A Reporter’s Diary: Where Is The Public In Public Health?

Find a room somewhere on this floor was one of the first things I was told when I joined the World Health Organisation (WHO) in Geneva some twenty years ago. I picked a nice corner room with large windows and splendid sunlight. I had just finished arranging my books and bags when a worried man, a medical doctor, walked in saying I couldn’t sit in the room, not even if I were a P. What’s a P I asked him and thereby hangs the tale of nonsense, corruption and the nepotism in the world of public health where entry is controlled, conversations and questions are banned and deals are fixed.

I told the harried doctor to take a flying leap out of one of my windows. The immediate consequence was I was asked to move into a pigeonhole that amply reflected the suspicion and despair that hangs over multilateral organisations and their extension in Geneva wailing that they save the world as they go from conference to conference in lovely destinations (discussing poverty in Bellagio is my best), making powerpoint presentations prepared by unpaid and padding themselves with friendly NGOs who depend on them for grants.

Mediocrity is interestingly competitive because none knows where the top or bottom is. The Geneva and New York-based healthocrats (two groups I know) compete not to get the best of public health knowledge to the most people in the world or fight for access to medicines. These people compete to become a P5 (professional diplomatic status) which brings with it international business class travel, large tax-free salaries, subsidised education for children till the first college degree and subsidised healthcare, all paid home leave and pencils, pens are rubbers they can steal at will. There’s almost zero accountability – who is going to ask whom?

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Working in public health is not the same thing as working for a technology company or car manufacturer. There’s a strong ethical (some say moral) reason and standards to which people that help to save others from life and death must be held to. It’s called accountability and it must be transparent because it is our money. I genuinely believe there are brilliant investigative pieces out there waiting to be done, as the rot is rather visible. The Global Fund to Fight Against Aids, Malaria and Tuberculosis saw a chief leave under serious corruption charges and another, more recently under charges of sexual abuse. This happens in other organisations too but there’s a big difference – people working in public health think nobody can question them because they are doing good work.

Well, their time in the sun is probably shrinking and shrinking fast not only because development aid and assistance is looking inward (there’s less money) but also because human rights groups and civil society advocates are calling out the nonsense.

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That’s what happened in the southern Indian city of Hyderabad recently for the 50th Union Conference on Lung Health. @AnantBhan a researcher (bioethics), Adjunct Professor, past President @AIBioethics and Mentor @SangathanIndia made the much-needed conversation happen on Twitter and in some newspapers. He did not attend the event despite being part of an accepted symposium. He cited exorbitant fees and referred to @RemaNagarajan speaking to the same issue. Many journalists wrote and Médecins Sans Frontiers (Doctors Without Borders) staged a silent protest about access to TB drugs. His position was one of solidarity and empathy with people who should have been there but couldn’t afford to.

How could they? The lunch menu for the international delegates suggested baguettes when what India needs desperately is Bedaquiline. There was apparently no stock out of food and frill when TB drugs face stock-outs regularly. If this doesn’t churn your stomach, what can?

Yes, this makes me sick. Multi-drug resistant (MDR) the strain of TB from where return is difficult if not impossible is all around us in India. Eight years ago when I wrote that international staff of organisations was advised to take tests for TB, if they coughed for long periods, I was laughed at. That only happens to poor people was the refrain. I wasn’t the only one. Many people were ringing the alarm bells. But TB is a poor person’s disease, romanticised in films and love stories. Polish composer and pianist Fréderic Chopin spluttered blood as he played the piano, dying of tuberculosis. Indians wrote love stories as they breathed their tuberculosis driven last.

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Within 500 metres of each other in Geneva there are at least four large multilateral organisations all working on TB, HIV/AIDS, Malaria and Non-Communicable Diseases (NDCs). Surely, right – surely they can come together to save money and time, but that would put the Ps and Ds in danger. The fight to head these organisations is bitter – one head hired personal spies to spy on spies who were spying on him. Some decades ago a bitterly contested fight saw dead fish in fountains, all in the name of public health. I’ve had two careers since and I return a little to public health in Geneva, I find the same people saying the same thing with a tinge of Artificial Intelligence lingo and ethics thrown in to appear relevant. If it wasn’t for how grotesque it is to see people hiring their friends, families and significant others to jobs, it would make a for a good comedy film.

Twenty years ago panels rarely had women and certainly not women of colour. Geneva is the home of panels and there’s a new twist. Women are brought in as moderators not from the city that has more public health experts than cars, but from London. In recent years I have noticed something interesting. During one major meeting of the WHO I saw a British editor – a usual suspect – raise voice and shout at health ministers as if they were schoolchildren.

Speeches, oh, how could I forget! I wrote many 20 years ago. That time they went something like this. We must not leave anyone behind; we must put people at the centre of health; Women must lead; feed a woman you feed a family; Public health is a public good.

The same lines are being still parroted. But medical doctors have gone from knowing what they do to agriculture experts to climate change pundits – who say public health doesn’t follow the money! Sustainable Development Goals (SDGs) is soon getting pasée. The United Nations (UN) family is coy about publicly working with the pharmaceutical industry but takes money and resources from their foundations. They are unwilling and unable to call out conflicts of interest because they are sitting on so many themselves. That places an entire chain of command and actin into jeopardy.

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People are not data or numbers to fill an Excel sheet for the next round of grants. These are human beings we are dealing with. Taking selfies with them is neither funny nor intelligent. It’s arrogant.

I want to end this piece with a positive message to all those who are going out to claim their public health rights democratically. Do so with dignity and courage. Something is giving – we’ll have to hold together when it does to push it over the edge. Public health is one area where social media can play a very serious role. It’s happening.

PS. I didn’t write much about diseases. That’s for another column. The big battle now is to keep the focus on leaders and their retinue who skew the policy and resources pitch by switching off the lights. Hyderabad may have just started something.

(The views and opinions expressed within this article are the personal opinions of the author. The facts, analysis, assumptions and perspective appearing in the article do not reflect the views of Republic TV/ Republic World/ ARG Outlier Media Pvt. Ltd.)