death and the person's belief that he is being so saved by the doctor sustain an illusion that seems to grow in strength, evidence of millennia of experience to the contrary pointing to the unreality of this illusion. I might say that the health theory and practice have not produced such startling results as to preclude all serious inquiry into the fundamental nature of health. 

It is pertinent to ask the question - what is this 'body'? Is it to be taken as a passive plaything pandering to the beliefs of two persons?

Has it any role apart from being a guinea pig? Who and what is that says I am ill? Can this 'I' which is usually ready to destroy the body by suicide at the slightest frustration, or is willing to have it cut or swallow anything offered to it without the slightest interest in the matter be really considered as the real owner? 'Do what you like doctor, I am in your hands. I completely surrender myself to you'. What is actually behind this high faulting surrender with a smack of spiritual vener, is 'Doctor, I surrender my body to you. Do what you will. But I shall not surrender one bit of my stupidity, my greed, my anger, my hatred, my intolerance, my habitual lying and cheating, in obedience to which my body has become ill. Do something, doctor, anything you like, to this body of mine, this horse, so that it can obey me and enable me to continue on my usual road to being the most clever and well-provided for average buffoon on earth. I surrender all except my stupidity.'

And the doctor, who has already surrendered his 'subject' at the medical college gate, accepts this surrender, and one more 'objective' guinea pig has been provided for his scientific work. Be objective - exorcise the 'subject'. There you have it. The greatest scientific achievement of Health Industry is that it has surgically removed the 'subject' of health. Is it not time to seriously ask, "Who is the 'subject' of Health?"

Now I shall take you through a sample of health concepts observed in practice. I am a civilian doctor. I watch my professor seeing a rich patient with 100 degrees Fahrenheit temperature and a little malaise. "Mr. Jones, we have examined your urine, blood and X-Rays. Nothing serious. You are working too hard, probably a bit of flu. Better stick to bed for a few days and keep out of chill. Hot chicken soup and a bite of toast. In any case, no work. Just lie down and relax, let the office run by itself.  

So, I learnt one principle of health. A month later I join the Army and become a regimental medical officer to a Rajput regiment during war time. At the first day's sick-parade in the morning there were about 20 soldiers. A few of them had 100 degrees Fahrenheit and a little malaise. I ordered full investigations and recommended three days bed rest, hot soup and asked them not to worry and let the Army look after itself. The sergeant-in-charge could not believe his ears. An hour later I was called to the phone, and the voice of the colonel of the regiment bellowed at me. 'Where the hell have you learnt our medicine, doctor? Is 100 degrees Fahrenheit a temperature?  The regiment is marching tomorrow and I can't leave half my men here. So, you will march along, doctor, and see that these men have bed rest while marching.' They marched and I marched. I do not remember anything dreadful happening to them or to me.

It is quite clear that what is health theory and practice is not quite the same for Mr. Jones, the business magnate, and Ramchand, the sepoy.

Climbing mountains and getting frost bitten and fractured, and persisting in such ambition is sign of healthy life for a mountaineer. It is not a sign of suicidal mania or accident prone neurosis. In a mountaineers' club, a man conforming himself to the principles and precautions of health manuals will be considered a health hazard.

A friend of mine, a medical man, concealed an old tuberculous pleuritis in order to escape being sent to a base camp, which would have prevented his epidemiological work which he loved, So it seems to me that if medical theory cuts its size and shape to the clients' social status, the goal of healthful life and what is health vary widely.

Let me take you to the railway station at Commila during the war time and famine in Bengal. Here is an emaciated woman snatching away a banana peel from the hands of a skinny lad and here is another bony ghost of a woman tottering with a morsel fo something to give it to a child. Health is based on amino acids.Take away the amino acids and you have the essence of the subject of health - a beast or a saint.

Then I have read a novel about a number of sailors stranded in a boat on the ocean somewhere. Faced with extremes of hunger and armed with knowledge about calories and human health, they cut up and ate one another.

Then I have read about captain Scott and his voyage to the Antarctic and his diaries - a voyage of a truly normal human representative on the sea of life. Then, too, I have read a few research articles on glossy paper about the disturbing effects of vitamin C deficiency on human behaviour.

Scott, Robert Falcon, via Wikimedia Commons

There was Jack Kennedy who with an injured back, exhausted, swam in the sea rescuing fellow sailors, unmindful of over-salination and dehydration and starvation. It was most unscientific, for had he known better he should have eaten his fellow men. Also unfortunately there was no pH indexometer close by to tell him to give up. 

Here is the person in the ward for terminal patients. This man has cancer and pain and is bedridden. I see visitors, relatives go in to sympathise, with tears in their eyes, and see them come out with a light in their eyes and a smile on their faces. 

Here is the person in the other ward. He has a fractured wrist, is in plaster and the brother who has gone to see him comes out a picture of misery, for the person is in pain and nobody is doing anything, and the visitor has been told how unfeeling he has been and so on.

Health is not just a one man concern. It affects others - not in the way an epidemic spreads, not just a matter of germs being carried. To investigate health with germs as the centre of the stage is to miss the whole point of man as new phenomenon.

The human body appears to be filled with innumerable alternative mechanisms whereby even under extremes of deprivation the body is able to express the aims of the personality.

A health science which is objective and piously deals with all other questions except the subject of health, is, well, yes health! For society has not yet decided who is the subject of health. I speak of myself. I understand less and less of man as I cut up frogs, rabbits, apes, higher apes, dead bodies, foetuses and prisoners and am also encouraged to sell my eyes, my kidney, and brain with a view to profitable business in human spare parts, and don't throw up your arms in cynical sneer at an unscientific man. Textbook of human physiology is the cover title on a book which is merely a massive collection of data on astronomical number of animals killed and on an equally large number of highest apes who have agreed to have themselves treated as test tubes and robots with changeable parts. It is not the textbook of human physiology it is the physiology of the highest ape, desperately trying to descend lower and lower into heights in the scale of apehood.

It might be argued that the Health Industry is not designed to cater to the exceptional cases and that its task is to cater to the needs of the average man. Not only does it succeed in catering to the average man but admirably manages by all the known business methods to keep the average man multiplying and the degree of averageness increasing so that there is hardly any danger of glut and slump in  the health industry whose target is the average man. By assiduously inducing the idea that statistical average of physical measurement and psychological behaviour is somehow the normal, the ideal, the goal is achieved. 

The 'normal man' is 5' 6" high, 70 kgs weight, eats three square meals a day, with at least one pound of flesh (only animal for the present), adequate vitamin coverage, has three orgasms per week, has normal amounts of aggression and greed, and hate, and knows what the time of day is and what to dress, and where to be nude, writes and talks filth but drinks sterile water, plays three games of squash, provides for his future, and has BP 120/80 mmHg, and smokes nicotine free cigarettes, uses condoms when visiting prostitutes, believes in Algebra and Astrophysics, has reasonably rational beliefs, visits the dentist once a month, sees his doctor every three months, lies down in an isolation ward for common cold so that others may not catch the infection, has an IQ of 110, has his children triple and quadruple vaccinated, reasonably hopes to have his heart replaced by a new one, and has evergreen hopes of living endlessly doing the same stupid things over and over again for another hundred years. 

At some stage, this idol of perfect health gets himself entombed in a box of ice. A hundred years later the body may be revived and with the latest technology of a century later he can be filled with brand new parts so that he may repeat his miserable life another century.

No, sir, the average man is the undying god of Health. He will and must remain average and while doing all we can to keep him average we will do our best to prevent epidemics, and wars which are the results of his determination to remain the average man. 

In the global conspiracy to keep the average man average the health industry over the ages has played an important role.

There is worse to be considered. The effort is not only to tie him down to his miserable average, but to drag him down to his animal base. Scientific investigation and publication at unlimited public expense is executed to demonstrate the very obvious biological origin of man. But, the covert and often overt purport of these specious scientific investigations and publications is not merely to demonstrate the biological origin of man, but to provide a solid excuse for man to continue scientifically as a chimpanzee armed with a cortex, contraceptives and atom bombs, and thoroughly devaluate the slightest advance a human being aspires to in the scale of evolution.

My interactions in the field of health lead me to question the very concepts of health as perceived today and the practical consequences of such concepts which are self defeating.

To cater for an average man in order to keep him a healthy average man with the permanent goal of averageness in view is like trying to scale mount Everest while making sure that everyone is lying flat on the Gangetic plain and also making it democratically obligatory for all to do so, with sterile safety belts on.

I have raised some doubts against the background of my empirical experience. I have no definite answers. Some of my other lectures might provide some ideas of my approach to the problem of health as met in the individual and the collective. I am not asking anyone to shut their shops. All I am asking, requesting, as a customer, is dear Sir, have you looked at the short and long term effects of your goods on man or are you looking at the health and longevity of mechanised apes? 

Page copy protected against web site content infringement by Copyscape