January 30, 2012

Health is a right to be delivered and consumed with responsibility

Health and human rights is a salient topic growing now within the global discussions on health development. And this period in the life of Maldivians is a very appropriate moment to flag the idea of health rights as we seek to understand, and nurture a fledgling democracy. Democracy and the right to health have close bearing. In a democracy we the people are the rights holders and those whom we have elected to govern us are the duty bearers.
Thus providing the opportunities for creating health must be the responsibility of the leaders. And congruently, to use the provided facilities by the public must be with a sense of thrift such that what we are given is used with wisdom. As we say in Maldives, "dhey meeha dinas kaa meeha kaan vaanee balaigenney" (even though someone gives, the one who eats must do so with restraint). Thus a benefit such as the Madhana of the past couple of years or now, the Aasandhu, must be used with a frugal mindset - being aware that the resources are limited and that this comes from our own resource; the budget for this is coming from the hard work that we have put into our economy being ferreted from overt and covert taxes.

I will not dwell here on the efficiency or effectiveness, or for that matter, even of the probity underlying the establishment of such a universal access processes so to say. The proof of the pudding will be in the eating. But a caveat here is the call for us to realize that this availability provides the avenue to flagrant misuse of the resources if the public are not made aware of this moral underpinning of the collective responsibility to be frugal. This must be a part of the structure of the process of doling out the funds, or it must be the face of a good public orientation process. When the funds run out through the exercise of possible irresponsibility by the public or the craftiness of the providers, the folly of such a quickly-cobbled-together endeavor will be revealed when the funds to sustain such a populist policy runs out. Medical care is a necessary part of the health rights demand and also happens to be the real costly segment of this process. But unfortunately, medical care alone will not make us healthy, it will only take us out of an illness which we are bound to get again in an environment that does not provide the preventive and promotive avenues to keep us healthy. If that latter is not thought through, the money doled out will only prove to be a waste of precocious resources which could have been used on more prudent health system strategies.

January 27, 2012

National day sentiments

Two days ago, the first of Rabeeul Awwal was a very special day for me. For one thing, it was my birthday on the Hijri calendar. But setting that aside, it was also the Maldives’ National day - the day when our Dhivehi-Raaje was rescued from the domination and yoke of the Portuguese in the 16th century; and the triumph of our national religion Islam.

Given this backdrop, what is the significance of this to our life as a nation? To my mind, it is to remember the agony of subversion and to celebrate freedom. It is also a time for the young and youth to connect with the legacy of our past and the notion of a one-Maldives. But, regretfully, this day in 2012 was marred by other untoward emotions. The present internal turmoil on our pristine coral soil is something to reflect on and feel the lament. A nation of such social and religious harmony such as ours must reflect it on the ground also by our actions. Artificial divisions only bring about conflict. And we as Maldivians need to look at the bigger picture that harbors on common interest rather than on the individual interests that can never be bridged without the effort of listening, accepting, reflecting, and dialogue. Anger is never assuaged by anger as fire is never squelched by fire. There has to be a give and take that will neutralize the war of words and swelled egos. The welfare of the majority of those who don't have voice must be protected by those who have the voice. This is the meaning of stewardship in a democracy. It is not for the powerful to take the day. But the powerful to prove they have compassion to exercise the responsibility that comes with the power that was bequeathed to them by vote or wealth. We cannot let the adage "a nation deserves the leaders they get" get the better of our national sensibilities. May Allah Bless us all as Brothers and Sisters of a common nation and clear the haze that blinds our eyes.

January 24, 2012

Mindfulness - being aware of the consequences of our actions

In a discussion today, a friend brought up the subject of the relative merits of my kind of advocacy in these blogs. How much do people read and actually want to change the way they are doing things? For instance regarding “where have all the grandparents gone?” he seemed to be of the opinion that this world is changing so much and however much we believe in the truth of what is being said, and accept it intellectually, we go back to the same life milieu and just forget the good words read. So how do we move people to action?

True, the obstacles are immense, for the modern development paradigm shows us all the enticing reasons to be separating ourselves from the crowd so to say, and taste the pleasures life has to offer just secluded in ourselves. It is rational too, for given the money most of us make, how can we live a life with others that will compel us to share what we have, and the work culture too: what when we have no control over where one has to get a job and have to relocate? All true and no one can argue that these are reasons why we do what we do. But perhaps, we can look at our arguments from another angle too if we so desire. Forget for a moment about this specific topic of living in nuclear families, moving to a larger house, or sending the kid to an international school. Let’s reflect on why we do it. All these are actions we take may be because we see our friends doing it or it is the way society is moving along in a new era of global habits and values.
To begin with, a few of society’s elite take this route because it is possible only for them because they have the money or because they want to be different from the others who don’t have so much. But soon, someone makes it a business model and it is made available to every one for a price that is affordable to many, but because this model already has the elite brand (the commercials do a great job of it – like enticing us to take our kids to McDonalds or the like --just because it is the in thing to do – even thought it may be to have a meal that is full of calories and which may not be good for you to indulge in too often) we all lap it up for the ego basis of our minds precedes moral value. As the masses grow into this fold of modern behavior so to say, slowly, the exclusiveness that defined the move in the first place is soon no more and the market quickly makes adjustments in look and rationale to entice the elite again in an upscale model. Soon the cycle starts over again. The masses are kept fooled every time (human desire is a very powerful thing and the market uses it superlatively) and big businesses mint the benefits.

The issue for us to understand here is about the consequence of all this. The separations and divisions these movements create in society and the ensuing conflict because of it. Given the specificity of vested interests in our societies, there will be arguments to the contrary, but a universal law cannot be negated. “Division precipitates conflict”. Whatever value is the basis of this separation --social, economic, political or religions – we have to accept that there will be conflict where there is division. For social harmony to prevail, getting out of this morass of view points is crucial -- to come to a common understanding “temporarily” through discussion and compromise or to come to a “permanent” consensus through acceptance and deference to majority views. If neither is possible, then the reversion is to measures uncalled for in a free society.

So in our society, the way to go about would be, as my friend and I finally rationalized and accepted, was to make ourselves become aware of where these desires of ours arise from. Mostly it is through our bloated egos – that intense desire it compels us to indulge in just to be different from what our brother or sister is; to feel for a moment that we are “better than’ our brother or sister. This competiveness is what propels us to want more and more. But yes, after we have this pleasure or that, we soon get tired and bored of it also and would want to move over to yet another glittering vista which will also wane sooner than we might expect. Be it a new house, a new car, new position in society, new friends and icons, and even life partners too if our thoughts only dwell on the surface where desire only reigns. Sad but true. But just being sad and being momentarily sparked is not enough to change our situation. To really want to live with our grandparents and see them as value to our values, we need to move towards greater self realization and self awareness by learning to be more mindful and understanding of the consequences of what we do. This will lay the foundation to healing. Being blind to the consequences of our actions, by believing that freedom is about doing whatever we want without being mindful of the consequences of our actions is to say we are very irresponsible as individuals, as parents, and ultimately as leaders. How can we build a sustainable and caring society with shallow and temporary mindsets?

January 19, 2012

Intensive and persistent larval and parasite survey is needed to keep malaria at bay

The World Malaria Report 2011 says there is a significant decrease in malaria deaths in our South-east Asia. That is good news to all.
I wonder how many of our youth in Maldives know we had a disease called malaria afflicting us for centuries. Yes, it was, and it took many a life and left families bereaved. Ibn Batuta the famous traveller of old, (who visited Maldives too--and incidentally, was also the chief Ghazee here for sometime, I believe, during the reign of Queen Rehendhi Khadija) even mentioned this disease as the Maldives fever. But due to the good effort of the energetic health workers of Maldives and the support of WHO, this disease is now history in our country. By the Grace of Allah, we achieved this way back in 1986, but we need to constantly keep up the larval surveys in our islands, and the active case detection at our entry ports to keep vigil of visitors from malarious countries. Hopefully this is being carried out with no less vigor. I say this because, given the new decentralized health structure in Maldives, and the role of being active mover in this now being the city councils, the control processes need to be well clarified and established as operational policy in the Councils. A lapse may leave us vulnerable again to the risk of this devastating disease, and having to re-enact the hardships of decades ago; and I can tell you personally, it's an understatement to say that it was not easy. Concerted supervision and surveillance is the way to keep the disease at bay and keep the tourists flowing in.

The world report 2011 goes on to say that "With an estimated 28 million cases and 38 000 deaths in 2011, malaria remains a significant public health problem in South-East Asia. However, malaria incidence and deaths have decreased significantly in the last decade, according to the World Malaria Report 2011. Globally, the estimated incidence of malaria has reduced 17% between 2000 and 2010, and malaria-specific mortality rates by 26%. This is attributed to increased availability of long-lasting insecticidal nets, indoor- residual spraying, better access to diagnostic testing, and effective treatment with artemisinin-based combination therapies (ACTs). Increasing drug resistance however, is a challenge. Resistance to artemisinins – a vital component of drugs used in the treatment of the most dangerous types of malaria – has been reported in a growing number of countries in South-East Asia".

January 18, 2012

It’s not the stars, it’s our conviction

Many people believe in the stars to guide their lives. But the problem with believing in the stars is that we begin to not believe in ourselves. There is a curious aspect to this very human foible of succumbing to the stories of fortune tellers - even by those seemingly disbelieving in it. On the one hand we tell ourselves that it's not true and agree that it is our conviction and belief in ourselves that drives us to success. On the other, we are nevertheless drawn towards any opportunity to eavesdrop or even participate on a discussion on horoscopes and fortune telling that draws a bit of the fatalist in us. In fact many seeming disbelievers in fortune telling visit in covert, popular sooth-sayers to get their "guidance", and yet pretend they don't believe in the hocus-pocus.

The reality is that we have been given the faculty to discern - our free will so to say, to decide on the route of life to take and within it various roads we want to traverse. Yet, it is our spiritual belief also that there is a destiny planned for us although veiled from us. Knowing the specifics of this "plan" beforehand will obviously take the will out of our freedom that Providence has bestowed on us to live our daily lives as we wish. But that doesn't negate the fact that something has been planned for us - we just don't know it. Perhaps, ignorance in this case is bliss. Cause and effect is the linear path this life has for us to construct our rationality; the non-linear synchronistic path of the spiritual dimension is for good reason, perhaps incomprehensible to us. So not knowing our future should not hinder us from making our "free-will" based decisions to chart our hopeful futures. Going to the sooth-sayer will only depress us if obstacles are foretold (whether they be true or false) and hinder us from giving our bet shot at life. The reverse may also happen - that a good portend may carry us in glee – for a while. But this kind of blind dependence on the advocates of others will ultimately rob us of our self worth and the essential quality of what it means to have free will. In such a state of dependence, we are no more governed by our free will but under the yoke placed by someone else. What good can that do to us in a world where we are trying to be free? Ultimately, freedom means freedom of the mind. We are what our mind wishes it to be. And when we set our minds in the strong conviction of our belief in the path we want to take, that is the destination "written" for us.

January 17, 2012

Division is anathema to peace

Continuing on my last blog post on the circle of life, let me say that we would hope for each such successive cycle (each generation) to bring with it enhanced social and economic and spiritual wellbeing. But such development cannot happen without that necessary factor called peace. And a divided society is never going to have peace; this is a universal truth, given that separation always brings about conflict. Democracy as a means of governance was meant to bring varying viewpoints to the table for consultation -- not to have heels dug in to maintain positions and interests. If we look deeply enough at any issue we can always separate our interests from it - if we so desire. But this is often hard to accept, even if understood, in a situation where the social climate is inflamed by anger, jealousy and greed. Where success in addressing an issue is the motive, whether it be social economic or political, it has to be achieved through mediation, negotiation and acceptance, either through consensus or through the crafting of good win-win solutions. But such solutions cannot come about through confrontation. It can only come through consultation as what our Islam encourages. It is easy to inflame anger, jealousy and hatred and the desire to win on an issue. The one who is louder, stronger, or who can shame the other, may win for the day. But the win will no doubt be only momentary and while the loser relents, either through fear or shame, would surely be marking time to battle again once the wounds are licked and healed, and the time is right again. Who can be that vigilant for anticipating when the next strike will happen? How can peace prevail in times of such anxiety? Alas, winning is only a dream from which we will quickly be uncomfortably awoken. To lay the issue to rest would require that anger and resentment to be reversed through discussion, through suspending our assumptions, pride or conceit, and seek to understand the view-point of the other through intense listening and attempting to truly understand the other. Only through such dialogue will peace prevail. Let not our oneness as Maldivians be divided by the seeds of discontentment sown by alien thoughts that dazzle us for a moment but will leave us regretful when the dust settles. We need to listen to our hearts to piece together a home-grown approach that will serve us best to bring about social harmony and peace in our homeland.

January 16, 2012

The circle of life

A dear friend died the other day.  And when people die the moment is one for reflection. To realize that there is a circle to life. We all have our time - to come and to go. In between we do our share of service to ourselves and to others. Joy and sorrows are a part of life. Our life begins with joy and laughter from others as we come out crying and we exit when our time is done with laughter in our hearts and leaving shimmering tears in the eyes of our loved ones. What a reverse? But such is life. And so are the ups and downs that characterize our life on this earth. For us to be living a fulfilling life with the least amount of stress we need to accept the joys and sorrows that cross our path with equanimity. The circle of life will have to be enacted for life to flow as it should. Circumventing it will bring conflict and sorrow. The young will grow to be youth, progress to the grey years and finally make our exit -- some say it's a passing over, some say it's death. The experience and wisdom reaped in the life lived will be what drives, energizes and sustains the generations that will come after us. An awareness of this dynamic is essential for us to feed the future with the stuff that will make tomorrow better than today. It is this awareness that will lay the foundation to love and social harmony rather than confusion and conflict.

In our sphere of family, education, health, and even governance, the circle plays out its ecological role. Learning, experiencing and discharging accumulated wisdom is the path life leads. A parent cannot be younger than the child, the teacher than the student, and the leader than the led. Wisdom builds on itself to make each successive group of human beings richer in knowledge and experience. To the degree we use this gift of Providence with abandon will lay the foundations and sustenance to a harmonious future. 

January 10, 2012

Celebrate the home island

My last visit to my home island brought sadness. The Male model was being enacted piece by piece. High rises were beginning to raise their heads above the digga trees, few cars plied the coral streets compacting them to an impermeable base that sealed and pooled falling rainwater into deep muddy puddles that stagnated, few motor cycles on languid rounds during the day, transformed by late night into a noisy horde rushing around with pillion-rider girlfriends. Will history have to repeat itself, and is this the only model of urban development we have to follow? Let’s go into a national reverie of refection and not be in a hurry to follow the leader.

True, being an island nation, our tropical environment has been a boon for the rise in our wealth over the past close to forty years. Yes, it’s been that long since our tourism boom began. The value visitors attribute to Maldives is its pristine beaches, the lush palms and the balmy environment – a sea change from the cold and grey winter weather and skies of Europe; that was the beginning. Of course later, as Maldives became a famous travel destination, other countries too joined in the rush, and it was no more to get away from the grey skies but just to enjoy the sea and sand and the corals for what it was – bounty in the tropics.
So our sustenance quickly became tied to the value of our environment. The price the tourist paid for the visit was the peg of value they attached to it, which was very high given that some pay thousands a night to spend under our star spangled skies. The wish for their resort to be as natural as one could possibly be, for most don’t want a repeat of the plush hotel environment they left back home. Our most sought after holiday berths may perhaps be our most naturally inclined in decor and surroundings. These hotels manage their solid wastes, their water and their sewage in ways that hurts the surroundings the least. For the owners, it is about managing their bottom line. More value for money. For the tourist it is the difference; a celebration of what they didn’t have at home.

The irony is that the rest and recuperation others come flying into Maldives for a thumping fee can be had by us for a trifle, if we could only learn to appreciate the potential for health and wellbeing available in our own home islands. If we can for a moment appreciate the fresh air, the stretch of open space, the close feel of family and friends, and the relaxed mood of our home island surroundings; not let it degrade into muddy puddles we have to clean up now by ourselves because we have opted for a democracy that places the onus of such responsibility only on us – not on a government in Male (if democracy and decentralization is to be comprehended in its right sense). True, there is a natural draw towards what is different and that is perhaps why most of us are drawn to Male, our urban square mile of chaos. Just as those tourists are drawn to the difference of the environment that Maldives is to what they left – for a while, I would hope that the stay in Male for many of us would also be a sojourn rather than a re-location.

With decentralization, the move to the islands must begin – to make our Councilors accountable and the governance system viable. We need an enhanced sense of responsibility to make the land we were born in a place of reverence, so that we can bring up a new generation of Maldivians to love their surroundings as if it was sacred. For regional development, following the urban chaos of Male should not be the choice. We need to think anew by reflecting on why following Male’s development model would be a folly. Reflect and confirm in our hearts the advantages, not just of the economic but of the social and spiritual that will be gained by our proximity with our loved ones, our home communities, and the priceless bounty of our environment. We need to build the social and cultural ties that bind us as a nation; not be just gung-ho on the economic wellbeing that inevitably brings competitiveness, envy, jealousy, division and conflict.

January 6, 2012

Where have all the grandparents gone?

Among the vociferous and tumultuous changes that are happening in Maldives on the physical, political and economic fronts of Maldives, very subtle social changes are also in the offing here perhaps quite unawares to us. That is about the changing role of grandparents in Maldivian society. Are they still the moulders of our society or just sentries guarding vacant households we have left behind in our home islands in our rush to inhabit this congested square mile of our Capital Male?

The past generation, I would assume, will perhaps recall quite vividly, the engaging tales our grandparents related to us. We would be snug in their laps listening to the tales of days gone by, intrigued by the wonder of the mysteries of the life that was unfolding in those formative years. Their stories touched on the heroics at sea and land during the harshness of the heat, rain or wind, exposed us to the wonder and miracle of how a little sluggish and scary worm transformed into a beautiful butterfly, the excited pursuit together of the meandering trail of a hermit crab on the cool coral sand of the morning, the sprouting of tender coconut fronds emerging through the eye of a buried coconut and the succulent cotyledon that filled its shell, or the strange yet sweet and watery taste of it melting in our mouth. Or the fairy tales that rang of life's lessons or the mesmerizing tales from the Arabian Nights that transported us into the delights and dramas of heroes and monsters, of dreams and visions of what could be awaiting us in life -- those that signaled the potential for what we could be if we set our minds to be what we want to be. Alas for me, those grandparents are long gone now, but their memories linger on just as it was yesterday. For many of us, the past spent this way has made our lives ever richer from those life lessons we imbibed. It has made our futures so much more meaningful than it would have been otherwise, to have us well grounded in the reality of who we are, what we stand for, and the reason why we are here on this mother Earth. These magical personalities left us with a piece of themselves that enabled us to understand our connections with our fellow citizens -- connections that epitomize our humanness. That life is to be lived more for others than for ourselves; that we must also leave something wondrous for the generations to come.

Where are those grandparents for our kids of today? Have they been replaced by loveless handhelds and senseless Ayas from foreign lands? Where is the quality time given to these budding minds if not by grandparents, by parents who but spend their time doing double duty to earn the living which they spend on the glittering luxuries of life unawares that they are forfeiting the biggest luxury of their lives - their children who will soon grow up and move away to re-enact that modern cycle of life yet again on their own kids. Can we ever be the grandparents of yore again! Alas, our children lament; where have those grandparents gone!!!

Sadly, the increasing trend in Maldives is our separation from our grandparents who were the anchor to our realty (and to our dreams too). Positively, this seemingly hopeless yearning can be realized yet gain if we only take time from our ever engaging mental and telephone chatter and reflect and meditate on life and its consequences. It is for us to leave a legacy of worth to our children -- a legacy not of material, but of morals.

January 2, 2012

Public health measures make for a healthy community

Happy New Year to you all! May 2012 bring you joy, love and peace.

Today I was surprised by an article I was reading that confused public health with health services received at a public facility. In fact, to me, this was quite astonishing, for having worked in the administration of public health programs now for a very long time, had never come across this delicate inference ever. Perhaps this perception of public health should not be taken too lightly for I now believe this thinking may indeed be more pervasive than I thought it to be. So here I am putting this on blog in an attempt to make the concept of public health a bit clearer.

From a health promotion point of view, clarity on this is absolutely necessary. Public health is about health related actions that address the public’s health as a whole, as contrasted with health service or care received that usually benefits one person at a time. This is called individual health care. For example, if we provide clean water to the masses, or dispose of solid wastes that our cities produce every day as a mass effort, or individual efforts that contribute to a mass effort, then these activities are termed public health related actions as these contribute the making a whole lot of people healthy in one go so to say. If we all have clean and safe water to drink, a lot of people will be kept from getting all kinds of stomach bugs, and if our garbage is removed from our homes and our cities, we will not have the flies and roaches, and smells that make us sick. Remember that flies and roaches and rodents carry the germs into our homes and on to our food that will make us sick. Actions such as these will make us all experience good health. But even if our streets are filthy and water contaminated, we can still go to the doctor and get well for a while from the medicines we can take. But of course this cure would be a very temporary measure. We will soon get sick again, and we have to make another trip to the doctor. This type of service is called private or individual heath service.

To call a place healthy or health promoting, both these types of health services must be available. The services of doctors in our clinics and hospitals must be available for the individual care we seek such as getting the medications we need for a disease we contract. Let’s not forget, they also provide public health services such as immunizations, and health advice that can benefit a whole community’s wellbeing. While these public health services available at the doctor’s clinic may not amount to too much as compared to the individualized services they provide, to be healthy as a community, we truly need to keep our neighborhoods clean of the garbage and sewage we produce, have safe drinking water and safe food (from the markets and restaurants) available. And of course we ourselves must practice good hygiene and safe practices such as washing our hands regularly, using our household chemicals in a safe way, not spitting about on our streets, covering our mouth and nose when sneezing and coughing in public, refraining from risky life-style behavior, and not smoking.

So, public health is about the type of actions and services that keep the whole community healthy; not about whether we get our health care from a public or private service outlet.