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June 17, 2010

The Missing Link: Day 11 at the 7th GHC

What an inspirational day. Talk about a wake up call. The lecture of writer Michael Meegan, author of the books All Will Be Well and Changing The World Step By Step, was what I needed, both as a public health physician and as an individual. He talked about the actors in Global health and he basically described how these huge international aid agencies would funnel their donations to supposedly help developing countries improve their health status. It is true when he said that most of these international aid agencies do so only to benefit themselves and not necessarily benefit the recipients. When he showed the "global stage" with all these key actors interlinking with each other for global health, he bluntly pointed out a glaring mistake in this global scene, a missing actor, one participant lacking in the drama of global health: the community, the supposed recipients of these aid funds.

It is so unfortunate that these big donors confine themselves only within their own bubble without even daring to ask what their recipients would want for themselves. He quoted President Nyerere of Tanzania when he said, "Those with the money have no idea of the realities across the thousands of villages across Africa. That’s why they so often fail”

Which is so true. He cited a case in the Philippines when in the 1990's the USAID came in and practically barged into the scene "dictating" that we should "all be using condoms", basically trying to impose on the Philippine government and society as a whole how to run our Family Planning Program.

While the Filipino society may be "more liberal" now compared to years ago, the large part of society remains conservative and this conservatism is not exclusive among the Catholic faithful which by coincidence is the most dominant religious belief in the Philippines.

Mr. Meegan quoted the late Jaime Cardinal Sin when he said, "The existing power structures that
offer development have a clear agenda, but it is often driven not by equality and respect but by manipulation of the poor world. Some think that because they have the money they also possess the monopoly on truth and values."

What Mr. Meegan was trying to drive at is that those who think they know everything (experts, corporate entities, donor grantors, etc) must learn how to involve their beneficiaries, treating them as partners and not just recipients of what appears to be a dole out. These so-called experts of health and particularly those with the huge funds to give away must also "Listen above all else" to quote Desmond Tutu.

That is why even until now, despite the huge fundings from big organizations, we still have to fight Tuberculosis, and Malaria, and Maternal Deaths and other health problems which should have been addressed already, given the deadline we have set upon ourselves as manifested in the Millennium Development Goals. And the reason for such is simple. Mr. Meegan quoted Nelson Mandela in his lecture saying, "The problem is so often that it is not a dialogue of equals. It is a series of conditions. The people who matter are not even invited to the discussion."

The aspiration of everyone is that such a system of attitude and belief must change because such "We Know More Than You Do" mentality is one determinant of health.

In one of his slides, Mr. Meegan shared what Desmund Tutu said which I think summarizes everything we have learned from his talk. "Change will come when those who have the resources learn that they do not have all the answers… they need to learn how to listen."


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