ABUJA, March 2 (IPS) – Paul Farmer, legendary global health equality warrior, has died in his sleep of heart-related complications at the University of Global Health Equity (UGHE) in Butaro, Rwanda, the university he co-founded.
Many tributes have been written to Paul Farmer, and he deserves all the praise that was given to him posthumously. My tribute to Farmer is to amplify his teachings about the social determinants of health. It is important for healthcare professionals and health planners to do these things to create comprehensive strategies for health care planning and delivery.
One of Famous sayings of the farmer aptly describes this, “You have to look at what’s happening with the patient in front of you and think of ways to address inequality in society. If there’s food insecurity, you’ll provide food as you provide care. Or If the patient drops out of treatment, you will provide transportation to the clinic, or you will send community health workers to the patient”.
I wholeheartedly agree. In 2019, I joined UGHE as part of an executive training program for my cohort of Atlantic Fellows for Health Equity at George Washington University. After 10 days of our research at the university and surrounding Butaro communities, I am increasingly convinced that healthcare without social determinants of health is ineffective.
In honor of Farmers, here are four examples of social determinants of health that health care workers and governments should consider.
Access to clean water
Sub-Saharan Africa has a population of 1.14 billion, but only 24% of the population have access to safe drinking water, according to the United Nations. This means a whopping 912 million do not have access to drinking water (more than 120% of Europe’s population). It is therefore not surprising that infectious diseases are rampant in the region.
Here’s a common scenario that can illustrate the problem: A child is being treated for diarrhea in a medical facility and is about to be sent home. Parents must make sure the baby drinks clean water. They must use clean water to wash cooking utensils.
However, the family’s only source of water is a polluted river. Although they wanted to follow the advice of medical staff, they were limited in the extent of their choices. Two weeks later, she had diarrhea and vomiting again. The family was not so lucky this time. The current situation is very serious. The child died before being returned to the medical facility. The solution to this problem is simple – sub-Saharan African governments must provide clean water to every community.
Availability of uninterruptible electricity
ONE survey out of 13 health facilities in 11 sub-Saharan African countries, 26% were without access to electricity. Furthermore, 28% of healthcare facilities have reliable electricity out of the 8 countries reporting the figures. Let me make the impact of this more obvious.
Imagine a woman in labor in one of these medical facilities without electricity. She has been in labor for a long time and now cannot push the baby out. Mom needs a vacuum to help pull the baby out.
Vacuum is available. However, there is no electricity to power the machine. Weak woman, tearful family and helpless midwife. Referring her to another medical facility was inevitable because of the long distance, difficult roads, and lack of means of transportation. Dead woman. Her unborn child died. These tragedies could have been avoided with electricity. To mitigate such tragedies, governments must invest in clean renewable energy like solar power.
Use a clean kitchen
Across communities in sub-Saharan Africa, families use wood and even cow dung for cooking. Sometimes cooking with both materials is done indoors where there is poor ventilation. In the process of cooking for the family, the woman breathes in smoke.
As carers, their children mostly stay with them. Sadly, mothers and babies are exposed to smoke particles that are hazardous to their health. Using these materials as the sole fuel for cooking means that they are always at risk for respiratory diseases such as asthma and other chronic obstructive pulmonary diseases.
Although they may have access to treatment for chest conditions, as long as the source of the smoke inhalation is not eliminated, they will continue to require health care. This is why using a clean stovetop is one way to end this inequality.
In Kenya, Clean Cooking Alliance is leading an initiative to develop efficient clean-burning stoves to improve health, the environment and save families in East Africa.
Mitigating the impact of climate change
Climate change is a health inequality that defines our time. Its effects on health vary widely. For example, Climate change leads to floods, droughts, population displacement, forced migration and many more. When there is a drought, families go hiking in search of water.
Women, girls and children are the most vulnerable. Some water sources are rivers. Taking water from these rivers exposes them to various neglected tropical diseases (NTDs) including river blindness, schistosomiasis and others.
Treating these infections through mass drug administration in their communities is a short-term measure as long as there is no plan to mitigate the effects of climate change. Therefore, ending the disaster of NTDs affecting around 1.5 billion of the world’s poorest people is unattainable without addressing Climate Change.
The death of a farmer at only 62 years old was untimely. However, his death at UGHE is only symbolic, as he follows a world-class organization that is training the next generation of health equality warriors. Africans believe that death is not the end. It is a transition to a new world.
We are comforted that the Farmer has united with our ancestors to look after us. We must not despair. We must continue to place social determinants of health at the heart of health care planning and delivery. That’s what he’s going to do, and it’s the fairest thing to do.
Ifeanyi McWilliams Nsofor . Dr Graduated from Liverpool School of Tropical Medicine. He is a Senior Fellow for New Voices at the Aspen Institute and a Senior Fellow for Health Equity at George Washington University. Ifeanyi is the Director of Policy and Advocacy at Nigeria Health Watch.
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