Healthcare - Winchester College


Montgomery
Bell
International
Symposium
March
26
–
31,
2011
Healthcare
Symposium
Record
Table
of
Contents
Introduction
3
5
Speaker:
Dr
Jeff
Balser,
Real
Healthcare
Reform
6
8
25
27
42
44
62
63
Headmaster’s
Foreword
Day
1,
March
26
Student
Responses
Domestic
Healthcare
Systems
and
Challenges
Day
2,
March
27
Speaker:
Congressman
Jim
Cooper,
Healthcare
Policy
Student
Responses
The
Balance
between
Public
and
Private
Provision
Day
3,
March
28
Speaker:
Dr
Darin
Portnoy,
International
Healthcare
Student
Responses
International
Healthcare:
A
Comprehensive
Vision?
Day
4,
March
29
Vanderbilt
University
Student
Responses
Healthcare
in
Rural
and
Impoverished
Areas
Day
5,
March
30
Siloam
Health
Center,
Dr
Morgan
Wills,
Vanderbilt
University
80
Student
Responses
Technology
and
Ethics
in
Healthcare
81
Day
6,
March
31
Speaker:
Mr
Paul
Zintl,
Healthcare
in
Impoverished
Areas
Individual
School
Responses
to
the
Symposium
Challenge
98
100
The
Symposium
Accord
119
123
125
Headmaster’s
Afterword
List
of
Participants
2
Introduction
This
Symposium
Record
documents
the
academic
activities
during
the
week
of
the
Montgomery
Bell
International
Symposium,
March
26‐31,
2011.
The
Symposium
preparation
began
in
September
2010,
when
the
students
began
work
on
monthly
assignments
online,
and
culminated
in
their
meeting
together
in
Nashville
in
March
2011.
The
theme
of
the
MBIS
was
healthcare,
and
students
tackled
a
number
of
healthcare
topics
by
month.
These
were
healthcare
in
developed
economies,
technology
and
ethics
in
healthcare,
international
healthcare,
healthcare
in
rural
and
developing
areas,
and
innovation
and
inspiration
in
healthcare.
Each
month
students
discussed
ideas
online,
were
given
directed
reading,
websites,
podcasts,
and
other
media
to
study,
and
wrote
on
the
topic
areas.
The
central
challenge
of
the
Symposium
was
the
following:
In
a
dynamic
world
of
inequality
and
cultural
diversity,
the
issue
of
healthcare
occupies
a
unique
place.
The
challenge
of
the
MBIS
is
to
examine
current
and
future
healthcare
approaches,
to
determine
what
practical
steps
our
countries
can
and
should
take
to
optimize
healthcare
provision
for
our
populations,
bearing
in
mind
varying
social,
cultural,
and
economic
pressures.
In
March
2011
at
Montgomery
Bell
Academy
the
students
attended
seminars
and
presentations
with
some
of
the
United
States’
finest
practitioners
and
experts
in
the
field,
visited
Vanderbilt
University,
its
Medical
Centre,
and
Siloam
Family
Health
Center,
and
discussed
ideas
amongst
themselves.
Informed
by
these
discussions
and
their
experiences,
they
redrafted
their
previously
completed
work,
and
then
presented
their
findings
to
the
whole
MBIS
group
and
invited
guests.
The
week
culminated
in
a
common
statement
by
all
18
students
–
The
Symposium
Accord
–
which
was
read
out
at
the
banquet
dinner
at
the
close
of
the
week.
The
Symposium
experience
was
greater
than
just
the
academic
work,
and
the
culminating
week
in
Nashville
contained
much
more
than
the
academic
program.
MBA
organized
cultural
trips
for
the
students
inside
and
outside
Nashville
–
for
example,
to
the
Ryman
Theatre
to
witness
a
live
presentation
of
A
Prairie
Home
Companion,
to
attend
a
songwriter’s
evening
at
Leiper’s
Fork,
and
to
watch
the
Nashville
Predators
ice
hockey
3
team
–
and
students
discussed
ideas
and
encountered
a
range
of
resources
over
the
whole
six‐month
period.
A
fuller
view
of
the
entire
Symposium
program
–
together
with
the
inaugural
Winchester
College
International
Symposium
2010
and
the
Raffles
Institution
International
Symposium
2012
–
can
be
found
at
the
Symposium’s
coming
website.
Many
thanks
go
to
Mr.
Kevin
Hamrick
of
Montgomery
Bell
Academy
for
his
notes
in
the
production
of
the
Record.
Any
errors
that
remain
are
mine
alone.
American
spelling
has
been
adopted
as
the
default.
Tim
Parkinson
Winchester
College
April
2011
4
Headmaster’s
Foreword
Welcome
to
the
Montgomery
Bell
Academy
International
Symposium
in
2011
and
to
Nashville,
Tennessee!
We
look
forward
to
focusing
on
the
topic
of
healthcare,
a
topic
central
to
the
business
and
environment
of
Nashville.
I
hope
this
second
annual
gathering
provides
the
same
kind
of
provocative
and
intellectual
conversations,
offers
the
kind
of
exchange
of
ideas
internationally,
and
builds
upon
the
friendship
and
association
already
established
among
our
schools
and
communities
at
last
year’s
event.
The
preparations
and
reflections
established
over
the
past
six
months
should
afford
you
great
learning
and
discussion
this
week.
We
have
arranged
for
some
terrific
speakers
and
opportunities
to
engage
and
challenge
your
studies,
readings,
and
writings.
I
hope
you
will
enjoy
the
hospitality
in
Nashville
and
extend
your
thanks
to
the
many
individuals
who
have
made
this
week
possible.
May
our
work
and
time
together
plant
the
seeds
for
greater
understanding,
collaboration,
and
development
for
many
more
years.
Bradford
Gioia
Headmaster
Montgomery
Bell
Academy
March
2011
5
Day
1,
March
26
Dr
Jeff
Balser,
Dean
of
Vanderbilt
University
School
of
Medicine,
opened
the
Montgomery
Bell
International
Symposium
with
a
presentation
on
real
healthcare
reform
in
the
United
States.
Despite
the
perception
of
the
primacy
of
the
private
sector,
Dr
Balser
noted
that
50%
of
healthcare
dollars
spent
are
already
federal
dollars;
21%
of
the
federal
budget
is
devoted
to
healthcare.
The
growth
of
overall
healthcare
spending
has
also
been
enormous:
a
forty‐
fold
increase
in
per
capita
spending
since
1960.
Despite
the
United
States’
enormous
expenditure
on
healthcare
–
annual
per
capita
spending
is
$3500
higher
then
the
European
average
–
the
US
performs
relatively
poorly
in
such
international
healthcare
measurements
as
infant
mortality,
longevity,
cancer
survival.
Dr
Balser
suggested
that
this
extra
$3500
spending
could
be
broken
down
into
higher
wages,
bureaucratic
inefficiencies,
and
overuse
and
misuse
of
healthcare
resources.
Rather
than
a
debate
on
public
v
private
provision,
Dr
Balser
felt
much
more
could
be
achieved
by
greater
efficiency
in
the
use
of
a
given
stock
of
resources.
Citing
Vanderbilt
as
an
example,
he
advocated
in
particular
increasing
access
to
healthcare
(for
example,
clinics
in
shopping
malls);
a
move
towards
electronic
record‐keeping
(98%
of
medical
records
are
still
paper‐based);
the
greater
monitoring
of
the
effects
of
inefficient
healthcare
delivery
(he
gave
a
stark
example
of
the
enormous
drop
in
ventilator‐acquired
pneumonia
when
using
an
electronic
checklist);
and
a
move
towards
personalized
healthcare
(side‐
effects
from
drugs
are
the
fifth‐leading
cause
of
death
in
the
US).
40%
of
healthcare
problems
and
solutions
were
behavioral,
according
to
Dr
Balser.
Furthermore,
30%
of
drug‐related
therapy
was
ineffective
because
of
genetic
make‐up;
he
thus
saw
great
potential
in
the
use
of
genomic
medicine
to
deliver
personalized
healthcare,
although
innovation
in
this
area
would
naturally
give
rise
to
ethical,
religious,
and
legal
debate.
Drawing
on
his
presentation
and
their
own
studies
before
the
MBIS,
students
redrafted
work
on
the
present
and
future
challenges
facing
their
own
healthcare
systems.
Nicholas
Dagnall
and
Julian
Ranetunge
from
Winchester
College,
and
Santiago
Pineda
Buitrago
and
6
Adriana
Medellin
Cano
from
Colegio
Claustro
Moderno
presented
their
work
at
the
end
of
the
day.
7
Using
examples
from
Dr
Balser's
presentation,
outline
the
position
of
your
own
healthcare
system.
Looking
to
the
future,
what
innovations
do
you
see
bringing
the
greatest
benefits
to
your
system?
African
Leadership
Academy
The
healthcare
system
in
Kenya
leaves
a
lot
to
be
desired.
The
government
spends
about
5%
of
the
GDP
on
healthcare,
which
is
way
below
the
9.8%
recommended
by
the
World
Health
Organization.
In
addition,
this
healthcare
is
mostly
easily
available
to
high
class
and
upper
middle
class
citizens
who
are
the
minority.
For
the
majority
of
citizens
who
fall
in
the
lower
middle
class
and
low
class,
healthcare
is
less
accessible.
However,
recent
years
have
seen
Kenyan
hospitals
undergo
renovations
to
better
the
quality
of
healthcare.
In
addition,
effort
has
been
put
in
setting
up
more
localized
health
centres
in
rural
areas
to
increase
accessibility.
There
is
also
an
increased
focus
on
training
of
nurses
and
doctors.
The
healthcare
in
Zimbabwe
has
been
characterized
by
battles
between
modern
and
traditional
medicine.
The
economic
recession
in
the
past
decade
crippled
the
government
expenditure
on
healthcare
to
an
extent
where
the
government
spent
only
$9
per
citizen
on
healthcare
in
2009.
During
this
time
many
people
resorted
to
traditional
medication
because
healthcare
became
expensive
and
inefficient
due
to
lack
of
medication.
In
a
positive
light
however,
this
lack
of
sufficient
medicine
led
to
a
behavioural
change
in
Zimbabweans.
Citizens
became
more
conscious
of
individual
health
as
show
by
the
decrease
in
HIV
prevalence
from
23%
to
15%.
The
use
of
general
technology
such
as
cell
phones
in
heath
systems
has
increased
efficiency
and
effectiveness
in
health
care
delivery
in
Africa.
Indeed,
the
growing
number
of
cell
phone
holders
in
Africa
presents
a
platform
where
mobile
phones
can
be
used
to
increase
efficiency
in
health
care
delivery.
The
decreasing
cost
of
mobile
phones
has
enabled
the
average
Zimbabwean
and
Kenyan
to
own
a
mobile
phone.
For
instance,
Vodacom
Kenya
sells
cell
phones
for
a
price
of
only
$12;
thus
many
average
Kenyans
own
a
mobile
phone.
With
a
subscriber
base
of
over
19.4
million
distributed
through
remote
Kenyan
villages,
Vodacom
Kenya
and
Safaricom
have
enabled
rural
Kenyans
to
have
access
to
information
(Telecompapers).
This
makes
communication
with
doctors
much
easier.
8
Communities
that
are
located
miles
from
health
clinics
can
now
easily
inform
a
doctor
of
a
pandemic
outbreak
and
get
instructions
on
how
to
act
to
prevent
further
spread.
This
has
gone
a
long
way
in
combating
Cholera
and
Malaria
(Coghlan),
the
two
diseases
that
singly
kill
most
people
in
Africa
annually.
The
same
revolution
has
been
taking
place
in
Sierra
Leone,
Zimbabwe
and
South
Africa.
All
the
same,
Africa
needs
to
reach
a
point
where
IT
can
seamlessly
be
integrated
into
healthcare
systems.
But
for
this
to
be
achieved,
the
international
community
needs
to
establish
standardized
levels
of
development
that
every
country
has
to
achieve
before
they
can
integrate
certain
technological
systems.
A
good
example
is
the
gradual
advancement
from
paper
systems
to
more
computerized
systems
when
it
comes
to
healthcare.
This
would
not
only
improve
efficiency
but
also
save
time.
But
at
the
same
time,
before
this
technology
can
be
adopted
in
developing
nations
for
instance,
there
needs
to
be
a
certain
level
of
advancement
in
these
individual
countries
for
the
technology
to
succeed.
In
this
case,
countries
need
to
take
into
consideration
the
availability
of
power,
computers
and
computer
literacy
in
their
individual
countries
before
they
do
away
with
paper
systems.
In
many
countries
in
Africa
at
the
moment,
great
effort
is
being
placed
in
improving
healthcare
systems
but
there
is
need
for
a
lot
of
international
support
to
aid
these
countries
to
achieve
the
level
of
healthcare
desired
for
such
countries.
More
focus
needs
to
be
placed
on
improvement
of
facilities
in
hospitals
both
in
rural
and
urban
areas.
Governments
need
to
write
plans
that
are
geared
towards
setting
a
timeline
for
improving
healthcare
in
their
own
countries.
In
the
meantime,
developed
countries
need
to
scrutinize
their
own
healthcare
systems
to
ensure
that
they
are
operating
at
the
optimum
efficiency.
In
this
way
he
future
of
healthcare
will
be
much
brighter
with
deliberate
steps
to
move
forward,
as
a
whole
continent,
when
it
comes
to
healthcare.
Colegio
Claustro
Moderno
The
Colombian
healthcare
system
is
based
on
two
regimes
on
the
social
healthcare
system:
the
contributory
and
the
subsidized
one.
This
means
that
the
citizens
who
have
got
a
job
and
economic
stability
ensure
their
right
to
comprehensive
healthcare
services
through
a
contribution
or
quotes
deducted
from
their
wages,
for
the
creation
of
a
common
9
fund.
Also,
these
same
citizens
give
a
little
part
of
their
salary
to
another
common
found
that
helps
and
subsidizes
the
vulnerable
citizens,
who
are
the
ones
who
have
not
have
job
stability
or
the
ones
who
are
unable
to
work
and
live
in
extreme
poverty
conditions
because
of
old
age,
illness
or
poverty.
We
think
that
a
proper
and
efficient
administration
of
all
these
resources
that
are
not
the
state
itself
but
the
resulting
and
arising
from
the
salary
contributions
made
by
each
citizen,
if
administered
administration
by
the
State,
directly
or
by
individuals,
but
with
the
supervision
and
monitoring
of
the
State,
would
mean
that
even
with
such
limited
resources,
the
health
of
a
country
were
well
attended.
In
comparison
with
the
USA’s
government,
Colombia’s
government
doesn’t
expend
and
use
a
lot
of
its
money
on
the
healthcare
service,
due
to
the
difficulties
that
the
government
posses,
so
if
the
government
decides
to
put
a
lot
of
money
in
the
healthcare
area,
will
neglect
and
put
aside
other
service
as
important
as
healthcare
service
is,
such
as
education,
public
defense,
public
works
infrastructure
or
the
creation
of
employment
sources.
However,
we
think
that
each
healthcare
system
have
both
good
and
bad
effects
in
the
community.
As
an
example,
Colombian
healthcare
system
allows
people
to
have,
in
most
of
the
cases,
a
cheaper
cost
on
the
healthcare
services,
but
sometimes,
it
is
not
able
to
cover
and
ensure
all
the
people
with
the
same
quality
or
efficiency.
By
the
other
hand,
United
States
healthcare
system
makes
people
pay
big
amounts
of
money
for
simple
medical
appointments
or
simple
surgical
interventions,
but
it
has
a
better
quality
and
has
better
equipment.
The
biggest
innovation
that
we
think
would
bring
and
is
bringing
great
benefits
to
our
society
is
the
use
of
all
our
effort
and
our
knowledge
on
the
research
field,
that
increase
the
new
discoveries
and
effectives
ways
to
control
some
diseases
or
even
avoid
them
as
well.
As
an
example
there
is
a
new
innovation
in
the
drug
field
specifically,
developed
by
Manuel
Elkin
Patarroyo,
a
Colombian
doctor,
between
1986
and
1988.
This
vaccine
helps
to
facilitate
the
Malaria
treatment
and
cure
with
the
40%
‐60%
effective
in
adults
and
77%
in
children.
This
disease
is
caused
by
parasites,
which
have
been
brought,
probably,
by
a
10
colony
of
occidental
gorillas.
The
vaccine
was
tested
with
a
colony
of
monkeys
in
the
Amazon
region
in
Colombia.
Malaria
has
and
still
causes
more
than
210
million
cases,
with
symptoms
such
as
fever,
headache
and
nausea,
in
its
first
phase,
and
after
the
disease
develops,
symptoms
such
as
kidney
failure,
nervous
system
disorders
and
in
the
most
serious
cases,
even
a
coma.
Although,
the
precise
statistics
are
unknown,
because
a
lot
of
the
malaria
cases
occur
in
rural
areas,
where
people
die,
in
most
of
the
cases,
for
not
having
any
kind
of
medical
attention,
this
malaria
vaccine
has
cured
millions
of
lives,
decreasing,
the
mortality
rate
caused
by
this
epidemic,
in
parts
of
Africa
and
South
America,
despite
this
vaccine
is
not
100%
effective.
In
the
field
of
technological
advances
we
have,
in
our
opinion,
the
best
innovation,
the
Hakim
valve,
created
by
Salomon
Hakim,
another
Colombian
doctor,
specialist
in
neurology.
This
valve
was
designed
to
drain
and
carry
the
amount
of
fluid
excess
in
the
brain
to
the
stomach
cavity,
so
that,
the
liquid
can
be
expelled
naturally.
For
this
procedure,
it
is
install
a
shunt
system
made
of
silicone
and
plastic,
which
is
placed
under
the
skin
behind
the
ear,
passing
through
the
neck
and
chest.
Thanks
to
Salomon’s
invention,
people
that
suffer
from
diseases
like
Hydrocephalus
or
increased
intracranial
pressure,
most
of
who
are
young
children,
have
been
highly
benefited
by
reducing
the
number
of
deaths
from
this
type
of
intracranial
diseases.
In
Colombia,
around
of
3000
children
have
been
cured,
in
the
last
14
years,
after
the
implantation
of
this
device,
the
manufacture,
despite
being
guided
and
designed
in
Colombia,
is
made
in
foreign
countries
due
to
their
large
requirements
of
high
technology.
Another
great
innovation
that
would
bring
really
good
outcomes
in
Colombia,
would
be
the
increment
in
the
way
of
how
patients
communicates
with
doctors,
making
even
closer
the
relationship
between
them.
This
could
be
achieved
by
using
“smartphones”,
such
as
BlackBerry
or
beepers,
where
patients
could
write
and
describe
the
symptoms
they
are
suffering,
since
there
are
lots
of
people
living
in
rural
and
impoverished
areas
without
any
kind
of
full
time
healthcare
service.
Also,
creating
web
pages,
as
the
Vanderbilt
University
web
page,
where
people
can
find
information
about
how
to
treat
any
kind
of
diseases
and
have
a
directly
communication
with
doctors,
at
any
time
of
the
day.
11
Having
a
better
and
a
superior
education,
provided
by
the
Colombian
government
itself
or
even
by
foreign
governments,
for
our
doctors
is
the
principal
way
to
be
able
to
end
the
problems
that
stop
us
for
having
a
perfect
healthcare
system.
Garodia
International
Centre
for
Learning
The
following
are
healthcare
issues
in
India
and
the
USA:
In
India
one
of
the
major
healthcare
issues
is
preventable
diseases
like:
Gastro‐Enteritis
(‐
of
which
diarrhoeal
diseases
are
recurrent)
and
Malaria;
Measles,
Jaundice,
and
Typhoid
(due
to
non‐immunization.)
amongst
others.
These
diseases
are
prevalent
due
to
poverty,
illiteracy
and
the
absence
of
proper
sanitation
in
the
affected
areas.
In
USA’s
economy
the
main
healthcare
issues
are
created
due
to
the
new
healthcare
reform:
there
is
an
anticipated
falling
doctor:
patient
ratio.
As
the
reform
was
introduced
so
that
all
strata
of
society
could
avail
of
insurance
coverage,
it
implies
lower
annual
payments
(greater
affordability).
This
would
mean
that
when
hospitals
are
paid
insurance,
they
receive
potentially
less
and
only
how
much
the
government
thinks
is
reasonable,
the
remaining
with
be
at
its
expense,
forcing
them
to
fire
staff
(doctors)
as
they
cannot
afford
to
keep
them,
while
incurring
losses.
The
most
pressing
Healthcare
Reform
issue
in
India
is
the:
accessibility,
affordability
and
availability
of
basic
health
care.
As
a
percentage
of
its
GDP
the
healthcare
spending
in
India
is
5.5%
(2009)
and
the
per
capita
spending
is
86
USD,
amongst
the
lowest
figures
observed
in
the
OECD
graphs.
Due
to
the
poverty
and
size
of
allotted
of
funds
($36),
few
can
afford
healthcare.
A
large
number
of
infant
(below
5yrs
of
age)
deaths
occur
in
rural
areas
due
to
preventable
diseases,
the
root‐cause
of
this
issue
is
inaccessibility,
as
medical
facilities
are
not
proximate
to
all
villages
and
settlements
in
India.
Due
to
the
unavailability
of
new
medicines
and
technology
to
tribes
and
villagers
there
are
many
avoidable
deaths
in
rural
areas.
12
I
would
like
to
close
by
talking
of
some
pioneers
and
some
possible
solutions
to
healthcare
in
India.
India
is
a
vast
country
and
I
do
not
claim
to
know
what
happens
in
every
nook
and
corner,
yet
I
feel
that
this
is
the
only
part
of
the
Earth
I
can
talk
about
with
some
authority.
I
would
like
to
talk
about
two
people
who
can
be
considered
as
pioneers
in
providing
for
healthcare
for
the
underprivileged,
who
are
well
known
throughout
India
for
their
work.
Perhaps
there
are
many
others
who
have
contributed
their
mite
and
are
not
so
well
known.
Baba
Amte,
the
founder
of
Anandwan.
Baba
Amte
was
a
lawyer
by
profession
who
had
participated
in
India’s
freedom
struggle
and
was
also
associated
with
Mahatma
Gandhi.
He
founded
Anandwan
in
1951,
an
ashram
and
community
rehabilitation
centre
for
leprosy
patients.
Leprosy,
those
days
was
associated
with
a
social
stigma.
The
ashram
is
self‐
sufficient
in
terms
of
basic
subsistence.
Baba
Amte
was
able
to
ensure
an
existence
of
dignity
for
leprosy
patients.
Dr.
Deviprasad
Shetty,
a
trained
surgeon
whose
brainchild
‘Yeshaswini”
provides
a
cheap
health
insurance
scheme
for
the
farmers
in
Karnataka.
These
are
some
of
the
people
who
have
shown
that
individuals
can
make
a
difference,
so
that
society,
politicians
and
governments
are
compelled
to
sit
up
and
not
only
acknowledge
them
but
also
pitch
in.
It
would
be
difficult
to
identify
the
single
most
important
step
to
be
taken
to
improve
healthcare
outcomes
in
India
without
listing
the
numerous
problems
associated
with
providing
effective
healthcare.
•
The
innumerable
religions,
sub
sects
and
sub
castes
with
their
inherent
beliefs,
taboos
and
prejudices
which
often
come
in
the
way
of
effective
medical
treatment.
E.g.
Smallpox
is
called
Devi
after
the
Goddess
of
smallpox.
•
Poverty,
illiteracy
and
ignorance
which
always
go
hand
in
hand
and
form
a
vicious
circle.
13
•
High
personal
investment
made
by
doctors
in
medical
education
as
well
as
setting
up
a
practice.
I
am
constantly
reminded
of
this
as
my
father
is
a
surgeon
and
one
finds
many
of
his
colleagues
desperately
trying
to
get
their
children
into
medical
colleges
so
that
they
can
continue
the
medical
establishments’
setup
by
them.
This
often
leads
to
high
fees
and
unethical
practices
to
recoup
the
fantastic
cost
of
medical
education
•
Low
doctor‐patient
ratio,
unavailability
or
inaccessibility
of
medical
facilities.
The
most
important
step
that
needs
to
be
taken
to
improve
healthcare
outcomes
is
dissemination
of
adequate
information,
backed
by
access
to
preliminary
medical
advice/aid.
To
achieve
this
without
enormous
financial
resources
appears
impossible.
Utilizing
all
modern
media
from
mobile
phones,
internet,
to
satellite
television
for
dissemination
of
information
relating
to
nutrition,
hygiene,
prevention
and
cure
of
diseases,
etc
could
go
a
long
way.
A
health
census,
training
Para‐medical
workers
to
operate
in
rural
areas
would
help
identify
diseases
before
it
is
too
late.
Subsidizing
medical
education
with
the
rider
that
doctors
be
subsequently
compelled
to
render
some
community
service
–like
attending
a
mandatory
number
of
medical
camps
per
year
in
remote
areas.
This
would
be
a
health
process
which
could
fund
its
expenses
to
some
extent.
Johannes
Kepler
Grammar
School
The
whole
system
of
healthcare
in
the
Czech
Republic
is
in
the
process
of
a
huge
change
which
is
essential
to
make
it
go
in
the
right
direction.
Everything
used
to
be
covered
by
the
health
insurances
and
the
state,
which
eventually
had
a
very
negative
effect
on
the
financial
situation
of
the
Czech
Republic.
However,
it
is
very
difficult
to
make
any
changes
because
people,
already
paying
for
their
health
insurances,
do
not
want
to
have
any
additional
expenses
on
their
own
health
and
feel
the
state
is
obliged
to
pay
for
their
health
and
provide
them
with
necessary
treatment.
14
The
worst
issue
of
the
Czech
Republic
healthcare
system
is
the
lack
of
finances,
which
is
getting
worse
and
worse
despite
several
attempts
to
improve
the
difficult
financial
situation.
The
system
is
very
social
and
tends
to
provide
the
treatment
regardless
of
the
financial
point
of
view.
A
charge
of
30
koruna
(about
$1.5)
has
been
introduced
in
the
Czech
Republic
to
improve
the
finances
in
the
healthcare
field
as
well
as
to
improve
the
efficiency
of
the
healthcare
system,
because
the
charge
is
also
supposed
to
discourage
people
from
visiting
their
doctors
when
they
are
not
in
need
of
treatment
or
check‐up.
Meanwhile,
doctors
in
hospitals
were
not
satisfied,
rightfully,
with
their
wages
and
demanded
an
improvement
of
their
pay.
The
government,
in
the
end,
gave
in
to
their
pressure,
as
they
were
ready
to
leave
the
hospitals
in
large
numbers,
and
improved
their
pays
about
a
month
ago.
Unfortunately,
as
many
measures
do
not
have
only
positive
but
also
negative
effects,
this
one
was
no
different
as
it
has
dealt
another
blow
to
the
economy
of
the
Czech
Republic.
Unlike
in
the
US,
where
the
expenditure
on
healthcare
is
21%
of
GDP,
the
expenditure
in
the
Czech
Republic
is
only
about
7%,
but
the
number
is
on
the
rise.
The
Czech
Republic
ranks
#48
in
overall
health
system
performance,
lower
than
the
US,
United
Kingdom,
or
even
Colombia.
Dr.
Balser
talked
about
the
necessity
of
the
“symphony”
of
doctors
in
his
speech.
What
would
best
describe
the
situation
in
the
Czech
Republic
is
“cacophony”,
as
the
cooperation
among
physicians
is
rather
triste.
A
great
improvement
to
the
healthcare
system
of
the
Czech
Republic
would
be
if
majority
of
people
realized
that
participation
on
their
health
is
in
their
own
benefit,
and
eventually
it
might
even
improve
the
financial
situation
of
every
individual.
At
the
moment,
majority
of
people
are
not
concerned
about
the
grim
financial
situation
of
healthcare
system
in
the
Czech
Republic
and
the
only
thing
they
are
concerned
about
is
whether
they
receive
what
they
are
expecting
to
receive
from
it.
The
30‐koruna
charge
for
visiting
a
physician
was
a
good
step
to
increase
participation
on
healthcare
and
it
should
be
retained
to
make
people
feel
a
bit
of
gratefulness
for
the
care
they
receive.
Present
Minister
of
Health
is
considering
to
raise
the
charge
from
30
to
50
koruna
these
days,
which
might
start
to
economically
gnaw
at
retired
people,
whose
retirement
pension
is
quite
low
in
most
cases.
For
that
reason,
it
might
not
be
a
bad
of
an
idea
to
stratify
the
charge.
Keep
the
current
30
koruna
charge
for
retirees
and
raise
it
to
50
koruna
for
people
whose
salary
exceeds
a
certain
15
number.
In
cases
of
families,
the
total
income
of
family
should
be
subdivided
on
family
members
with
working
potential
to
prevent
discrimination
of
families
where
one
makes
money
and
the
other
one
takes
care
of
the
household.
Another
huge
improvement
would
be
to
reallocate
the
money
in
healthcare
system
of
the
Czech
Republic,
because
there
are
places
where
money
is
seriously
missing
and
places
where
money
is
very
abundant,
such
as
pharmaceutical
companies.
Redistributing
this
money
would
certainly
be
a
great
step
and
should
be
the
step
to
be
taken
in
order
to
improve
the
healthcare
system
in
the
Czech
Republic.
Montgomery
Bell
Academy
The
primary
challenge
for
healthcare
reform
in
the
United
States
is
determining
how
to
distribute
the
country’s
already
abundant
health
care
resources
more
efficiently
while
still
remaining
cognizant
of
the
international
implications
of
any
action.
With
a
smarter
policy
agenda
the
United
States
can
not
only
alleviate
its
health
care
woes
at
home,
but
also
become
a
leader
in
promoting
healthcare
development
around
the
world.
The
problems
with
health
care
in
the
United
States
relate
to
the
payment
system,
not
the
availability
of
care.
It
is
no
secret
that
American
health
care
costs
an
exorbitant
amount,
especially
relative
to
its
rather
mediocre
quality
(as
measured
by
most
quantitative
metrics).
One
driving
up
expenses
is
the
administrative
largesse
of
the
system—the
Kaiser
Family
Foundation
estimates
that
7%
of
total
health
care
expenditure
in
the
U.S.
is
directed
toward
marketing,
billing,
and
other
services
which
are
almost
entirely
a
function
of
a
private
health
care
economy.
There
is
very
little
coordination
between
the
different
parts
of
the
system;
this
friction
slows
down
the
transfer
of
ideas
and
contributes
to
higher
cost.
The
other
important
element
of
the
cost
equation
was
identified
very
clearly
in
the
presentation
made
by
Dr.
Jeff
Balser,
dean
of
Vanderbilt
Medical
School:
inefficiency
in
the
actual
systems
by
which
care
is
delivered.
Americans
tend
to
equate
more
care
with
better
care;
hospitals,
seeking
to
maximize
their
profits,
are
more
than
willing
to
perpetuate
that
myth.
16
At
the
same
time,
reformers
want
to
expand
coverage
of
health
insurance.
About
one
in
six
Americans
lacks
health
insurance
and
millions
more
have
inadequate
coverage.
The
nature
of
a
private
system
allows
insurers
not
to
cover
those
who
would
be
most
costly
to
insure:
people
pre‐disposed
to
medical
problems
and
conditions.
Thus,
the
patients
who
are
in
the
greatest
need
of
support
are
the
most
likely
to
fall
through
the
cracks
of
the
system.
But
while
the
domestic
challenges
are
daunting,
policymakers
must
also
understand
that
the
United
States
does
not
exist
in
a
health
care
vacuum.
One
critical
example
is
physician
migration.
A
survey
published
in
Health
Affairs
estimates
that
over
one‐quarter
of
all
practitioners
in
the
United
States
are
educated
abroad.
Many
of
them
hail
from
countries
with
acute
shortages
of
medical
personnel.
According
to
data
from
the
ECFMG,
an
organization
that
certifies
foreign
medical
graduates
to
practice
in
the
U.S.,
34%
of
physicians
who
immigrated
to
the
United
States
in
2009
were
from
countries
identified
by
the
World
Health
Organization
as
particularly
at
risk.
And
the
problem
will
continue
to
grow.
A
rapidly
aging
U.S.
population
will
need
at
least
40
percent
more
primary
care
providers
by
2020,
according
to
a
study
by
the
U.S.
Bureau
of
Health
Professions
and
the
Association
of
American
Medical
Colleges;
the
recent
health
care
legislation
will
only
accelerate
that
trend.
In
the
face
of
this
unique
set
of
challenges,
the
United
States
must
act
decisively
to
avert
disaster.
The
Affordable
Care
Act
passed
in
early
2010
was
a
good
start
for
this
process.
But
tweaking
the
payment
system
will
only
get
us
so
far.
It
is
important
that
we
address
the
fundamental
problem
of
cost
by
changing
the
character
of
the
American
health
care
system.
Smart
reforms
initiatives
have
the
potential
not
only
to
increase
the
efficiency
of
the
system,
but
also
reduce
the
negative
impact
that
the
United
States
has
on
the
rest
of
the
world.
One
such
model
might
be
the
physician
compensation
system
pioneered
by
the
Mayo
Clinic.
By
setting
salaries
for
physicians,
the
Mayo
Clinic
finds
a
middle
ground
between
the
more
common
fee‐for‐service
charges
in
most
private
practices
and
the
capitation
methods
of
accountable
care
organizations.
With
the
Mayo
Healthcare
Model,
physicians
can
work
a
certain
number
of
hours
for
a
fixed
salary,
and
in
doing
so,
practice
medicine
with
less
motivation
for
personal
gain.
This
system
enables
even
the
most
morally
upright
physicians
to
devote
time
and
effort
to
the
treatment
of
individual
patients
without
the
17
concern,
whether
conscious
or
subconscious,
for
payment.
As
with
any
approach
to
healthcare
provision,
there
are
drawbacks.
Skeptics
point
out
that
medicine
will
attract
less
academic
talent
if
the
financial
award
is
regimented
in
such
a
manner.
Although
this
projection
is
possible
with
the
introduction
of
the
Mayo
system,
the
field
will
also
attract,
even
more
so
than
before,
those
who
take
a
genuine
interest
in
patient
care.
More
widespread
adoption
of
electronic
health
records
might
also
improve
efficiency.
The
current
paper‐based
system
often
hampers
efforts
at
cooperation
between
different
care
facilities.
In
an
ideal,
digital
world,
the
medical
records
of
a
patient
would
be
easily
transferrable
from
hospital
to
hospital,
lowering
the
risk
of
expensive
redundancies
and
referrals.
Not
many
nations
have
the
luxury
of
considering
such
a
technologically
demanding
technique,
but
electronic
medical
records
do
hold
great
promise
for
the
U.S.
Healthcare
is
a
tremendous
challenge
for
the
United
States,
but
also
a
tremendous
opportunity.
It
is
up
to
this
country’s
leaders
to
right
the
ship
and
work
toward
a
brighter,
healthier
future
for
the
U.S.
and
the
rest
of
the
world.
Nada
High
School
83
―
Do
you
know
what
this
figure
is?
This
is
the
life
expectancy
of
Japan
in
2010.
As
you
may
know,
this
is
the
highest
in
the
whole
world.
What
is
the
reason
for
this?
It
is
said
that
the
Japanese
healthcare
system
has
much
to
do
with
this
situation.
According
to
the
survey
done
by
WHO,
the
Japanese
healthcare
system
is
one
of
the
best
systems
at
keeping
people
healthy.
The
survey
also
shows
that
more
than
90%
of
all
Japanese
people
are
satisfied
with
the
treatment
they
can
get.
First,
let
us
give
a
short
explanation
of
the
system
of
Japanese
healthcare.
It
is
compulsory
to
be
enrolled
in
one
of
the
Japanese
insurance
programs
if
you
are
a
resident
of
Japan.
There
are
eight
health
insurance
systems
in
total.
They
can
be
divided
into
two
categories.
Employees’
health
insurance
and
national
health
insurance.
Employees’
health
insurance
is
of
course
for
the
workers.
This
is
managed
by
the
government
and
the
union.
The
other,
national
health
insurance
is
generally
reserved
for
self‐employed
people
and
students.
In
Japan,
services
are
provided
either
through
regional
or
national
public
hospitals
or
through
private
hospitals
and
clinics,
and
patients
have
universal
access
to
any
facility.
The
18
public
health
insurance
system
pays
70%
or
more
of
the
medical
or
drugs
costs
with
the
remainder
being
covered
by
the
patients.
This
rate
is
little
higher
than
the
rate,
about
50%
that
the
government
of
the
United
States
pays.
However,
when
we
look
at
the
health
expenditure
as
the
share
of
GDP
or
the
health
expenditure
per
capita,
it
is
clear
that
Japanese
government
spend
as
little
as
half
money
as
the
government
of
the
United
States
spends.
The
monthly
insurance
premium
is
paid
per
household
and
scaled
to
annual
income.
There
are
several
points
that
are
quite
unique
to
the
Japanese
system.
a) Japanese
public
healthcare
system
covers
all
the
citizens
in
Japan.
There
are
not
so
many
countries
that
have
similar
systems
like
Japan.
For
example,
the
United
States
doesn't
have
a
universal
health
care
system.
The
US
system
is
just
for
the
elderly
and
the
poor,
which
is
called
Medicare
and
Medicaid.
On
the
contrary,
in
Japan,
even
jailed,
or
poor
people
can
get
medical
services
equally,
just
like
the
rich.
b) The
Japanese
people
can
have
access
to
any
facility
in
Japan.
This
is
also
peculiar
to
the
Japanese
system.
Japanese
can
get
medical
treatment
at
any
hospital
you
go
with
your
insurance
card.
As
you
can
see,
Japanese
healthcare
system
enables
whoever
needs
the
medical
support
to
get
enough
treatment
whenever
they
need,
wherever
they
want
to.
Regarding
the
situation
in
Japan
now,
we
think
that
in
order
to
reduce
the
cost
of
healthcare
and
build
an
ultimate
healthcare
system,
which
we
define
as
a
system
that
enables
us
to
get
personalized
care,
it
is
inevitable
that
we
must
introduce
what
Dr.
Balser
mentioned,
that
is,
a
system
based
on
the
latest
information
technology
and
HGP,
Human
Genome
Project
created
in
2003.
HGP
is
an
international
scientific
research
project
with
a
primary
goal
of
determining
the
sequence
of
chemical
base
pairs
which
make
up
DNA
and
identifying
and
map
the
approximately
20,000–25,000
genes
of
the
human
genome
from
both
physical
and
functional
standpoints.
We
can
identify
the
specific
cause
of
illness
that
each
of
us
is
likely
to
come
down
with
using
the
genetic
information
that
we
analyze.
This
might
enable
us
to
get
treatments
that
are
suited
for
our
individual
bodies.
We
might
be
able
to
prescribe
medicines
that
fit
ourselves.
In
order
to
realize
this
amazing
idea,
it
is
vital
to
introduce
medical
informatics.
This
means
to
tie
up
the
healthcare
system
with
IT
19
such
as
the
Internet
and
other
information
systems.
First,
we
need
to
analyze
the
information
from
our
genes
and
then
preserve
that
information
to
a
system
called
the
Bio
Bank.
This
idea
has
also
emerged
in
hospitals
around
Vanderbilt
University
such
as
MyHealth@Vanderbilt.
When
we
need
any
treatment,
we
can
get
our
genetic
information
from
the
Bio
Bank,
and
use
cures
that
fit
us
individually.
As
Dr.
Balser
said
in
his
presentation,
this
results
in
cutting
wasteful
medical
expenses.
Moreover,
one
of
the
working
groups
in
the
Ministry
of
Health.
Labor
and
Welfare
in
Japan
predicts
that
introducing
this
new
system
would
result
in
significant
economic
effects.
We
must
admit
that
there
are
still
some
issues
to
solve
in
order
to
introduce
the
new
system.
As
Dr.
Balser
has
pointed
out,
this
genetic
information
might
be
misused.
This
has
been
a
big
controversial
issue
in
Japan
too.
It
is
also
uncertain
how
much
we
actually
have
to
pay
to
introduce
this
system.
In
spite
of
these
difficulties,
we
still
believe
that
it
is
necessary
to
introduce
this
new
system
in
Japan
all
the
more
because
the
Japanese
healthcare
system
is
nearly
an
ideal
system.
Raffles
Institution
In
relation
to
the
pyramid
model
of
healthcare
described
by
Dr
Balser
during
his
presentation,
we
would
like
to
critique
Singapore’s
healthcare
model.
The
categories
mentioned
from
the
bottom
of
the
pyramid
to
the
top
are:
Advanced
Healthcare/Information
Technology,
Continuous
Care
(Accessible
and
Transportable),
System‐based
Care
(Consistent,
Evidence‐based),
and
Personalized
Care,
respectively.
Starting
from
the
bottom
of
the
pyramid,
this
essay
will
open
by
discussing
the
factor
of
advanced
healthcare.
Singapore
envisages
itself
as
a
biomedical
hub
and
hence
has
equipped
itself
with
cutting‐edge
and
state
of
the
art
medical
research.
This
is
then
translated
into
the
local
medical
healthcare
scene.
Patients
in
Singapore
benefit
from
this
by
having
access
to
the
latest
advancements
in
the
field,
be
it
in
terms
of
drugs
or
procedures
or
machines.
In
addition,
Singapore
possesses
an
E‐filing
system
that
a
majority
of
the
nation’s
public
hospitals
have
access
to.
This
E‐filing
system
which
houses
the
medical
records
of
patients
greatly
improves
the
efficiency
of
the
medical
system.
20
In
addition
to
this,
the
presence
of
Continuous
Care
is
also
one
that
is
highly
present
in
Singapore's
healthcare
system.Dr
Balser
mentioned
in
his
sharing
that
some
patients
do
not
actively
seek
preventive
treatment
as
the
medical
centres
tend
to
be
located
quite
far
away
from
their
homes.
Hence,
the
patients
only
come
in
for
treatment
once
it
is
in
the
later
stages
and
the
symptons
start
developing.
However,
this
does
not
seem
to
be
the
case
in
Singapore,
due
to
its
(comparatively)
small
land
size,
clinics
are
mostly
within
walking
distance
from
the
flats.
In
addition,
the
Government
has
had
various
campaigns
in
the
past
encouraging
active
prevention
of
diseases.
For
example,
just
a
few
years
back,
the
Government
had
a
campaign
where
it
converted
a
bus
into
a
mobile
mammogram
screening
centre.
It
drove
around
the
heartlands
and
actively
promoted
the
concept
of
'prevention
before
it's
too
late'.
These
measures
are
combined
to
promote
the
awareness
of
the
different
diseases.
This
now
brings
us
to
the
factor
of
System‐based
care,
an
important
one
which
Singapore
recognizes
the
importance
of.
In
Singapore,
the
Government
has
ensured
standardization
throughout
General
Practioners
(GP)
as
the
government
effectively
controls
the
number
of
doctors
that
are
able
to
practice
in
Singapore.
This
is
further
aided
by
the
limited
number
of
medical
schools
in
Singapore,
(2)
ensuring
that
there
will
be
much
less
variation
in
training
and
practice.
As
such,
the
training
that
these
potential
doctors
receive
is
largely
homogeneous,
resulting
in
far
less
variation
in
patient
treatment
and
prescription,
leading
to
an
overall
improvement
in
system‐based
care.
In
addition,
Singapore
has
implemented
and
established
a
systemic
framework
to
ensure
that
all
citizens
get
the
healthcare
that
they
need.
This
model
is
leaning
towards
that
of
a
'socialist'
one,
where
the
Government
provides
heavy
subsidies
for
public
healthcare.
This
can
be
done
as
Singapore's
population
is
small
and
its
GDP
per
capita
is
one
of
the
highest
in
the
world,
allowing
for
the
annual
Budget
for
the
country
to
increase
and
enabling
the
Government
to
set
aside
funds
for
healthcare.
This
comprehensive
system
allows
Singaporeans
to
be
able
to
afford
healthcare
costs,
giving
them
access
to
healthcare
when
they
need
it
most.
However,
it
is
imperative
to
note
that
Singapore
is
a
small
country
with
a
small
population,
allowing
the
government
to
have
a
tighter
control
over
healthcare
systems.
Due
to
the
dense
communication
links
between
the
various
Ministries
in
the
country,
Singapore
is
able
to
maintain
a
high
standard
of
living
and
sanitation,
both
fundamental
for
disease
prevention.
Singapore
also
works
towards
reducing
the
number
of
ill
patients
through
21
prevention
rather
than
simply
curing,
this
has
been
achieved
via
educational
campaigns
etc.
Hence,
Singapore
is
able
to
adopt
a
many‐pronged
approach
to
combat
the
healthcare
situation,
creating
an
efficient,
systemic
approach
that
combats
the
healthcare
problem
on
many
levels.
Last
but
not
least,
we
feel
that
Singapore
has
addressed
the
issue
of
personalized
care
relatively
well
due.
In
Dr
Balser's
speech,
personalised
care
was
defined
as
prescribing
treatments
to
patients
based
on
their
individual
needs,
as
opposed
to
"treating
the
average
patient".
In
Singapore,
this
is
largely
present
due
to
the
high
emphasis
on
doctor‐patient
relations.
Most
Singaporeans
have
a
family
doctor
to
whom
they
go
in
the
event
of
sickness
and
hence,
the
family
doctor
understands
their
specific
needs
and
is
able
to
prescribe
treatments
accordingly.
In
addition,
the
Singaporean
government
strongly
discourages
the
practice
of
"doctor‐hopping"
at
hospitals,
thus
emphasizing
and
supporting
the
strong
doctor‐patient
relationship
which
is
crucial
in
ensuring
the
provision
of
personalised
care.
As
such,
doctors
will
be
well
aware
of
the
needs
of
the
patients
under
their
care,
allowing
them
to
tailor
their
treatments
such
that
these
treatments
will
have
the
greatest
efficiency
in
combating
the
illness
afflicting
the
patient.
The
main
problem
that
Singapore
would
be
facing
over
the
long
term
would
be
the
problem
of
an
ageing
population.
People's
bodies
tend
to
suffer
from
more
illnesses
as
their
body's
immune
system
is
not
as
strong
as
it
used
to
be.
As
a
result,
the
elderly
face
a
host
of
diseases
as
they
approach
old
age.
This
would
in
turn
push
up
the
total
healthcare
expenditure.
The
innovation
we
see
that
will
bring
the
most
benefit
to
the
current
healthcare
system
is
in
the
identification
of
a
patient's
susceptibility
to
diseases
such
as
Alzheimer's.
From
the
diagnosis,
the
doctor
could
then
advise
the
patient
accordingly
to
tweak
his/her
lifestyle
habits
to
better
prevent
the
onset
of
the
disease.
This
will
certainly
help
reduce
the
‘reactive’
measures
that
are
needed
in
the
future,
cutting
costs
and
saving
more
lives.
Shiyan
Cooperation
High
School
As
the
world
is
striding
towards
a
new
healthcare
era,
the
medical
technology
and
unhealthy
lifestyle
make
the
medical
expenditure
and
financial
ability
clash.
22
Since
China
reformed
and
opened
up,
the
healthcare
system
has
changed
a
lot.
But
you
know,
there
are
a
lot
of
differences
between
cities
and
countryside
in
China.
But
in
many
places
people
still
complain
that
it’s
hard
and
expensive
to
see
a
doctor.
This
is
because
the
medicine
became
market‐led
and
the
expenses
of
healthcare
rose
rapidly.
In
practice,
the
government
put
less
to
the
healthcare.
So
most
people
have
to
pay
for
their
health.
Many
hospitals
with
fantastic
facilities
are
built
in
big
cities.
There
are
still
many
problems
after
the
first
reforms.
The
government
has
posed
new
reform
to
improve
it.
They
will
make
the
poor
be
possible
to
see
a
doctor
when
they
get
sick.
From
the
healthcare
system
in
developed
countries,
we
learn
that
first
we
should
choose
a
healthcare
system
in
accord
with
the
condition
of
our
own
country.
China
has
a
large
population.
So
we
can’t
copy
western
system
blindly.
We
should
adopt
policy
in
line
with
China’s
needs.
Though
China
is
a
country
with
long
history,
we
have
only
reformed
and
opened
up
for
31
years.
A
lot
of
achievements
have
been
achieved.
And
we
need
time
to
improve
our
system.
Second,
government
should
play
a
major
role
in
reforming
medical
survives
system
and
the
reformed
plan
and
carrying
out
should
be
transparent
to
all
the
citizens.
Third,
it
should
be
stressed
that
the
duty
the
government
has
to
public
medical
domain.
Fourth,
government
should
try
its
best
to
make
everyone
be
able
to
see
a
doctor
while
sick
especially
for
the
people
in
rural
places
and
impoverished
areas.
The
government
should
pay
more
towards
healthcare,
and
promote
the
consumption
of
it.
All
this
will
help
more.
Winchester
College
The
UK
allocates
9%
of
its
GDP
to
healthcare,
unlike
the
US,
which
spends
21%.
However,
this
isn’t
a
fair
comparison:
the
predominately
private
health
system
in
the
US
incurs
different
sorts
of
costs
to
the
public
NHS.
In
the
UK
each
person
pays
an
average
of
ten
thousand
pounds
towards
state
funded
healthcare
in
the
form
of
tax;
but
it
is
possible
to
pay
higher
fees
for
quicker,
and
often
better,
private
treatment.
This
engenders
a
clear
tradeoff
between
cost
and
quality.
The
US
prioritizes
quality,
which
drives
up
the
cost
of
treatment
as
doctors
are
paid
more.
On
the
other
hand,
healthcare
is
more
generalized
and
less
personalized
in
the
UK,
making
it
cheaper
(doctors
are
paid
less)
and
more
efficient.
23
These
are
the
two
main
reasons
why
the
healthcare
in
the
UK
consumes
less
of
its
GDP
than
the
USA
healthcare
budget.
The
main
issue
surrounding
British
healthcare
has
inevitably
been
contaminated
with
politics.
When
the
Labour
party
left
office
in
2010
they
left
a
legacy
of
centralized
bureaucracy:
power
was
concentrated
on
the
policy
makers
and
the
businessmen,
who
knew
how
to
run
a
business
but
didn’t
know
what
the
patients
truly
required.
The
result
was
a
purely
business
model
that
didn’t
fit
the
system
it
was
made
for.
Compromises
were
made
on
the
quality
of
healthcare
for
the
patient
or
the
doctors
simply
didn’t
follow
the
economically
viable
plans
laid
out
in
front
of
them.
However,
when
the
dominantly
conservative
Coalition
came
into
power,
the
situation
was
seemingly
rectified.
Their
solution
to
the
problem
was
to
decentralize
the
entire
system
thereby
giving
control
of
resources
and
finance
to
individual
doctors
and
rendering
the
bureaucrats
obsolete.
This
ties
in
to
Mr.
Balser’s
point
about
how
in
the
US,
the
same
doctor
could
treat
ten
patients,
but
each
patient
would
receive
a
completely
different
level
of
care.
There
is
minimal
accountability
in
the
US
system,
leaving
doctors
to
process
as
many
patients
as
possible
merely
to
gain
higher
wages.
With
the
conservative
changes,
there
is
now
increased
accountability
because
there
were
no
bureaucrats
to
blame;
the
doctors
know
that
any
blame
will
fall
heavily
on
them.
It
will
be
their
duty
to
uphold
the
quality
of
care.
Some
doctors
welcome
this
initiative
but
others
see
it
as
an
undesirable
administrative
imposition.
In
a
time
when
economic
cuts
are
being
made
across
the
board,
the
British
government
is
attempting
to
leave
the
NHS
unscathed.
Unfortunately
it
is
becoming
more
and
more
difficult
to
avoid
what
seem
to
be
inevitable
cuts
to
the
health
service.
These
cuts
are
to
employment
which
will
increase
the
workload
on
the
staff,
probably
decreasing
quality.
With
these
harsh
measures
the
Coalition
government
will
reduce
the
number
of
middle‐
men
(and
thus
the
cost).
This
will
increase
communication
between
doctors,
their
colleagues
and
patients.
Dr
Balser
spoke
about
a
situation
where
six
doctors
were
being
used
to
treat
one
patient
and
these
doctors
did
not
communicate
with
each
other.
This
situation,
with
the
new
measures,
can
be
avoided:
now
there
will
only
be
one
doctor
with
one
patient,
creating
a
more
personalized
healthcare
system.
24
Day
2,
March
27
Students
began
day
two
by
debating
amongst
themselves
issues
relating
to
technology
in
healthcare,
and
the
ethical
dilemmas
that
might
come
with
technological
advance.
Presentations
on
the
topic
would
take
place
later
in
the
Symposium
week,
after
further
discussions
and
experiences.
Congressman
Jim
Cooper
addressed
the
MBIS
after
lunch
on
the
subject
of
US
healthcare
policy.
Before
moving
to
the
US
healthcare
system
in
particular,
he
covered
global
health
using
a
stark
series
of
maps
to
illustrate
the
unequal
nature
of
world
healthcare
issues.
As
had
Dr.
Balser
on
Day
1,
he
also
noted
that
40%
of
healthcare
outcomes
were
behavior‐
related,
and
thus
of
all
healthcare
approaches,
perhaps
education
would
have
the
best
chance
of
success.
He
went
on
to
outline
the
US
system,
noting
that
elements
of
international
systems
were
present
in
the
US
model:
public
provision
via
Medicare
and
Medicaid
was
similar
to
the
Canadian
system;
the
Veterans
Affairs
model
was
similar
to
Britain’s
National
Health
Service;
elements
of
private
health
insurance
were
common
with
the
German
model;
and
the
uninsured
in
America
faced
a
situation
not
unlike
the
Indian
cash‐for‐care
system.
He
suggested
that,
ironically,
the
US
healthcare
system
was,
in
many
regards,
more
socialized
than
much
of
Europe.
Nevertheless,
as
with
Dr
Balser
on
Day
1,
he
believed
that
the
United
States
was
getting
far
from
its
money’s
worth
with
the
current
system.
He
referred
to
healthcare
via
a
triangle
of
quality‐cost‐access
and
believed
that
only
two
out
of
these
three
were
being
effectively
satisfied
at
any
one
time.
Worrying
about
the
spiraling
costs
of
the
private
sector,
he
reminded
the
MBIS
participants
of
the
old
healthcare
adage
“never
visit
a
surgeon
on
a
slow
day”,
referring
to
the
tendency
of
the
system
to
create
huge
expenditures
because
of
the
profit
motive
inherent
in
the
private
sector.
He
acknowledged
the
efficiency
of
for‐profit
motivation,
yet
he
called
for
a
system
that
combined
that
with
the
compassion
of
the
non‐profit
sector.
President’s
Obama’s
health
reforms,
he
suggested,
reduced
the
number
of
uninsured
but
left
the
fundamentals
of
the
system
unchanged.
What
was
needed
was
a
greater
spreading
of
risk
–
he
used
an
analogy
25
of
a
large
tent
roof
allowing
more
to
shelter
without
appreciably
reducing
individual
coverage;
but
doing
nothing
was
simply
not
a
sustainable
financial
option
given
the
current
and
predicted
outlay.
Drawing
on
his
presentation
and
their
own
studies
before
the
MBIS,
students
redrafted
work
on
the
optimum
balance
between
public
and
private
provision
of
healthcare,
noting
also
the
most
pressing
healthcare
challenges
facing
their
own
systems.
Karthik
Sastry
and
Paul
Baker
from
Mongomery
Bell
Academy,
and
Samuel
Ching
and
Bryan
Seethor
from
Raffles
Institution
presented
their
findings
later
in
the
day.
Following
the
presentations,
all
MBIS
participants
visited
Nashville’s
Parthenon,
and
were
given
a
tour
inside
and
out
by
MBA
faculty
members
Mr.
Jim
Womack
and
Dr
Ed
Gaffney.
On
return
to
MBA,
students
reconvened
to
discuss
healthcare
in
rural
and
impoverished
areas,
a
discussion
led
by
Mr
David
Scudder
of
African
Leadership
Academy.
26
"What
is
the
optimum
balance
of
public
and
private
healthcare,
bearing
in
mind
the
competing
claims
on
scarce
resources?
Identify
the
most
pressing
healthcare
reform
issue
for
the
healthcare
system
of
your
choice."
African
Leadership
Academy
Public
healthcare
should
fundamentally
be
accessible
to
all
people
in
a
country
especially
those
who
least
can
afford
healthcare
while
private
healthcare
should
supplement
private
healthcare.
Governments
should
ensure
that
its
citizens
have
access
to
basic
public
healthcare
to
begin
with.
Private
healthcare
would
then
exist
to
provide
more
luxurious
healthcare
per
se
and
be
the
channel
through
which
innovations
penetrate
the
healthcare
system
with
more
room
for
experimentation
and
more
money
to
invest
in
new
technology.
In
many
countries
however,
the
degree
to
which
a
population
seeks
either
public
or
private
healthcare
will
mostly
depend
on
the
cost
of
the
service.
Private
healthcare
tends
to
be
more
expensive
than
public
healthcare
and
therefore
many
people
will
tend
to
utilize
public
healthcare.
The
richer
people
of
a
population
often
then
prefer
private
healthcare
as
they
can
easily
pay
for
it.
In
addition,
accessibility
of
public
healthcare
will
determine
whether
or
not
people
seek
private
healthcare.
If
a
government
is
failing
in
its
role
to
provide
health
services,
the
population
will
resort
to
private
healthcare.
This
is
the
case
especially
in
many
areas
where
the
top
echelon
of
society
resides.
These
are
people
who
often
require
and
demand
the
best
and
most
accessible
of
social
amenities
healthcare
being
one
of
them.
Moreover,
the
quality
of
service
in
public
healthcare
will
ultimately
determine
the
extent
and
numbers
of
people
who
seek
private
healthcare.
In
Kenya
for
example,
many
people
will
go
to
private
hospitals
because
the
service
offered
there
is
do
much
better.
There
is
more
emphasis
on
hygiene
and
tailoring
of
services
to
suit
the
patient.
The
patient
is
also
treated
much
better
than
in
public
hospitals.
For
this
reasons,
many
will
prefer
private
healthcare
despite
the
fact
it
is
more
expensive.
27
It
is
hard
to
dictate
where
the
balance
should
lie
especially
because
it
is
determined
mainly
by
the
consumers’
preferences.
Governments
should
however
take
care
not
to
over
rely
on
private
healthcare
even
if
a
larger
percentage
of
the
population
seeks
this
healthcare
because
even
in
a
very
rich
country,
not
all
the
citizens
can
afford
private
healthcare
and
for
these
citizens,
the
option
of
public
healthcare
should
exist.
At
the
same
time,
governments
should
strive
to
better
the
public
healthcare
system
in
their
individual
countries.
Colegio
Claustro
Moderno
Healthcare
being
a
scarce
and
limited
resource,
states
would
be,
theoretically,
obligated
to
cover
all
their
citizens
with
this
service.
In
theory,
it
should
be
like
this,
however
we
believe
to
implement
fully
a
policy
to
change
national
health
systems
would
be
utopian
because
it
is
well
known
that
although
healthcare
is
very
important,
countries
do
not
have
the
necessary
resources
to
achieve
this
purpose
and
governments
cannot
neglect
other
important
basic
needs
such
as
education,
public
defence,
public
works
infrastructure
or
the
creation
of
employment
sources.
Therefore,
we
believe
free
healthcare
service
might
be
given
to
all
the
population
in
a
basic
level
of
assistance,
urgent
cases
principally,
since
the
coverage
of
all
medical
services
for
free,
such
as
medication,
surgical
assistance,
hospitalization
costs,
therapeutic
and
rehabilitation
equipment,
along
with
others,
would
represent
a
huge
economic
impact
of
enormous
dimensions
for
governments
that
they
would
not
be
able
to
afford
and
confront.
However,
when
it
comes
to
scheduled
surgical
interventions,
medicines
for
lifetime
treatments,
etc.
governments
with
scarce
resources
should
implement
similar
healthcare
systems
to
the
one
in
use
in
Colombia.
For
example,
it
is
based
on
two
regimes
on
the
social
healthcare
system:
the
contributory
and
the
subsidized
one.
This
means
that
the
citizens
who
have
got
a
job
and
economic
stability
ensure
their
right
to
comprehensive
healthcare
services
through
a
contribution
or
quotes
deducted
from
their
wages,
for
the
creation
of
a
common
fund.
Also,
these
same
citizens
give
a
little
part
of
their
salary
to
another
common
found
that
helps
and
subsidizes
the
vulnerable
citizens,
who
are
the
ones
28
who
have
not
have
job
stability
or
the
ones
who
are
unable
to
work
and
live
in
extreme
poverty
conditions
because
of
old
age,
illness
or
poverty.
We
think
that
a
proper
and
efficient
administration
of
all
these
resources
that
are
not
the
state
itself
but
the
resulting
and
arising
from
the
salary
contributions
made
by
each
citizen,
if
administered
by
the
State,
directly
or
by
individuals,
but
with
the
supervision
and
monitoring
of
the
State,
would
mean
that
even
with
such
limited
resources,
the
health
of
a
country
were
well
attended.
In
other
words,
health
is
a
right
that,
theoretically,
must
be
provided
to
all
people
but
is
impossible
for
most
states
to
comply
with
this,
because
it
is
excessively
difficult
to
furnish
this
right
to
everyone
(equally),
when
they
do
not
possess
sufficient
resources
to
do
so.
For
this
reason,
governments
must
ensure
good
health,
providing
it
to
the
majority
of
people
in
need
as
possible,
taking
into
account
the
amount
of
money
(resources)
that
they
should
and
can
implement
on
this
issue
without
leaving
aside
important
issues
as
well
as
education,
social
security
and
defence.
Also,
we
believe
that
a
State
could
be
able
to
reach
a
free
standard
healthcare
system
for
all
its
citizens,
but
they
certainly
cannot
afford
the
finance
of
a
more
complex
healthcare
since
it
would
neglect
the
coverage
of
other
essential
and
important
community
needs.
Conversely,
the
United
States
of
America
do
not
agree
with
this
assumption
due
to
their
economic
and
their
good
healthcare
infrastructure
and
has
made
it
known
with
their
recent
health
care
reform
proposed
by
President
Barack
Obama.
The
controversial
reform
based
on
the
healthcare
in
the
United
States
is
based
on
implementing
a
universal
health
service
that
should
cover
all
U.S.
citizens,
making
compulsory
the
possession
of
a
health
insurance.
This
reform
also
proposes
a
health
care
system
more
affordable
and
fairer,
allowing
people
with
low
income
to
have
a
medical
assistance
either
basic
or
more
complex.
This
controversial
reform
is
not
entirely
clear
in
aspects
such
as
the
financing
and
budget
they
must
reach
to
achieve
the
universal
social
system
or
the
progressive
enrichment
of
insurance
companies,
the
ones
that
are
being
forced
to
change
their
insurance
policies
by
the
new
reform
itself,
which
does
not
leave
the
American
People
very
satisfied.
29
In
our
point
of
view,
the
most
pressing
issue
in
this
reform
is
the
social
purpose
since
it
seeks
a
good
standard
of
living
for
all
citizens,
enabling
them
to
have
a
medical
system
that
finances
and
takes
care
of
the
expenses
that
may
arise
in
the
treatment
of
a
particular
disease.
Likewise
we
believe
it
is
very
important
the
funding
to
implement
this
reform
because
a
State
must
have
a
very
strong
and
secure
economy
to
be
able
to
afford
healthcare
to
all
its
population
equally.
Garodia
International
Centre
for
Learning
The
basic
economic
problem
faced
by
every
economy’s
producers
is
the
problem
of
allocating
a
limited
number
of
resources
efficiently.
This
problem
goes
hand
in
hand
with
a
choice;
in
economics
this
choice
is
referred
to
as
the
‘opportunity
cost’
viz.
the
choice
of
the
next
best
opportunity
forgone.
The
government,
being
a
producer
in
the
healthcare
scenario,
has
to
make
this
choice
when
deciding
its
spending
on
healthcare,
which
has
been
mentioned
[‘competing
…scarce
resources’].
In
the
case
of
healthy
citizens
we
feel
that
the
government
should
provide
healthcare
for
all,
despite
the
opportunity
costs
it
faces.
As
we
all
know,
a
man
is
less
productive
when
ill
and
there
are
many
people
who
cannot
work
due
to
health
conditions.
Hence
with
investment
in
healthcare,
production
(health
conditions)
and
productivity
(illness)
will
improve,
which
would
in
turn
boost
the
GDP
in
the
long
run,
making
the
opportunity
cost
worthwhile.
In
our
opinion,
a
government
should
provide
for
citizens
even
if
their
personal
behavior
is
detrimental
to
their
health;
however,
the
aid
provided
should
be
only
up
to
a
certain
extent
due
to
the
paucity
of
resources.
In
the
given
example
‘Should
a
smoker…private
behavior’
the
question
posed
is
whether
alcoholics
or
smokers
should
be
denied
organ‐
transplant.
For
this
issue,
our
suggestion
is
that
they
be
given
a
single
chance
for
recovery
which
would
include
free
rehab
admission
and
treatment,
transplant,
etc
F.O.C.
But
on
repeating
their
error,
any
such
medical
services
from
the
government
should
be
denied
to
them,
as
the
scare
resources
allotted
for
this,
can
now
be
employed
in
more
productive
ways.
The
pressure
on
presidents
to
be
re‐elected
does
affect
their
long
term
planning
in
terms
of
healthcare
reform,
since
all
politicians
are
self‐
serving.
They
will
not
push
through
a
30
reform
if
its
outcome
will
only
be
visible
post
their
electoral
term,
and
for
which
they
shall
not
entirely
receive
credit.
In
allocating
goods
like
healthcare
and
education
the
power
of
market
forces
cannot
be
used
as
effectively.
As
private
firms
are
solely
profit‐driven,
there
is
likely
to
be
competition
amongst
them.
There
can
be
positive
effects
of
this
competition,
leading
to
utilization
of
cutting‐edge
technology
and
better
service.
On
the
other
hand
there
may
be
ill
effects
like
unnecessary
frills,
advertising
expenses
etcetera,
the
bills
for
which
the
patients
shall
end
up
paying.
Market
forces
will
not
prove
efficient
in
the
healthcare
sector,
as
health
care
is
a
universal
necessity
and
right,
whereas
the
market
forces
of
demand
and
supply
only
serve
those
who
can
back
their
demand
with
the
ability
to
pay.
Recessions
are
characterized
by
a
fall
in
demand,
this
leads
to
unemployment
in
the
long
run.
Therefore
the
economic
slow‐down
is
highly
relevant
to
our
debate,
as
it
is
indirectly
putting
pressure
on
the
government
to
direct
more
funds
towards
healthcare
coverage
for
its
escalating
number
of
unemployed
citizens.
Johannes
Kepler
Grammar
School
Every
citizen
of
any
given
country
should
have
the
access
to
some
kind
of
health
insurance
program,
regardless
of
their
financial
situation.
It
is
even
stated
in
article
12
of
the
International
Covenant
on
Economic,
Social
and
Cultural
Rights
adopted
by
the
UN
General
Assembly
in
1966
that
everyone
has
the
right
to
health.
Yet,
everyone
should
take
initiative
and
make
use
of
being
granted
the
access
and
financially
take
part
on
it
as
it
would
not
be
sustainable
for
any
state
to
cover
the
cost
of
healthcare
provided
to
their
citizens
due
to
the
omnipresent
scarcity
of
resources.
Now,
we
have
to
ponder
where
the
optimal
balance
between
the
private
healthcare
and
public
healthcare
lies.
First,
it
is
actually
important
to
draw
the
line
between
private
and
public
healthcare.
Both,
the
public
and
private
healthcare
are
financed
by
the
citizens
of
the
country.
The
difference
is
that
for
one
you
are
paying
directly,
for
the
other
one
you
are
paying
in
a
bit
31
more
vague
way.
What
are
the
pros
and
cons
of
each
of
them?
When
it
comes
to
private
health
care
that
you
have
to
pay
entirely
yourself,
you
know
what
you
are
paying
for
and
you
know
what
you
can
expect
to
get
back
for
the
price.
You
have
it
under
you
own
control,
but
the
unfavorable
thing
is
that
you
need
to
pay
a
lot
more
than
you
would
pay
for
public
health
care.
Now,
what
are
the
positives
and
negatives
of
public
health
care?
The
positive
thing
is
that
the
cost
is
lower
than
the
cost
of
private
health
care
as
the
money
is
shared
on
a
communal
level
and
redistributed
where
it
is
needed.
The
negative
thing
about
public
health
care
is
that
you
do
not
have
any
control
over
the
money
that
you
put
into
it
and
you
have
no
way
of
telling
whether
it
pays
off
and
you
are
really
getting
your
money's
worth
of
care
back.
That
is
because
the
money
comes
back
to
you
in
a
round‐about
way.
Public
healthcare,
i.e.
a
public
health
insurance
plan,
should
be
provided
and
should
be
obligatory
to
take
part
in
–
that
is
to
prevent
extra
financial
burden
on
the
state
and
its
citizens
in
cases
of
treating
uninsured
individuals
–
to
all
people
without
discrimination
and
it
ought
to
contain
all
necessary
treatment
and
to
be
affordable
for
everyone.
Private
healthcare
should
come
into
play
at
the
point
where
the
standard
treatment
ends.
In
other
words,
if
you
want
to
receive
something
that
exceeds
the
regular
standards,
you
should
pay
for
it.
For
instance,
if
you
demand
a
tooth
filling
that
is
less
visible
but
more
expensive
than
the
regular
one,
you
should
be
ready
to
bear
the
cost.
The
health
care
system
of
the
Czech
Republic,
as
many
other
health
care
systems
all
over
the
world,
is
in
a
grim
situation.
The
worst
issue
is
the
lack
of
finances
which
is
getting
worse
and
worse
in
spite
of
attempts
to
improve
the
situation,
one
of
which
was
the
introduction
of
medical
treatment,
consultation,
and
prescription
charge
of
30
koruna
(approximately
$1.5).
This
regulation
fee
incited
a
strong
wave
of
protests
as
opposition
parties
together
with
large
numbers
of
citizens
claimed
that
everybody
should
have
the
right
to
free
medical
treatment
since
they
already
pay
for
their
health
insurances.
Eventually,
the
question
of
30
koruna
charge
became
a
fierce
political
battlefield,
which
has
not
reached
its
end
yet,
and
a
populist
way
to
receive
support
of
voters
in
elections.
The
original
idea
of
the
30
koruna
charge
was
to
redistribute
the
provision
of
medical
treatment
and
consultation
in
order
to
improve
the
efficiency
of
the
system
and
make
sure
that
people
who
need
medical
treatment
will
receive
an
improved
care
as
doctors
would
most
likely
have
more
time
to
cater
to
their
needs.
Even
though
the
charge
is
only
32
symbolic
compared
to
the
real
cost
of
treatment,
many
people
regarded
the
introduction
of
this
charge
as
infringement
of
their
right
to
receive
free
medical
treatment.
On
this
case
we
could
observe
a
problem
which
is
current
in
many
western
countries:
people
are
so
used
to
the
high
standard
of
living
that
they
feel
almost
every
reform
as
being
unnecessary
and
leading
to
a
decrease
of
their
standard
of
living.
We
need
to
face
the
fact
that
the
conditions
in
our
country
are
variable
and
the
system
that
might
have
worked
twenty
years
ago.
Montgomery
Bell
Academy
The
authors
of
the
United
States
Constitution,
in
the
document's
preamble,
state
that
one
of
the
purposes
of
a
responsible
government
is
to
"promote
the
general
welfare"
of
its
citizens.
This
concept
of
ensuring
well‐being
is
central
to
the
very
idea
of
the
modern
state,
an
organization
which
not
only
enforces
the
rule
of
law
but
also
provides
basic
services
for
its
citizens.
Considerable
disagreement,
however,
has
arisen
as
to
precisely
what
extent
governments
should
act
to
achieve
this
end,
considering
both
the
practicality
and
efficacy
of
any
policy.
The
specific
issue
of
health
care
adds
another
layer
to
the
already
contentious
debate:
a
humanitarian
one,
making
it
difficult
to
ignore
the
conflict
of
interests
at
play.
In
reality,
the
role
that
a
government
should
take
in
health
care
depends
on
individual
context.
For
an
advanced
nation
such
as
the
U.S.,
policymakers
are
concerned
with
distributing
already
abundant
health
care
resources
more
effectively,
often
through
government
reform.
Developing
nations
struggling
to
provide
adequate
care,
in
contrast,
have
no
choice
but
to
pursue
government
control
in
order
to
facilitate
the
creation
of
a
health
infrastructure
from
the
ground
up.
Reform
efforts
within
the
United
States
have
primarily
attempted
to
tweak
the
payment
system,
focusing
on
two,
often
conflicting
goals:
reducing
costs,
and
expanding
coverage.
It
is
no
secret
that
American
health
care
costs
too
much,
impacting
the
country's
economic
competitiveness
on
the
global
scale,
and
hurting
the
average
consumer.
Perhaps
the
more
controllable
factor
driving
up
expenses
is
the
administrative
largesse
of
the
system—the
Kaiser
Family
Foundation
estimates
that
7%
of
total
health
care
expenditure
in
the
U.S.
is
directed
toward
marketing,
billing,
and
other
services
which
are
almost
entirely
a
function
of
a
private
health
care
economy.
At
the
same
time,
reformers
want
to
expand
coverage.
A
33
2008
survey
estimated
that
15%
of
the
country
lacked
any
insurance
plan.
Only
27%
were
enrolled
in
government‐sponsored
programs
(Medicare,
Medicaid,
SCHIP,
veteran's
benefits,
etc.);
the
rest
purchased
coverage
either
through
their
employer
or
on
the
open
market.
The
nature
of
a
private
system
allows
insurers,
seeking
to
maximize
profit,
not
to
cover
those
who
would
be
most
costly
to
insure:
people
pre‐disposed
to
medical
problems
and
conditions.
Thus,
the
patients
who
are
in
the
greatest
need
of
support
are
the
most
likely
to
fall
through
the
cracks
of
the
system.
The
health
care
bills
passed
earlier
this
year
by
Congress
fell
short
of
instituting
a
"public
option,"
or
a
broad
government‐run
health
care
agency.
Critics
suggested
that
such
a
plan
would
be
nothing
short
of
"European‐style
socialism,”
a
politically
unacceptable
outcome
on
this
side
of
the
Atlantic.
But
bearing
in
mind
the
realities
of
the
situation,
the
reforms
adopted
were
not
unreasonable.
The
Affordable
Care
Act
mandates
that
all
Americans
have
health
insurance,
in
an
effort
to
force
more
healthy
people
to
obtain
insurance
and
thus
reduce
premiums
across
the
board.
It
also
works
toward
increasing
availability,
stiffening
penalties
on
companies
that
refuse
to
provide
coverage
and
establishing
health
care
"exchanges"
which
facilitate
the
purchasing
of
insurance.
Only
time
will
tell
whether
these
efforts
are
successful,
but
at
the
moment
it
seems
the
United
States
is
committed
to
its
private‐market
strategy.
While
a
public
option
may
have
been
more
ideal,
a
reform
effort
which
operates
within
the
existing
framework
may
be
more
practical.
The
rest
of
the
world
does
not
have
quite
the
same
luxury.
For
developing
nations
in
which
health
care
access
is
sparse
at
best,
centralized
government
control
may
be
the
only
option.
The
health
care
system
of
Cuba
is
an
interesting
case
study.
Cuba
has
some
of
the
lowest
mortality
rates
in
the
entire
world,
in
sharp
contrast
with
its
Caribbean
neighbors.
In
the
biography
Mountains
Beyond
Mountains,
author
Tracy
Kidder
mentions
a
brief
visit
he
made
to
the
island
with
famous
medical
anthropologist
Dr.
Paul
Farmer,
who
had
been
working
primarily
in
Haiti.
The
contrast
was
incredibly
sharp:
whereas
one
nation
was
in
absolute
disarray,
the
other
was
able
to
provide
health
coverage
for
almost
all
its
citizens.
The
Cuban
model
illustrates
that
often
the
institution
of
society
most
capable
of
building
a
healthcare
system
with
limited
resources
is
the
government.
Charitable
efforts
are
not
sufficiently
organized
to
make
a
broader
impact
in
nations
with
struggling
health
care
systems—a
more
centralized
authority
is
needed.
34
The
conflict
of
health
care
and
government
will
continue
to
define
the
health
care
debate
around
the
world.
Developed
nations,
such
as
the
United
States,
can
afford
to
trust
the
market
under
certain
conditions
to
provide
health
care.
But
for
those
in
much
more
dire
need
of
health
care,
an
expanded
government
role
may
be
required.
Nada
High
School
The
healthcare
reform
has
become
a
big
problem
in
every
developed
country
such
as
the
United
States,
the
United
Kingdom,
and
even
in
our
country,
Japan,
which
is
said
to
have
the
best
healthcare
system
in
the
world
according
to
WHO.
There
has
been
a
big
argument
between
people
in
those
countries
and
the
government.
What
is
the
most
important
factor
that
a
government
has
to
ensure?
We
think
that
it
is
whether
people
can
live
safe
lives,
without
being
annoyed
by
diseases
and
other
bad
physical
conditions.
Actually,
the
Japanese
Constitution,
for
example,
says
that
all
the
citizens
have
basic
human
right
which
must
not
be
robbed
of
forever.
This
“basic
human
right”
includes
the
right
to
live.
This
means
that
keeping
people
healthy
is
one
of
the
most
significant
matters.
From
this
point
of
view,
we
believe
that
a
government
should
ensure
the
provision
of
healthcare
for
its
citizens
to
the
extent
that
citizens
can
live
“normal”
lives,
that
is,
to
the
extent
that
they
can
live
with
good
physical
conditions
until
they
die.
At
least,
they
have
the
right
to
do
so,
and
a
government
should
try
to
protect
their
citizen's
right
to
do
so.
In
order
to
accomplish
this
task,
a
government
should
spend
as
much
money
as
it
can
for
the
healthcare
expenditure,
regardless
of
their
GDP.
With
regards
to
balancing
the
public
and
private
healthcare
that
we
get,
we
think
that
Japan
today,
and
Nordic
countries
such
as
Norway
and
Denmark
provides
public
healthcare
that
are
very
close
to
an
ideal
one.
As
Congressman
Jim
Cooper
noted
in
his
presentation,
“Improving
America
and
World
Health”,
these
countries
are
in
good
balance
of
public
healthcare
and
private
healthcare
unlike
the
countries
such
as
the
United
States.
In
these
countries,
nearly
80%
of
the
healthcare
spending
is
funded
by
public
resources.
For
example,
in
Japan,
70%
of
the
medical
expenses
are
basically
paid
by
the
government,
and
the
citizens
pay
the
rest.
All
the
people
in
Japan
are
ensured
of
their
health.
35
Furthermore,
these
countries
have
either
the
high
employment
rate
of
human
resources
like
doctors
and
nurses,
or
the
high
number
of
acute
care
hospital
beds.
However,
we
have
to
admit
that
even
in
these
countries,
there
are
many
issues
for
healthcare
reform.
Next,
we
are
going
to
take
an
example
of
Japan
to
make
it
easy
to
understand
the
most
pressing
healthcare
reform
issue.
According
to
the
report
by
OECD,
Japan
spent
only
7.9
percent
of
GDP
on
healthcare
in
2008,
which
was
the
twenty‐first
place
among
thirty
countries
that
are
members
of
OECD.
And
the
absolute
amount
of
state
spending
per
capita
was
also
twenty‐first
place
in
all
OECD
countries.
Considering
that
the
life
expectancy
has
been
increasing,
this
situation
now
results
in
the
serious
issues
that
Japanese
healthcare
system
face.
For
example,
the
number
of
medical
accidents
is
increasing
steadily.
Japanese
hospitals
experience
a
"crowding
out"
effect,
with
space
for
emergency
care
and
serious
medical
conditions
sometimes
overwhelmed
by
a
flood
of
patients
seeking
routine
treatment.
There
are
shortages
of
doctors,
nurses,
obstetricians,
anesthesiologists
and
emergency
room
specialists.
This
is
because
of
too
much
overtime
work
which
violates
the
Labor
Standard
Law,
too
little
reward
for
it
and
so
on.
In
other
words,
doctors
have
been
paid
so
bad
salaries
despite
their
prolonged
work
because
of
the
little
medical
expenses.
A
research
shows
that
doctors
working
in
teaching
hospitals
earn
only
six
million
yen
a
year
on
average.
The
Japanese
government
says
that
the
government
has
to
cut
down
expenses
for
the
healthcare.
Actually,
the
Japanese
government
now
owes
a
debt
of
more
than
900
trillion
yen,
and
as
the
Japanese
society
ages,
the
healthcare
expenditures
will
get
much
higher.
Doctors
say
a
different
thing.
Most
of
the
money
they
get
from
the
healthcare
system
is
not
for
the
doctors
but
for
medicines
and
medical
instruments.
If
the
government
cut
down
the
expenses,
doctors
could
not
even
get
money
for
their
living.
According
to
the
research
by
Japan
Medical
Association,
over
90%
of
all
the
hospitals
are
now
in
red.
Both
sides
remain
far
apart
on
this
issue.
As
you
can
see
from
this,
the
lack
in
the
funds
of
sufficient
healthcare
system
is
the
major
issue.
This
can
be
seen
in
many
developed
countries,
even
though
the
reason
for
the
lack
differs
from
country
to
country.
In
order
to
achieve
our
ideal
healthcare
system,
this
issue
will
be
the
greatest
obstacle
we
have
to
face.
36
Raffles
Institution
More
often
than
not,
governments
around
the
world
are
constantly
facing
difficulties
trying
to
balance
their
budget,
yet
at
the
same
time,
trying
to
ensure
healthcare
for
all.
Here,
we
would
like
to
present
the
case
study
of
Singapore's
healthcare
system
to
offer
the
unique
insights
that
this
system
has
in
response
to
the
question.
At
the
same
time,
we
believe
that
there
will
never
be
an
optimum
balance
between
public
and
private
healthcare.
Rather,
there
will
be
a
constant
flux,
a
constant
're‐balancing'
act
that
will
change
according
to
the
public
health
circumstances.
There
are
two
core
areas
which
the
Singapore
healthcare
system
operates
on:
the
3M
framework
and
the
private/public
healthcare
system.
The
3M
framework
comprises
three
tiers.
The
first
tier
of
protection
is
provided
by
heavy
Government
subsidies
of
up
to
80%
of
the
total
bill
in
acute
public
hospital
wards,
which
all
Singaporeans
can
access.
The
second
tier
of
protection
is
provided
by
Medisave,
a
compulsory
individual
medical
savings
account
scheme
which
allows
practically
all
Singaporeans
to
pay
for
their
share
of
medical
treatment
without
financial
difficulty.
Working
Singaporeans
and
their
employers
contribute
a
part
of
the
monthly
wages
into
the
account
to
save
up
for
their
future
medical
needs
and
this
is
portable
across
jobs
and
after
retirement.
The
third
level
of
protection
is
provided
by
MediShield,
a
low
cost
catastrophic
medical
insurance
scheme.
This
allows
Singaporeans
to
effectively
risk‐pool
the
financial
risks
of
major
illnesses.
Individual
responsibility
for
one’s
healthcare
needs
is
promoted
through
the
features
of
deductibles
and
co‐payment
in
MediShield.
ElderShield,
a
severe
disability
insurance,
is
also
available
for
subscription
by
Singaporeans
to
risk‐
pool
against
the
financial
risks
of
suffering
a
severe
disability.
Many
middle
and
higher
income
Singaporeans
have
also
supplemented
their
basic
coverage
with
integrated
private
insurance
policies
(“Integrated
Shield
plans”)
for
treatment
in
the
private
sector.
Singaporeans
must
subscribe
to
the
basic
MediShield
product
before
they
can
purchase
the
add‐on
private
Integrated
Shield
Plans.
This
industry
structure
preserves
the
national
risk
pool
and
guards
against
‘cherry
picking’
of
healthy
lives
by
private
insurers.
Similarly,
“ElderShield
Supplements”
allow
policyholders
to
enhance
the
disability
benefits
coverage
offered
by
the
basic
ElderShield
product.
Finally,
Medifund
is
a
medical
endowment
fund
set
up
by
the
Government
to
act
as
the
ultimate
safety
net
for
needy
Singaporean
patients
37
who
cannot
afford
to
pay
their
medical
bills
despite
heavy
subsidies,
Medisave
and
MediShield.
As
for
the
balanced
healthcare
system,
80%
of
primary
healthcare
treatment
is
done
in
private
clinics,
the
remainder
of
patients
are
treated
in
public
clinics
'polyclinics'
where
treatment
is
heavily
subsidized
by
the
government
(up
to
80%‐90%
of
the
fees).
Most
Singaporeans
are
able
to
go
to
private
clinics
(where
payment
is
done
out
of
the
pocket)
as
they
are
able
to
afford
it.
However,
the
converse
is
true
for
acute
healthcare
treatment,
where
80%
of
patients
go
to
public
hospitals
and
the
remaining
20%
to
private
hospitals.
This
is
due
to
the
high
cost
incurred
for
hospitalization
and
the
surgery
itself.
Hence,
comfort
and
speed
(waiting
time
for
doctors)
are
the
two
'luxuries'
that
private
healthcare
is
able
to
offer
vis‐a‐vis
public
healthcare.
Consumers
then
decide
if
they
are
able
to
fork
out
more
money
for
these
'luxuries',
if
not,
they
are
still
able
to
go
to
public
polyclinics
to
receive
treatment.
In
conclusion,
as
one
can
see,
the
public/private
healthcare
balance
in
Singapore
is
largely
left
to
the
affluence
of
the
consumers
themselves.
While
the
government
is
able
to
ensure
that
all
Singaporeans
have
a
basic
standard
of
healthcare
(through
the
savings
scheme
and
co‐payment
insurance
plan),
it
also
allows
the
private
sector
to
provide
healthcare
for
the
more
well
to
do
in
society.
In
addition,
the
public
hospitals
publishes
its
pricing
list,
acting
as
a
benchmark
for
private
healthcare
providers
to
adjust
their
prices
according
to
market
forces.
However,
aside
from
these
'demand‐side'
measures,
the
government
also
firmly
believes
in
taking
preventive
steps
to
reduce
the
need
for
treatment
all
together.
For
example,
the
Health
Promotion
Board
(HPB)
created
to
raise
awareness
of
the
need
for
healthy
living.
Using
this
two
pronged
approach,
Singapore
is
able
to
keep
its
healthcare
expenditure
below
4%
of
GDP
Shiyan
Cooperation
High
School
Should
the
government
provide
healthcare
to
all
the
people?
We
do
think
it
is
an
important
thing
to
give
people
a
better
life
to
lead.
There
is
lots
of
news
about
it
that
we
have
read.
Some
people
have
died
in
front
of
a
doctor
because
of
doctors’
selfishness,
a
creature
had
lost
the
precious
lives.
Yes,
what
do
the
people
do
nowadays?
Even
though
38
they
know
the
problem
of
the
patients,
they
just
do
nothing.
The
money
from
the
rich
is
wasted
and
the
poor
still
don’t
have
the
chance
to
go
to
be
cured.
Of
course,
some
people
are
afraid
of
helping
others.
Because
of
some
people’s
choices,
they
have
lost
their
jobs.
How
can
the
government
help
this?
I
hope
the
government
can
change
a
little
bit.
Everybody
has
got
basic
rights;
all
the
human
beings
should
be
respected.
They
cannot
lead
a
dog’s
life.
Rich
people
should
help
the
poor
that
can
make
the
world
a
better
place.
Or
maybe
the
government
should
help
all
the
people.
Hospital
closures
and
other
market
changes
have
adversely
affected
rural
areas
in
China,
leaving
the
State
and
Federal
health
market
in
a
worse
condition,
and
others
concerned
about
access
to
health
care
in
rural
areas.
Considerable
changes
in
health
care
delivery
system
over
the
past
decade
have
intensified
the
need
for
new
approach
to
health
care
in
rural
areas,
partly
because
of
low
population
density.
Compared
with
urban
residents
have
a
higher
poverty
rates,
a
large
percentage
of
elderly,
tend
to
be
in
poorer
health,
have
fewer
doctors,
hospitals
and
other
health
resources,
and
face
more
difficulties
getting
to
health
services.
According
to
official
figures
released,
as
of
the
end
of
September
2005,
China's
total
poverty‐stricken
urban
population
was
21.86
million
people.
Urban
and
rural
poor
in
health
and
health
services
utilization
showed
that
in
general
of
their
health
situation
was
not
better
than
the
rest
of
the
population
and
even
to
some
extent
than
the
rest
of
the
poor
population,
but
within
a
poor
population,
the
use
of
health
services
is
obviously
insufficient.
In
addition,
the
same
survey
also
showed
that
in
two
weeks,
many
remain
the
untreated
patients,
in
addition
to
the
self‐perceived
diseases
themselves.
These
economic
difficulties
are
the
most
important
thing
we
need
to
correct
in
China’s
health
system.
Winchester
College
In
an
ideal
situation,
everyone
would
receive
a
high
quality
of
healthcare.
If
a
balance
is
struck
between
the
public
and
private
healthcare
services
in
a
country,
this
ideal
could
become
a
reality.
Both
services
complement
each
other,
but
each
has
its
limitations.
Public
healthcare
ensures
that
virtually
every
citizen
is
covered
by
healthcare
and
there
is
39
relatively
a
greater
level
of
accountability
if
something
were
to
go
wrong.
However,
there
are
many
disadvantages
to
such
a
large
corporation:
it
squanders
a
large
proportion
of
the
government
finances
and
tends
to
become
an
ever‐increasing
burden
on
public
expenses.
The
government
has
a
lot
of
control
over
the
funding
going
into
a
public
healthcare
system,
and
bureaucratic
complications
are
introduced.
Public
healthcare
is
less
personalised:
as
an
example,
new
technology
to
treat
a
rare
type
of
cancer
will
only
be
purchased
if
this
cancer
is
prevalent
in
many
people,
which
would
lead
a
minority
of
people
suffering.
When
one
looks
at
public
healthcare
systems
from
afar
though,
it
seems
as
if
overall,
it
is
beneficial
to
the
population.
Private
healthcare
often
caters
for
a
specific
branch
of
medicine
and
so
is
more
personalised
than
public
healthcare.
Although
its
budget
may
be
less
than
public
healthcare,
private
healthcare
services
have
greater
control
over
their
spending
and
choose
to
invest
in
systems
which
cater
for
their
smaller
group
of
patients,
instead
of
catering
for
the
masses.
Private
healthcare
is
generally
regarded
as
having
a
higher
quality
of
healthcare
than
public
healthcare,
and
is
far
more
comfortable.
This
all
comes
at
a
price.
The
current
unequal
balance
of
public
and
private
healthcare
systems
in
place
in
the
US
means
that
fifteen
million
Americans
are
left
vulnerably
uninsured
for
their
healthcare.
According
to
Congressman
Jim
Cooper,
Obama’s
healthcare
reforms
had
little
effect.
Congressman
Cooper
summarised
his
view
of
healthcare
in
a
neat
triad,
with
‘quality’,
‘cost’
and
‘access’
as
the
three
corners.
With
any
healthcare
system,
only
two
out
of
the
three
corners
are
covered.
The
optimum
balance
of
public
and
private
healthcare
will
seek
to
reach
equilibrium
between
these
three
factors.
A
system
would
be
created
where
cost
was
reasonable,
quality
was
acceptable
and
there
was
sufficient
access.
The
large
pharmaceutical
companies
claim
that
a
fifth
of
the
world’s
population
is
‘brand‐eligible’:
a
corporate
euphemism
for
‘unable
to
afford
medicine’.
Any
arguments
which
are
biased
towards
high
quality
healthcare
for
the
privileged
are
immediately
dispelled
by
this
figure.
A
large
issue
in
the
UK
healthcare
system
is
that
of
(de)centralisation.
This
issue
is
magnified
by
the
two
different
governmental
parties,
Labour
–
left‐wing
and
pro‐
centralisation;
and
Conservation
–
right‐wing
and
pro‐decentralisation.
Should
the
power
be
with
the
providers,
who
know
how
the
right
medical
aid
to
give,
or
with
the
bureaucrats,
who
know
how
to
operate
a
financially
sound
business?
The
issue
has
been
40
somewhat
clouded
for
the
average
Briton
as
Labour
proposed
a
central
computer
file
system
which
outraged
some
members
of
the
general
public,
and
recently
the
Tories
have
returned
much
power
to
the
doctors
and
GPs.
But
how
far
should
doctors
have
the
freedom
to
administer
expensive
medical
remedies?
41
Day
3,
March
28
The
day
began
with
early
morning
discussions
on
international
healthcare,
led
by
Mr
Kevin
Li
from
Shiyan
Cooperation
High
School
and
Mr
Mark
Aynsley
from
Nada
High
School.
This
area
of
healthcare
–
particularly
its
overlap
with
healthcare
in
rural
and
impoverished
areas
–
provoked
much
thought
and
discussion
with
the
varying
perspectives
and
backgrounds
of
the
MBIS
body
giving
great
depth
to
the
debate.
Online,
the
students
had
been
asked
to
approach
these
questions
with
one
mind,
and
to
consider
the
idea
of
a
comprehensive
vision
of
healthcare.
Themes
of
great
weight
and
importance
were:
personal
and
governmental
responsibility;
the
role
of
the
World
Health
Organisation;
educational
failure
and
scope
for
improvement;
economic
and
political
pressures;
drug
pricing
and
the
costs
and
benefits
of
the
profit
motive;
the
gains
and
losses
from
a
unified
approach
to
healthcare
as
opposed
to
discrete
ones
for
different
countries’
circumstances.
MBIS
participants
then
joined
the
entire
faculty
and
student
body
of
Montgomery
Bell
Academy
for
assembly.
Dr
Darin
Portnoy,
President
of
the
American
branch
of
Médecins
Sans
Frontières,
addressed
the
assemblage
on
the
global
work
of
MSF
and
the
challenges
it
faces.
Dr
Portnoy
then
led
an
extended
seminar
on
international
healthcare
and
particularly
in
areas
undergoing
conflict.
This
was
an
especially
compelling
issue
for
the
Symposium
as
students
had
all
read
Tracy
Kidder’s
Mountains
Beyond
Mountains
prior
to
coming
to
Nashville,
and
the
issues
facing
MSF
and
the
international
community
were
keenly
felt
by
all.
It
was
made
clear
that
MSF
has
a
purity
of
mission,
in
the
sense
that
it
discriminates
in
no
way
between
those
it
treats,
provided
patients
leave
weapons
at
the
door.
Its
$1bn
budget
comes
largely
from
private
sources,
the
rest
from
institutional
funds,
with
none
from
the
US
government.
This
reliance
on
private
funding
makes
the
media
profile
of
any
health
emergency
critical:
there
is
a
strong
correlation
between
the
media
coverage
of
an
event
and
the
subsequent
level
of
donations
to
MSF.
42
Dr
Portnoy
spoke
of
the
balance
of
risks
when
it
came
to
speaking
out
on
a
healthcare
issue.
For
example,
in
Darfur,
MSF
doctors
had
to
weigh
up
the
risk
of
being
ejected
from
the
country
with
that
of
remaining
silent
on
the
plight
of
those
affected
by
the
government’s
actions.
MSF
has
a
strong
role
in
advocacy.
Dr
Portnoy
talked
of
the
need
to
remind
the
world
of
ongoing
health
crises
–
such
as
the
enduring
conflict
in
the
Democratic
Republic
of
Congo,
and
the
extent
of
global
child
malnutrition
(in
excess
of
150m).
Many
of
Dr
Portnoy’s
themes
were
central
to
the
Symposium
preparation:
he
talked
of
the
role
of
innovation
in
helping
some
of
the
most
vulnerable
(for
example,
in
the
use
of
inflatable
hospitals
and
emergency
medical
kits);
he
stressed
the
key
role
of
international
organizations
and
individual
governments
(for
example,
in
funding
research
into
a
malaria
vaccine
and
HIV,
and
on
negotiating
agreements
on
drug
pricing
for
poor
countries);
and
he
discussed
the
different
and
critical
role
that
could
be
played
by
private
corporations
in
aiding
such
healthcare
(in
order
to
keep
MSF
independent
from
government
itself).
Students
were
presented
with
a
number
of
ethical
dilemmas
faced
by
MSF,
such
as
whether
MSF
should
sign
a
confidentiality
agreement
to
be
allowed
to
give
treatment,
and
whether
they
should
accept
protection
from
armed
guards
(which
might
be
seen
to
compromise
their
independence),
and
whether
they
should
give
evidence
to
the
International
Criminal
Court
as
a
way
of
possibly
saving
lives
in
the
future.
After
lunch
Dr
Portnoy
very
kindly
sat
in
on
the
student
discussions,
taking
further
questions
and
pushing
the
whole
MBIS
body
towards
a
greater
understanding
of
the
challenges
in
this
particular
field
of
healthcare.
The
discussion
was
facilitated
by
Mr
CJ
Ong
of
Raffles
Institution
and
Mrs
Silvia
Börgmann
Medellin
of
Colegio
Claustro
Moderno.
Courage
Matiza
and
Daisy
Nashipa
Mepukori
from
African
Leadership
Academy
presented
their
impressions,
informed
by
Dr
Portnoy’s
seminar
and
intra‐MBIS
debate,
on
the
final
day
of
the
Symposium;
Courage
added
a
Zimbabwean
perspective
to
his
presentation,
and
Nash
a
Kenyan
one
to
hers.
43
What
is
the
role
of
international
healthcare
in
a
comprehensive
vision
of
healthcare?
To
what
extent
do
you
agree
that
medicine
is
a
social
science,
and
politics
is
nothing
but
medicine
on
a
large
scale?
African
Leadership
Academy
International
initiatives
improve
people’s
health
by
providing
the
resources
and
support
that
local
governments
may
not
have
in
addition
to
increasing
the
pool
of
knowledge
in
a
country.
Notably,
during
health
emergencies
in
developing
countries
such
as
the
cholera
outbreak
in
Haiti,
international
initiatives
have
provided
the
much‐needed
capital
to
curb
the
spread
of
the
disease.
As
international
initiatives
operate
at
a
global
level,
they
accelerate
the
dispersal
of
capital,
medical
technology
and
health
information
to
not
only
needy
communities
but
also
developed
nations
afflicted
by
natural
disasters
such
as
the
recent
Tsunami
in
Japan.
In
addition,
international
healthcare
facilitates
the
efficient
transfer
of
knowledge
and
skills
across
the
world.
Through
international
health
organizations
like
MSF
and
WHO,
knowledge
and
skills
from
one
part
of
the
globe
are
transferred
to
another
that
is
in
great
need
of
such.
Organizations
like
PIH
and
MSF,
for
instance,
have
deployed
a
lot
of
their
qualified
staff
to
remote
and
crisis
stricken
regions
like
Haiti
to
facilitate
and
educate
locals
about
healthcare
delivery.
Furthermore,
through
coordinating
research
and
sharing
information
with
many
countries,
organization
like
WHO
have
facilitated
the
spread
of
health
information
that
have
helped
countries
to
come
up
with
better
policies
and
drugs
about
healthcare.
For
example,
during
the
swine
flu
epidemic,
WHO
played
a
huge
role
in
collecting
and
disseminating
data
of
the
vaccine
of
the
H1N1
which
helped
in
finding
the
vaccine
for
the
virus.
In
the
developing
world,
international
initiatives
have
saved
millions
of
lives
through
their
intense
capital
injection
and
spread
of
not
only
information
but
also
technology
to
the
many
poor
regions.
Health
watchdog
institutions
such
as
WHO
and
PIH
have
funded
projects
aimed
at
curbing
epidemics
in
developing
countries
like
Zimbabwe,
Kenya
and
Haiti,
and
these
are
projects
that
the
local
government
cannot
afford.
The
European
Union,
for
instance,
spent
9
million
Euros
in
curbing
Zimbabwe’s
2008
cholera
outbreak
(The
44
Standard),
money
which
the
government
did
not
have.
In
addition,
international
initiatives
help
in
the
dispersal
of
technology
that
can
improve
the
lives
of
a
population.
This
can
be
seen
in
Haiti
today
where
Kopernik
(Global
Whisper),
an
American
company,
invented
the
Q‐drum
that
makes
the
transportation
and
storage
of
clean
water
easy
for
Haitians
and
thus
helps
prevent
peasant
families
from
contacting
cholera.
Moreover,
global
initiatives
help
in
the
dispersal
of
health
related
information
such
as
birth
control
and
disease
prevention
that
go
on
to
improve
the
lifestyle
of
poor
people.
Global
Health
Partnerships
(Tomedi),
a
Mexican
NGO,
educated
members
of
Kisesini
village
in
Kenya
about
taking
care
of
the
sick
in
a
resource‐limited
setting,
an
initiative
that
the
government
could
not
provide
due
to
lack
of
funds
to
sponsor
such
a
project.
As
a
result
it
is
evident
that
international
initiatives
do
play
a
critical
role
in
improving
the
health
of
people
in
developing
countries
as
they
provide
the
missing
resources
needed.
Evidently,
medicine
is
a
social
science
that
seeks
to
improve
the
status
of
a
people.
Politics
however
cannot
be
equated
to
medicine
as
unlike
medicine,
politics
may
bring
harm
to
people
and
as
such
is
undeserving
synonymous
equation
to
medicine.
Colegio
Claustro
Moderno
The
international
initiatives
toward
the
healthcare
can
help
to
improve
a
population’s
level
of
health
in
so
many
ways.
They
create
a
big
educational
and
preventive
impact
on
the
society,
helping
to
achieve
all
the
objectives
proposed
by
different
countries´
programs,
in
a
simple
way,
like
MSF
that
helps
that
have
big
problems
with
their
healthcare,
even
because
of
a
crisis
o
because
of
their
economical
situation,
and
to
achieve
this
goal,
the
main
thing
that
they
do
is
get
to
know
the
countries
that
they
are
going
to
help,
then
when
they
have
a
strong
relationship
with
the
community
they
start
to
treat
and
help
en
many
different
ways.
First
of
all,
these
health
campaigns
aware
the
population
to
prevent
the
most
prevalent
diseases
by
given
them
the
correct
advices
that
can
be
understood
by
any
person,
no
matter
what
socioeconomic
status
they
belong
to.
One
example,
are
the
commercials
showed
to
calm
down
people
when
the
occurrence
of
swine
flu
was
creating
panic
around
the
world.
Also,
the
publicity
given
by
international
initiatives
helps
the
society
to
have
a
basic
knowledge
of
the
diseases
they
can
suffer
because
of
the
environment
they
live
in,
45
their
hygiene
and
others
factors
that
can
provoke
diseases.
Lung
cancer,
is
a
perfect
illness
for
this
case,
since
in
Colombia
12
people
die
per
day
caused
by
it
what
makes
clear
that
without
basic
information
about
it,
people
wouldn’t
know
they
might
have
lung
cancer
for
just
being
addicted
to
tobacco;
that
this
cancer
and
other
diseases
like
cholera
(affecting
Haiti
nowadays,),
can
also
be
caused
by
the
environment
they
frequent
and
the
hygiene
they
posses.
The
international
Organizations
should
help
in
a
specific
issue,
this
means
that
when
all
the
organizations
treats
the
same
problem
at
once,
all
the
issues
that
they
left
behind
they
left
them
without
solution.
In
our
point
of
view
the
role
of
the
international
initiatives
should
be
to
take
care
of
global
problems,
but
with
some
kind
of
order
and
equality.
All
of
these
organizations
should
work
together
on
the
poverty
problem
that
is
the
biggest
and
hardest
one,
and
then
each
of
this
initiatives
should
focus
in
one
single
point,
and
the
with
these
all
of
the
helps
would
go
to
where
they
are
need
it,
and
no
problem
would
have
no
solution.
This
“basic
knowledge”
is
based
on
simple
ideas
people
can
follow
to
avoid
particular
diseases,
like
how
to
treat
a
person
who
is
infected?
How
to
prevent
other
people
to
get
sick
by
the
same
diseases?
As
an
example,
the
publicity
of
international
agencies
that
have
been
promoting
this
information
and
have
been
using
lots
of
them
like
UNICEF:
“clean
hands
saves
lives”,
which
has
had
extraordinary
results
on
its
purpose
in
places
like
Nigeria,
where
diarrhoea
is
the
cause
of
some
194.000
deaths
of
children
under
five
every
year,
which
is
the
second
in
the
world.
Washing
hands
with
soap
and
water
frequently
is
effective
to
keep
away
from
diarrhoea,
swine
flu,
hepatitis,
meningitis
and
many
others
diseases.
Doctors
say
eating
fruits,
stop
smoking
and
doing
exercise
are
another
ways
to
prevent
most
of
the
diseases
since
it
makes
your
body
stronger
to
defeat
any
kind
of
virus.
As
international
agencies
have
access
to
the
newest
scientific
and
genetics
advances,
discovered
and
used
by
developed
societies
specialized
on
preventive
and
curative
research;
they
are
able
to
help
the
poorest
and
most
underdeveloped
societies
because
they
give
them
implementation
of
specific
preventive
and
healing
policies
which
the
governments
can
incorporate
into
their
own
internal
legislation.
As
an
example
of
the
scientific
advances,
we
can
talk
about
the
creation
of
vaccines,
like
the
malaria
vaccine
found
out
in
Colombia
and
treatments
against
the
flu
and
cancer.
Besides,
international
46
initiatives
improve
the
studies
and
the
investigations
on
the
field
of
healthcare,
improving
the
resources
used
to
solve
a
population’s
health
problem
such
as
the
use
of
new
drugs,
studies
about
the
birth
and
spread
of
any
kind
of
virus
and
epidemics,
and
how
to
prevent
them.
Indeed,
medicine
is
a
social
science
because
it
is
developed
for
and
in
favour
the
human
well‐being,
due
to
its
contribution
to
the
prolongation
of
healthy
and
high
quality
life
expectancy.
Medicine
is
also
a
social
science
because
it
can
be
used
by
any
kind
of
person
irrespective
of
gender,
sexual
orientation,
creed,
colour,
race,
ethnic
origin
or
religion.
Taking
the
definition
of
politics
as
“the
art
of
governing
people”,
everything
that
has
to
do
with
the
management
of
the
state
is
a
politic
theme
so
that
one
of
the
issues
all
governments
around
have
to
considered
the
most,
are
the
ones
that
have
a
close
relationship
with
the
population’s
health
care,
and
even
more
when
they
are
focus
on
health
preventive
ways.
Medicine
takes
a
big
role
on
the
good
operation
of
politics,
and
vice
versa.
Because,
if
a
society
is
malnourished
it
will
not
achieve
a
high
level
of
economic
output,
will
not
have
high
IQ
levels
and
all
the
diseases
a
society
can
suffer,
repletes
the
economical
resources
that
can
be
used
to
the
social
and
industrial
growth
of
any
society.
Taking
everything
on
consideration,
we
believe
medicine
is
a
social
science,
because
their
principals
propose
is
to
improve
human
race’s
life
conditions
and
be
always
on
serve
of
every
person
in
the
world
equally.
It
is
true
that
medicine
and
politics
relate
each
other
and
may
have
similar
goals,
since
none
of
them
can
function
properly
without
the
other,
which
is
why
we
can
not
say
politics
is
nothing
but
medicine
on
a
large
scale.
Garodia
International
Centre
for
Learning
International
healthcare
has
to
be
considered
in
an
economic,
political,
cultural
and
religious
context.
47
Religious
values
would
be
protected
by
a
country,
in
a
scenario
where
they
belong
to
a
religious
group
constituting
a
large
portion
of
the
country’s
population.
For
example,
Afghanistan
has
a
90%
Muslim
population,
hence
it
would
not
co‐operate
with
an
initiative
if
it
violated
the
values
of
Islam.
Differences
in
values
and
beliefs
are
possible
even
within
a
country
when
it
has
a
diverse
population,
like
India.
Many
religions
do
not
take
kindly
to
birth
control.
Therefore
the
situation
that
occurs
depends
on
the
makeup
of
the
population.
Increasing
mobility
in
a
globalized
world
also
highlights
the
importance
of
healthcare.
Global
travel
is
prone
to
disruption
due
to
the
occurrence
of
an
airborne
flu
of
pandemic
potential.
The
temperature
checks,
various
restrictions
and
the
fear
of
catching
the
virus
make
travel
inconvenient
or
undesirable.
Dealing
with
outbreaks
of
the
mentioned
diseases
should
definitely
be
an
international
concern;
as
such
outbreaks
affect
the
international
community.
Every
country
does
not
have
the
financial
or
scientific
resources
at
hand
to
battle
diseases,
e.g.
the
war‐torn
DRC.
Even
if
an
affluent
nation
were
able
to
contain
the
disease,
it
would
continue
to
spread
elsewhere
and
pose
a
threat
of
recurrence.
Today
the
global
village
is
so
intertwined
that
such
an
outbreak
will
affect
the
global
economy!
The
outbreak
can
compel
countries
to
change
their
trading
partners.
This
in
turn
can
affect
the
exchange
rates,
GDPs
etc.
of
the
afflicted
countries.
Recently
there
was
an
outbreak
of
swine
flu
which
reached
pandemic
proportions.
Instead
of
pooling
their
efforts
and
resources,
various
countries
and
companies
developed
vaccines
separately.
This
sheer
duplication
of
efforts
should
be
avoided
under
such
circumstances.
Implementing
all
the
changes
and
circumventing
the
problems
is
easier
said
than
done
owing
to
the
great
economic
disparities
and
cultural
differences.
International
initiatives
come
up
against
other
road‐blocks:
1. Due
to
the
poor
standards
of
living
and
sanitation
facilities
in
most
LEDCs,
epidemics
and
diseases
are
more
frequent.
To
help
battle
these
diseases,
international
initiatives
may
collect
money
to
donate
to
the
LEDCs
or
countries
may
provide
help
in
other
forms.
Many
LEDCs
are
war‐torn,
dictatorships
or
48
autocracies
and
corruption
is
rampant.
This
prevents
monetary
or
medical
aid
from
reaching
the
needy.
2. Help
doesn’t
necessarily
imply
goods;
at
times
an
international
body
may
recommend
implementing
regulations
or
rules
to
improve
the
health
and
well‐
being
of
the
people.
But
governments
may
refuse
to
comply
on
grounds
of:
foreign
policy,
religious
values
and
beliefs
etc.
However
all
these
obstacles
do
not
preclude
the
importance
of
international
initiatives:
1. The
global
community
can
effectively
put
up
funds
for
healthcare
in
an
impoverished
country,
2. An
international
body
can
research
new
and
effective
vaccines
and
medications
faster.
Duplication
of
efforts
would
also
be
avoided.
3. The
global
village
together
has
more
medical
technology,
man
power,
research
material
and
medicines
to
battle
diseases
than
a
single
or
few
affected
countries.
We
agree
completely
with
the
aphorism
in
the
2nd
question.
Earning
a
living
is
inherent
to
practicing
a
profession,
but,
you
choose
your
profession
according
to
what
motivates
you,
who
inspires
you
and
what
you’d
like
to
do
when
you
work.
After
reading
Mountains
beyond
mountains,
young
readers
might
have
been
inspired
to
become
doctors
so
they
could
help
the
needy
like
Dr.
Paul
Farmer.
Hence
the
intention/objective
of
those
in
the
field
of
medicine
and
the
outcome
of
medicine
quite
plainly
relates
to
social
science;
to
a
healthy
society
and
fewer
victims
of
diseases.
Politics
is
nothing
but
medicine
on
a
large
scale‐
this
sounds
rather
far‐fetched
at
first
sight.
Why
do
people
elect
governments?
To
provide
effective
governance,
this
will
result
in
a
better
quality
of
life.
Which
factors
contribute
to
a
better
quality
of
life?
A
decent
standard
of
living.
What
constitutes
a
decent
standard
of
living?
Which
Education
Which
requires
Employment
Requires
Physical
and
mental
wellbeing
Which
requires
Hygiene,
sanitation
and
nutrition.
49
In
efficient
governance
the
above
constituents
are
provided
for
by:
free
or
subsidised
education
and
healthcare,
affordable
housing
for
the
homeless,
improved
sanitation
and
water
treatment
facilities
etc.
Therefore
in
the
ultimate
analysis
the
government
must
and
does
provide
for
good
healthcare.
Unfortunately
the
same
is
less
efficient
due
to
corruption
being
omnipresent
in
several
systems
of
government.
Therefore
co‐operation
in
healthcare
on
an
international
basis
is
necessary
for
the
happiness
and
prosperity
of
humanity
at
large.
Johannes
Kepler
Grammar
School
The
international
healthcare
connects
healthcare
systems
and
healthcare
resources
in
individual
countries.
Otherwise,
they
are
too
isolated,
thus
less
efficient.
It
is
necessary
to
bear
in
mind
that
international
healthcare
is
about
collaboration.
The
resources
that
may
be
temporarily
limited
in
one
area
may
be,
on
the
contrary,
very
abundant
in
another
one.
For
example,
the
first
aid
kits
are
very
valuable
items
in
the
third
world
countries,
while
in
developed
countries
they
are
not
used
to
their
full
potential
and
their
use
is
wasteful.
In
the
Czech
Republic,
a
new
regulation
was
enacted
saying
that
almost
all
first
aid
kits
in
cars
had
to
be
disposed
of,
even
though
they
could
have
been
sent
to
countries
where
they
might
have
helped
countless
people.
We
are
not
talking
only
about
the
technical
resources
but
also
about
the
human
resources.
The
healthcare
is
also
about
education
and
policy.
These
resources
can
be
shared
on
international
level
as
well
so
as
to
provide
a
sufficient
healthcare
in
every
area
that
may
need
it.
International
initiatives
possess
a
great
advantage,
the
possibility
that
developed
countries
join
forces
and
give
a
helping
hand
to
a
state
in
need
of
some
aid.
There
are
many
countries
in
the
world
that
are
not
able
to
improve
their
level
of
health
due
to
their
stark
financial
situations.
When
a
catastrophe
degrading
the
health
level
befalls
a
country
like
that,
that
country
cannot
do
anything
to
overcome
it
and
their
only
hope
is
a
sanitary
aid
from
other
countries.
However,
international
help
cannot
be
as
efficient
as
national
initiative
could
be
since
the
locals
know
the
best
what
they
need
to
focus
on
in
order
to
50
improve
their
situation
and
the
level
of
health.
Therefore,
cooperation
with
locals
is
needed
to
achieve
the
best
possible
results.
What
international
healthcare
could
provide
without
any
harm
on
efficiency
and
should
provide
is
education
about
health.
When
it
comes
to
healthcare,
it
is
not
enough
to
provide
it
if
there
is
nobody
asking
for
it.
People
need
to
be
able
to
actively
seek
medical
treatment
when
they
need
it,
for
which
they
need
to
be
able
to
realize
that
something
is
wrong
with
them
and
they
should
seek
a
doctor’s
help.
However,
many
people
in
developing
countries
lack
the
information
or
simply
do
not
care
even
if
they
are
ill,
so
they
do
as
though
nothing
was
wrong
and
their
condition
is
worsening
until
it
is
too
late
for
them
to
be
saved.
Therefore,
healthcare
education
is
an
important
factor,
essential
for
every
healthcare
system
that
is
striving
for
efficiency.
Unless
people
are
cognizant
of
health
risks
and
health
problems,
they
cannot
seek
medical
aid.
And
unless
they
actively
seek
medical
aid,
the
healthcare
providers,
that
is
doctors,
physicians,
surgeons,
medics,
nurses,
etc.,
cannot
work
efficiently.
Some
of
the
worldwide
known
philosophers
and
writers
such
as
Elfride
Jelinek
and
Thomas
Bernhard
described
the
western
society
as
an
“ill
society”.
The
question
is
which
“social
disease”
the
western
world
suffers
from.
Enormous
changes
in
everyday
life
during
the
20th
century
have
resulted
not
only
in
recent
financial
crisis
but
also,
for
example,
in
the
crisis
of
religion
as
more
and
more
people
are
becoming
atheists.
As
a
result,
we
can
observe
a
spread
of
psychological
diseases,
which
of
course
result
in
various
problems
befalling
the
whole
society.
Politicians
are
here
to
deal
with
these
problems.
Their
task
is
to
keep
the
society
healthy
or
at
least
to
try
to
do
so.
It
could
be
extremely
helpful
for
them
and
eventually
for
the
whole
society
if
they
tried
to
learn
something
from
people
with
different
professions.
Medical
professionals,
for
instance,
especially
professionals
that
are
familiar
with
traditional
medicine,
know
that
in
human
body,
everything
is
connected
with
everything.
It
is
impossible
to
cure
a
medical
issue
without
knowing
the
roots
of
it.
For
example,
when
a
doctor
is
treating
abdominal
pain,
it
is
often
not
enough
just
to
prescribe
a
medicament.
Such
a
treatment
can
release
some
pain,
but
it
does
not
cure
the
root
of
it,
which
could
be
a
wrong
diet
or
stress,
or
even
something
much
worse
that
would
eventually
cause
severe
health
problems.
Only
by
solving
all
of
the
causes
is
it
possible
to
actually
heal
the
issue.
51
Exactly
the
same
thing
applies
in
the
field
of
politics.
Only
with
the
knowledge
of
preceding
events
and
with
consideration
of
the
importance
to
keep
balance
in
the
system
will
the
politicians
be
able
to
find
an
effective
medicament
for
an
ill
society.
Montgomery
Bell
Academy
The
health
of
the
human
population
cannot
be
categorized
according
to
lines
drawn
on
a
map,
or
physical
barriers
between
nations.
However,
it
is
from
each
enclosed,
political
border
to
another
that
cultures,
social
standards,
financial
security,
sanitation,
and
natural
environments
differ.
Accordingly,
health
demands
and
challenges
vary
within
each
nation,
often
despite
the
proximity
to
other
health
concerns.
Therein
lies
the
weakness
of
international
health
initiatives
such
as
the
efforts
of
the
World
Health
Organization.
The
strength
of
international
health
organizations
lies
in
their
ability
to
respond
to
health
crises
with
its
expansive
resources,
both
tangible
and
intangible.
The
conglomeration
of
international
resources
is
the
driving
force
behind
the
WHO.
From
sources
across
the
globe,
it
acquires
financial
support,
peer‐tested
research
results,
medicines,
antibiotics,
and
international
experts,
such
as
epidemiologists,
engineers,
and
those
in
risk
communication,
case
management,
and
laboratory
work.
The
consolidation
and
focus
of
these
resources
is
evident
in
the
WHO’s
response
to
the
cholera
outbreak
in
Haiti.
By
last
October,
the
WHO
was
constructing
twelve
cholera
treatment
centers
for
the
purpose
of
isolating
and
treating
the
3342
cases
acknowledged
at
the
time.
The
advantages
of
an
international
force
extend
beyond
the
potency
of
its
immediate
response
to
a
health
crisis.
Prevention
programs
also
improve
the
long‐term
health
of
a
population’s
health.
If
a
nation
does
not
already
have
proper
educational
programs
in
place,
an
organization
such
as
the
WHO
is
able
to
introduce
and
make
common
basic
sanitation
practices.
Again,
Haiti
is
a
place
currently
benefiting
from
such
practices.
To
prevent
future
recurrence
of
the
cholera
outbreak,
the
WHO
promotes
personal
hygiene,
proper
disposal
of
fecal
matter,
clean
water
supplies,
and
hand
washing.
Yet
another
significant
contribution
of
an
international
front
against
a
health
crisis
is
its
expansive
52
physical
presence
for
the
sake
of
containing
outbreaks
to
their
original
locations.
The
WHO
can
advise
the
Dominican
Republic
on
its
contingency
plan
to
protect
its
border
with
Haiti.
The
future
of
healthcare
lies
with
international
cooperation
because
the
expenses
and
challenges
of
crises
such
as
the
cholera
outbreak
in
Haiti
are
too
daunting
for
the
resources
of
one
government.
However,
the
role
of
each
nation’s
government
in
its
own
health
will
never
be
phased
out.
An
international
effort
lacks
the
intricate
methods
for
dissecting
a
problem
entangled
with
social
traditions.
The
intimate
role
of
the
local
power
is
necessary
in
this
situation.
The
rarity
of
political
consensus
has
traditionally
been
the
largest
obstacle
to
international
cooperation.
Governments
can
rarely
come
together
to
promote
healthcare
initiatives
around
the
world:
case
in
point,
the
World
Health
Organization,
which
still
lacks
the
funding
it
needs
to
pursue
all
its
admirable
initiatives.
But
as
Dr.
Portnoy
noted
in
his
seminar,
there
is
a
significantly
greater
possibility
that
charitable
non‐governmental
organizations
like
Doctors
Without
Borders
could
unite
under
a
common
humanitarian
purpose.
The
combined
force
of
these
international
actors
could
be
powerful
enough
to
enact
meaningful
changes
on
healthcare
in
afflicted
areas.
Still,
one
ought
to
be
cautious
about
extrapolating
the
relationship
between
politics
and
medicine
too
far.
To
say,
“Medicine
is
a
social
science,
and
politics
is
nothing
but
medicine
on
a
large
scale”
is
a
gross
over‐generalization.
Governments
are
put
in
place
for
the
well‐
being
of
those
who
create
it.
A
poorly
run
government
undoubtedly
results
in
stressful
living
conditions,
which
further
precipitate
in
health
issues.
However,
this
statement
overlooks
the
physician‐patient
relationship
that
is
the
core
of
medicine.
While
this
creed
applies
to
massive
disturbances
in
the
health
of
a
population,
it
takes
for
granted
the
conscious
decisions,
made
by
individuals
every
day,
which
may
affect
her
or
his
health.
Nada
High
School
Over
the
ages,
since
various
nations
were
established,
we
have
made
our
own
laws
and
systems
and
governed
our
own
citizens
by
ourselves.
In
the
present
time,
however,
through
the
increase
in
the
globalization
of
the
world,
international
alliances
between
nations
have
become
necessary
for
improving
a
population’s
level
of
health.
Because
of
the
53
ease
and
frequency
of
air
travel
and
international
trade,
without
cooperating
with
each
other,
we
cannot
avoid
the
danger
of
infectious
disease
such
as
bird
flu
and
SARS.
This
is
indeed,
one
of
the
reasons
the
government‐linked
WHO
was
established.
There
are
also
some
kinds
of
non‐governmental
organizations
helping
people
internationally,
such
as
MSF
(Médecins
Sans
Frontières,
Doctors
without
Borders)
and
MDM
(Médecins
du
Monde,
Doctors
of
the
World).
In
terms
of
helping
people
around
the
world
with
its
healthcare,
there
is
some
room
for
governments
to
act
for.
For
example,
the
Japanese
government
announced
the
Okinawa
Infectious
Diseases
Initiative
in
2000.
This
is
as
an
expression
of
Japan’s
commitment
to
global
health
issues
in
taking
measures
against
infectious
diseases.
It
also
stresses
the
need
for
countermeasures
by
demonstrating
the
grave
implications
of
infectious
diseases
and
the
possibility
of
carrying
out
control
activities.
The
principles
in
this
initiative
including
urging
developing
countries
to
take
independent
action
toward
fighting
infectious
diseases,
and
training
people
who
can
either
cure
infectious
disease
or
educate
people
in
advance
so
as
not
to
get
infected
in
the
first
place.
This
action
resulted
in
helping
to
control
global
polio,
through
close
collaborations
with
international
organizations.
The
Japanese
government
made
contributions
totaling
over
2.4
billion
dollars
over
a
2
year
period
until
the
end
of
2002.
There
are
other
times
when
we
need
international
healthcare,
for
example,
unpredictable
disasters.
About
2
weeks
ago
in
North
Eastern
Japan,
a
severe
earthquake
occurred,
and
huge
tsunami
followed.
More
than
10,000
people
died,
and
more
than
15,000
are
still
missing.
It
brought
about
various
kinds
of
harm.
Thousands
of
cars,
houses,
and
buildings
were
swept
away,
leaving
nothing
but
debris.
Towns,
cities,
and
villages
were
reduced
to
rubble.
Fuel
tanks
along
the
coastal
areas
were
compromised
and
wildfires
followed.
Moreover,
nuclear
power
plants
in
Fukushima
prefecture
experienced
serious
damage,
and
radiation
levels
around
the
plant
rose,
although
no
serious
damage
to
human
beings
or
the
surrounding
environment
has
been
reported
yet.
The
circumstances
of
the
victims
–
the
displaced
from
this
disaster
‐
are
getting
worse.
One
of
the
biggest
problems
is
the
lack
of
medical
facilities
and
supplies.
The
elderly
are
dying
because
of
illness
even
after
they
have
survived
the
initial
disaster
itself.
The
victims
can’t
get
enough
medical
support.
Even
sanitary
diapers
can
be
included
in
the
serious
shortages
being
experienced.
In
facing
this
disaster,
it
goes
without
saying
that
the
international
society
has
helped
us
in
various
ways.
Some
countries
dispatched
its
military
troops
and
NGO
rescue
units
in
order
to
54
search
for
the
missing
people
in
rubble
and
debris.
Some
countries
and
organizations
sent
lots
of
relief
supplies
including
water,
food,
medicine,
blankets,
and
clothes
for
people
who
were
hit
by
the
earthquake.
Other
countries
sent
doctors
to
Japan
to
help
people
who
got
injured
by
the
earthquake.
These
actions
were
surely
a
big
help
to
Japan,
suffering
from
the
serious
damage
by
the
earthquake
and
tsunami.
Regarding
these
periodic
disasters
happening
in
the
world,
it
is
of
course
true
that
international
aid
or
healthcare
is
indispensable.
However,
is
international
healthcare
always
“good”?
There
are
so
many
kinds
of
people,
cultures,
and
religions
in
the
world
that
we
cannot
disregard
these
differences
when
we
treat
people.
For
example,
some
people
agree
with
donating
blood
and
others
do
not.
Jehovah’s
Witnesses,
for
example,
believe
that
the
Bible
prohibits
ingesting
blood
and
that
Christians
should
therefore
not
accept
blood
transfusions
nor
donate
or
store
their
own
blood
for
transfusion.
This
is
because
of
their
religious
beliefs.
Different
people
in
different
countries
have
different
ideas
of
ethics.
Therefore
we
should
not
treat
people
in
the
same
way.
At
the
very
least
we
should
not
assume
that
there
could
ever
be
a
universally
applicable
model
for
international
healthcare.
Indeed,
this
basic
differentiation
must
be
stressed
from
the
beginning.
It
could
easily
be
assumed
that
international
healthcare
has
something
to
do
with
the
standardization
of
various
national
methods
of
healthcare.
However,
international
healthcare
is
not
to
treat
all
kinds
of
peoples
almost
in
the
same
way,
but
to
recognize
these
differences
and
cooperate
internationally
with
each
other.
When
we
treat
different
kinds
of
people
in
an
international
framework,
we
must
understand
their
medical
systems,
policies,
and
ideas.
As
we
can
learn
from
the
situation
of
Haiti,
development
of
such
diseases
as
HIV/AIDS,
malaria,
and
tuberculosis
is
mostly
due
to
their
serious
poverty.
People
cannot
afford
to
take
suitable
medical
treatment
because
they
are
so
desperate
for
their
survival.
As
a
result,
even
a
pity
disease,
which
would
not
affect
our
lives
in
good
environment,
may
lead
to
the
death
of
people.
Paul
Farmer
mentioned
a
woman
in
Haiti
and
said,
“You
want
to
stop
HIV
in
women?
Give
them
jobs.”
As
it
can
be
said
that
“medicine
is
nothing
but
politics”,
it
is
impossible
to
improve
the
quality
of
healthcare
without
considering
the
whole
structure
of
the
society.
In
addition,
the
very
role
of
international
healthcare
should
be
to
provide
some
kind
of
basic
level
of
treatment
all
over
the
world.
Considering
the
fact
that
people
in
the
world
have
various
ideas
about
healthcare,
what
is
important
is
to
make
a
structure
and
an
environment
where
people
can
get
suitable
medical
treatment.
Just
55
donating
some
money
to
NGOs
or
the
UN,
or
even
to
the
government,
even
it
may
save
some
lives,
cannot
lead
to
a
fundamental
solution.
Moreover,
what
governments
do
and
what
international
organizations
do
may
well
be
quite
different.
As
Dr.
Portnoy
said
in
his
seminar,
governments
sometimes,
or
maybe
even
usually,
hinder
what
international
organizations
try
to
do.
However,
this
is
not
the
situation
people
are
longing
for.
So,
our
conclusion
or
answer
to
the
question
is
this:
The
essence
of
healthcare,
especially
international
healthcare
is
to
help
people
who
are
suffering
from
any
kinds
of
health
troubles.
With
regards
to
this
concept,
the
role
of
international
healthcare
would
be
to
provide
people
all
over
the
world
with
equal
basic
healthcare.
In
order
to
promote
international
healthcare,
it
is
important
that
both
governments
and
international
organizations
do
what
they
should
do,
not
interfering
with
each
other,
and
search
for
a
way
to
cooperate.
In
what
specific
ways
is
the
fuel
for
future
discussion.
“Medicine
is
a
social
science,
and
politics
is
nothing
but
medicine
on
a
large
scale”
―
when
we
met
this
phrase
for
the
first
time,
we
were
confused
how
we
should
comprehend
this
word.
It
is
true
that
we
should
save
all
the
individual
lives,
even
if
it
cost
too
much,
too
difficult
to
save.
This
is
what
Dr.
Paul
Farmer
said
in
the
book.
From
this
point
of
view,
the
government
should
spend
all
the
money
they
can
afford
on
healthcare
until
all
the
citizens
can
live
safely.
However,
what
we
have
found
through
thinking
about
this
phrase
is
that
the
expense
of
the
government
on
economics
also
might
be
a
help
for
people
suffering
from
the
difficulties.
If
the
government
spends
enough
money
on
economics,
people
who
are
poor
would
be
able
to
get
enough
wages
and
be
able
to
get
enough
healthcare.
Also
from
this
viewpoint,
politics
is
doing
enough
for
maintaining
healthcare
on
the
large
scale.
From
this
contemplation,
we
can
at
least
agree
to
these
words
in
the
sense
that
the
politics
have
a
lot
to
do
with
medicine.
Basically,
what
politics
should
do
is
to
prevent
people
from
death
and
give
them
the
most
fundamental
right,
that
is,
the
right
to
live
(please
refer
to
our
essay
for
October).
On
a
large
scale,
all
of
the
policies
that
the
government
does
are
related
with
the
lives
of
people.
In
a
broad
sense,
politics
is
nothing
but
medicine.
56
Raffles
Institution
We
hear
of
international
healthcare
initiatives
almost
daily
in
the
news.
The
British
Broadcasting
Corporation
(BBC)
has
even
an
entire
section
dedicated
to
health
and
healthcare
related
news.
A
quick
check
on
the
World
Health
Organisation
(WHO)
website
would
reveal
a
slew
of
different
measures
and
initiatives
that
the
international
community
has
in
place
to
‘cure’
the
sick
of
those
in
less
well‐off
nations.
When
identifying
the
most
important
factors
and
the
role
of
international
healthcare,
we
first
need
to
consider
the
effectiveness
of
the
international
healthcare
initiatives
and
need
to
be
aware
of
the
loopholes
which
currently
exist.
As
proven
in
Tracy
Kidder’s
book
Mountains
Beyond
Mountains,
the
WHO
DOTS
program
that
was
implemented
against
TB
cases
in
Peru
was
limited
in
its
effectiveness
and
instead,
increased
the
incidence
of
Multidrug
Resistant
(MDR)
TB
in
the
area.
Such
initiatives
would
have
pass
through
tremendous
amounts
of
red
tape
just
to
get
cleared
for
execution,
as
Dr.
Paul
Farmer
aptly
terms
them:
Transnational
Bureaucrats
managing
inequality
(TBMIs).
In
addition,
international
initiatives
often
have
to
pass
through
the
hands
of
bureaucrats
of
these
countries,
many
of
whom
will
siphon
away
a
large
portion
of
the
aid
money.
An
example
of
how
aid
money
was
misused
is
the
case
of
how
a
large
sum
of
money,
initially
meant
to
bolster
the
Ugandan
Education
Program,
was
‘mismanaged’
by
the
Ugandan
officials,
resulting
in
only
a
paltry
13%
reaching
the
schools
in
Uganda.
This
is
indeed
a
classic
case
of
how
international
initiatives,
despite
being
good
in
intention,
may
eventually
fail
in
practice.
These
problems
need
to
be
addressed
before
international
healthcare
can
play
a
bigger
role
in
the
vision
of
healthcare.
Before
beginning,
one
must
also
look
into
the
problems
faced
by
the
world
today
with
regards
to
healthcare.
A
comprehensive
vision
would
then
be
one
that
encompasses
a
solution
which
effectively
combat
this
problem
in
a
way
such
that
it
is
sustainable,
far
reaching
and
efficient.
The
main
reason
why
medicine
is
shaping
into
such
a
global
affair
is
due
to
the
uneven
distribution
of
medicine
vis‐à‐vis
that
of
disease.
In
a
well‐connected
global
society
such
as
57
ours,
disease
can
spread
rapidly
from
one
country
to
another,
for
it
is
as
simple
a
matter
as
an
infected
passenger
boarding
a
flight
to
another
country.
Nevertheless,
due
to
rapid
advances
in
medical
technology
and
the
biochemical
industry,
most
of
such
diseases
can
be
combated
in
the
top
medical
institutions
around
the
world.
However,
we
often
overlook
the
poorer
nations
that
do
not
have
the
capital
to
fund
such
advanced
medical
technology.
Many
a
time,
it
is
in
these
countries
that
diseases
will
propagate
and
spread
like
wildfire.
In
the
past,
it
used
to
be
that
a
lack
of
medical
expertise
was
the
reason
that
a
person
would
die
of
disease.
Yet,
in
our
current
society,
this
is
not
the
case.
Rather,
it
is
due
to
the
inherent
uneven
geographical
development
of
countries.
Hence
as
can
be
seen
from
above,
the
need
for
understanding
of
such
social
constructs
is
important
to
address
medical
problems
of
today.
This
disparity
between
the
presence
of
disease
and
the
actual
allocation
of
resources
required
to
combat
and
eradicate
this
disease
is
a
worrying
one,
to
such
an
extent
that
international
healthcare
has
developed
on
such
a
scale.
MEDCs
see
international
healthcare
as
a
way
for
removing
this
disparity,
allowing
LEDCs
to
gain
access
to
resources
they
may
lack,
improving
the
healthcare
situation
in
the
country.
After
all,
the
healthcare
situation
in
a
particular
country
is
extremely
dependent
on
the
extent
to
which
said
country
is
able
to
procure
the
resources
required.
International
healthcare
attempts
to
alleviate
this
situation
through
the
introduction
of
external
resources
into
other
countries
in
an
effort
to
improve
the
ability
of
these
countries
to
combat
disease.
This
then
brings
us
to
rethink
the
very
definition
of
medicine.
Like
many
other
things
in
this
revolutionized
world,
medicine
on
a
global
scale
is
shaping
up
in
a
way
that
many
of
us
could
have
ever
imagined.
We
would
have
never
have
thought
that
medicine,
in
itself
being
a
hard
science
(i.e.
one
having
to
learn
the
actual
medical
skillset
in
order
to
be
certified
as
a
doctor),
would
evolve
into
such
a
multifaceted
field.
For
example,
Dr.
Paul
Farmer
took
up
a
PHD
at
Harvard
in
anthropology
as
he
felt
that
only
through
understanding
the
socio‐economic
complexities
behind
a
sick
person
would
he
be
able
to
effectively
raise
the
level
of
health
in
a
population.
Medicine
can
no
longer
stand
solely
as
a
hard
science.
It
is
imperative
that
doctors
have
a
global
outlook,
as
diseases
are
rapidly
becoming
a
transboundary
affair,
as
explained
below.
58
Some
say
that
due
to
the
increasing
overlapping
of
fields
such
as
the
social
sciences,
politics
and
medicine,
it
could
simply
be
said
that
politics
is
another
approach
in
treating
the
poor.
However,
it
is
of
our
personal
stance
that
it
is
not
these
petite
arguments
of
terminology
that
should
be
focused
on,
rather,
it
should
be
finding
ways
and
means
of
putting
together
the
expertise
in
such
fields
to
effectively
cure
as
many
people
as
possible.
In
conclusion,
as
we
were
answering
the
above
two
essay
questions,
we
had
to
question
our
own
believes
and
assumptions
of
what
medicine
should
be
and
how
international
initiatives
although
grandiose
in
nature,
may
not
be
as
effective
as
efficient
local
treatment.
Shiyan
Cooperation
High
School
To
enable
us
make
the
right
form
of
decision,
the
expert
advisers
study
the
global
health
insurance
market
so
they
can
quickly
give
you
personalised
comparative
quotes.
They
will
also
help
you
understand
the
different
types
of
medical
coverage,
making
our
choice
as
transparent
and
as
easy
as
possible.
Throughout
the
world,
the
demand
for
first
class
international
health
care
insurance
has
never
been
greater.
As
social
health
insurance
services
that
could
once
be
relied
upon
are
no
longer
able
to
keep
pace
with
ever
increasing
cost
of
medical
treatment,
so
the
need
to
make
arrangements
has
become
of
crucial
importance,
particularly
to
the
expatriate.
When
you
are
overseas,
it
is
important
to
have
confident
in
your
international
insurance
plan.
Accident
and
emergencies
will
always
happen,
so
having
confident
in
your
insurance
plan
will
give
you
peace
in
your
mind.
Since
each
individually
to
fit
our
specific
needs.
As
part
of
a
comprehensive
vision,
we
care
about
the
international
healthcare.
Healthcare
is
needed
for
lots
of
reasons
and
it
is
not
always
that
marvelous
nowadays,
but
we
can
change
it
in
different
kinds
of
ways.
Education
is
one
of
them.
Actually
it
is
quite
difficult
to
solve,
maybe
the
government
is
trying
very
hard,
but
people
will
not
accept
it
easily.
If
all
of
as
can
cooperate,
we
believe
that
the
healthcare
internationally
will
be
much
better.
59
Improving
the
environment
can
make
the
percentage
of
death
lower.
Technology
is
also
important.
If
the
technology
is
perfect
for
all
of
us,
we
can
also
make
the
world
a
better
place.
Poor
technology
means
that
lots
of
important
operations
won’t
be
available.
Nutrition
is
also
important.
People
may
have
clean
water
or
local
food
to
keep
fit
and
healthy,
so
good
nutrition
can
also
make
us
all
healthy.
Winchester
College
The
role
of
international
healthcare
in
a
comprehensive
vision
of
healthcare
has
been
discussed
in
great
detail
throughout
the
symposium.
In
third
world
countries
international
healthcare
provides
great
relief
to
struggling
national
health
systems.
International
healthcare
provides
complex
equipment
and
new
drugs
to
poorer
countries.
Doctors
can
also
be
trained
by
international
organizations;
however
this
is
a
little
ineffective,
as
often
situations
in
Western
cultures
and
Africa
are
very
different.
Doctors
are
trained
to
spot
cancer
not
cholera,
even
though
the
latter
is
more
prevalent.
Understanding
of
cultural
and
environmental
differences
is
vital
for
international
healthcare
to
function
to
greatest
efficacy.
Simple
monetary
aid
can
help
build
infrastructure
which
provides
a
strong
foundation
for
the
national
healthcare
system.
International
healthcare
also
benefits
from
the
fact
that
it
doesn’t
automatically
have
to
follow
a
political
agenda.
This
allows
it
more
freedom
to
operate
in
an
efficient
manner;
and
not
one
that
pleases
the
people
short‐term
or
matches
a
particular
political
system.
International
healthcare
can
also
help
in
disaster
situations.
The
hope
is
that
eventually
all
national
healthcare
systems
will
be
able
to
support
themselves
and
their
people.
Thus
in
the
long
run
it
is
viewed
that
international
healthcare
will
only
feature
in
attempts
to
clear
up
disasters
and
restore
order.
In
such
a
situation
government
health
initiatives
and
NGOs
try
and
relieve
the
stress
on
the
national
system
by
providing
extra
resources
both
as
drugs
and
manpower.
Organisations
such
as
MSF
pledge
to
spend
as
little
time
as
possible
in
a
country,
stating
that
its
role
is
to
go
into
an
area
of
conflict
and
treat
the
sick
and
the
dying,
without
carrying
any
affiliations
or
messages
of
peace.
This
image
of
impartiality
and
completely
unbiased
motives
allows
MSF
to
treat
is
many
inaccessible
regions
which
60
are
plagued
by
political
unrest.
In
this
manner,
they
believe
that
international
healthcare
efforts
should
not
aim
to
interfere
with
the
healthcare
systems
in
operation
in
other
countries,
but
should
seek
to
ameliorate
them
by
appreciating
and
understanding
the
country’s
situation.
An
imposition
of
international
medical
standards
and
beliefs
is
not
what
impoverished
countries
need;
it
is
an
integration
of
international
doctors
into
impoverished
countries,
and
a
joint
effort
between
the
country,
international
aid
and
the
government.
There
are
many
comparisons
between
medicine
and
politics.
If
one
takes
society
to
be
the
body
and
politics,
where
‘good’
politics
is
a
cure
and
‘bad’
politics
is
a
poison
of
ineffective
cure,
to
be
the
medicine
the
similarities
are
as
follows:
politics
can
try
to
improve
society
but
still
comes
across
problems.
The
banking
crisis
has
the
same
effect
as
liver
failure:
the
body’s
state
is
heading
downhill
but
a
cure
is
attempted;
as
a
replacement
liver
may
be
needed
so
might
a
new
financial
system.
To
drive
the
analogy
into
the
ground:
a
close
ratio
of
HDL
to
LDL
minimises
the
chance
of
cardiovascular
disorders;
perhaps
this
is
comparable
to
the
split
between
rich
and
poor
–
if
it
is
too
great
then
the
risk
of
society/the
body
breaking
down
is
high.
Society
must
buy
into
what
is
regarded
as
success
in
politics.
For
the
politicians
it
is
staying
in
power
whilst
for
the
populace
it
is
having
their
views
represented.
In
politics,
‘what
is
success?’
is
political
question
in
itself.
Yet
politics
always
has
a
curing
solution;
medicine
provides
constant
preventatives.
Medicine
strives
to
keep
one
alive
until
the
body
itself
gives
in.
Society,
in
theory,
never
dies.
Anarchy
after
all
is
a
form
of
society.
The
methods
and
objectives
also
differ.
Politicians
are
driven
by
desire
to
impress
electorate
whilst
medicine
cares
only
for
final
result.
Thus
we
have
to
conclude
that
politics
is
comparable
to
medicine
but
certainly
not
‘nothing
but’.
Society,
and
thus
politics,
has
decided
the
point
and
purpose
of
medicine.
Perhaps
if
you
shrink
politics
you
might
get
medicine,
but
enlarge
medicine
and
you
lack
the
lies
and
complexity
of
politics
and
societies.
61
Day
4,
March
29
The
fourth
day
of
the
MBIS
was
spent
entirely
off
campus,
predominantly
at
Vanderbilt
University.
Following
breakfast
at
VU
Admissions
Office,
MBIS
participants
listened
to
a
presentation
from
the
Dean
of
Admissions
on
entry
into
highly
selective
universities
in
the
US.
This
was
followed
by
a
guided
tour
round
the
campus
by
current
VU
undergraduates,
and
a
short
talk
by
the
Dean
of
the
Commons,
Dr
Francis
Wcislo,
on
the
spirit
of
community
at
Vanderbilt
and
the
importance
of
residential
accommodation
in
fostering
that
spirit.
All
MBIS
participants
were
then
privileged
to
have
a
hands‐on
session
in
the
experiential
learning
facility
at
VU
School
of
Medicine.
Experiential
learning
is
an
innovative
method
designed
to
facilitate
physician
training
without
the
immediate
need
for
practicing
on
live
patients.
Resuscitation
techniques,
intubation,
keyhole
surgery;
all
these
were
practised
in
a
variety
of
virtual
and
simulated
environments
by
the
MBIS
fraternity.
All
participants
then
listened
to
a
fascinating
lecture
by
Dr
William
Pao
on
the
genomics
of
cancer,
and
the
possibilities
that
exist
in
targeted
therapy
based
on
a
patient’s
own
genetic
profile.
He
was
followed
by
Dr
Mia
Levy
on
the
subject
of
bioinformatics.
This
is
the
contribution
that
improved
data
management
and
technology
can
make
to
tangible
healthcare
outcomes
by
reducing
waste
and
inefficiencies.
The
goal
of
both
her
work
and
that
of
Dr
Pao
is
to
increase
the
personalization
of
medicine,
and
thus
its
effectiveness
at
the
individual
level.
Dr
Billy
Hudson,
Director
of
VU
Medical
School’s
Center
for
Matrix
Biology,
then
gave
a
presentation
on
the
detection
skills
required
to
treat
rare
diseases,
and
the
role
of
complex
biology
in
advancing
medical
knowledge.
Participants
were
able
to
look
at
3‐dimensional
modeling
of
proteins
and
understand
the
process
of
medical
research
from
experts
in
the
field.
62
Using
examples
from
Haiti
and
Dr
Portnoy's
presentation,
which
do
you
consider
the
most
important
factors
that
might
contribute
to
a
comprehensive
vision
of
healthcare?
African
Leadership
Academy
Development
of
a
health
care
vision
in
impoverished
countries
like
Haiti
is
a
daunting
task
that
requires
myriad
factors
to
be
taken
into
account.
Due
to
the
numerous
factors
to
be
considered,
the
underlying
principle
of
critical
analysis
of
the
population
involved
is
paramount
as
it
gives
birth
to
insights
that
enhance
the
understanding
of
the
dynamics
that
have
to
be
dealt
with.
A
comprehensive
health
care
vision
for
an
impoverished
country
like
Haiti
should
consider
the
level
of
poverty,
political
stability,
tradition
and
religion
of
the
population
at
hand.
An
analysis
of
the
level
of
poverty
helps
in
determining
the
type
of
inputs
to
be
provided
for
better
health
care
delivery.
Data
on
the
proportion
of
the
population
living
under
the
poverty
datum
line
will
help
in
dissemination
of
necessary
and
adequate
resources
to
address
the
needs
of
the
impoverished
community.
In
Cange,
for
instance,
the
majority
of
the
peasants
were
poor
and
this
knowledge
helped
Partners
in
Health
(PIH)
to
build
a
hospital
that
caters
for
the
poor
(Kidder
20).
Also,
this
knowledge
helped
PIH
to
initiate
programs
such
as
employment
of
Haitian
staff
(Kidder
33)
aimed
at
economically
empowering
local
Haitians
to
rise
from
the
low
standards
of
living.
Moreover,
understanding
the
extent
of
poverty
in
rural
Haiti
helped
PIH
in
knowing
the
extent
of
prevalent
diseases
caused
by
poor
standards
of
living
such
as
diarrhea
and
typhoid.
Indeed,
it
is
due
to
the
understanding
of
the
economic
status
of
peasant
Haitians
that
PIH
was
able
to
deliver
an
effective
health
care
through
channeling
of
the
necessary
resources
to
Cange
and
understand
the
prevalence
of
certain
diseases.
Moreover
assessing
the
political
stability
of
a
country
helps
to
foreshadow
the
milestones
a
health
care
system
would
face
and
prepare
beforehand.
Political
instability
tends
not
only
to
deteriorate
the
health
of
a
population
but
also
to
undermine
all
the
achievement
that
a
health
care
system
might
accomplish
through
either
destruction
of
infrastructure
or
63
corruption.
During
Haiti’s
political
unrest
period,
for
instance,
thousands
were
reported
to
have
died
of
preventable
diseases
as
they
could
not
access
health
facilities
either
because
these
facilities
had
been
shut
down
by
the
army
like
Zanmi
Lasante
(Kidder
119)
or
because
health
services
had
been
politicized–that
is
only
those
that
supported
Jean‐Claude
Duvalier
the
army
leader
of
the
coup
had
access
to
health
care.
Similarly,
all
the
progress
that
PIH
had
been
making
in
Cange
was
undermined
by
the
1991
coup
that
resulted
in
a
restored
increase
in
the
number
of
TB
cases,
deaths
due
to
treatable
diseases
such
as
diarrhea
and
also
a
halt
to
the
gynecology
projects
in
Cange
(Kidder
120).
Certainly
the
political
instability
negatively
impacted
the
health
care
system
in
Haiti
and
any
health
care
vision
that
is
to
be
developed
for
Haiti
has
to
take
into
consideration
the
role
that
politics
play
in
the
health
of
the
population.
In
addition,
analysis
of
the
social
dynamics
such
as
religion
and
tradition
should
be
paramount
in
developing
an
effective
health
care
system.
Due
to
the
influence
that
religion
and
tradition
has
on
people’
response
to
medical
initiatives,
understanding
the
religion
and
tradition
of
the
population
at
hand
should
be
paramount
if
the
policies
implemented
are
to
work.
In
Cange
for
instance,
initially
Farmer
assumed
Haitian
peasants
were
just
not
committed
to
finishing
the
TB
dosage.
However,
after
deeper
research,
he
discovered
that
tuberculosis
was
considered
a
spell;
thus
soon
after
the
pain
goes
a
patient
assumes
that
the
disease/spell
was
gone
(Kidder
34).
Similarly,
many
traditional
Haitians
still
consult
their
traditional
medicine
man
for
treatment
as
not
only
is
it
convenient
but
also
a
source
trusted
for
decades.
Understanding
this
trust
will
go
a
long
way
in
trying
to
design
appropriate
ways
of
reaching
these
traditional
Haitians
rather
than
forcing
modern
medicine
on
them.
Thus
prioritizing
the
tradition
and
religion
of
the
population
is
crucial
in
designing
a
system
that
will
affect
their
daily
well‐being.
The
most
important
factor
that
might
contribute
to
a
comprehensive
healthcare
vision
is
collaboration
among
stakeholders.
This
means
that
the
stakeholders
have
a
stronger
voice
that
can
more
strongly
be
heard
by
governments
according
to
Dr
Portnoy,
which
will
make
their
work
more
effective
as
governments
collaborate.
Many
international
initiatives
which
have
great
amounts
of
resources,
skill
and
knowledge
fail
to
effectively
achieve
their
goals
mainly
because
they
do
not
collaborate
with
each
other
to
address
one
need.
While
they
go
into
a
place
with
need
many
NGOs
tend
to
individually
address
a
need
that
might
be
already
being
addressed
by
another.
A
good
example
is
the
NGOs
in
Haiti
just
after
the
64
earthquake,
which
chaotically
addressed
the
medical
needs
of
Haitians.
According
to
Dr
Portnoy,
if
NGOs
has
initially
collaborated
and
find
effective
ways
of
distributing
their
resources
the
issue
in
Haiti
would
have
been
addressed
faster.
Therefore
as
a
result,
for
effective
delivery
of
healthcare
by
international
initiatives
there
is
a
great
need
for
them
to
collaborate
together.
Colegio
Claustro
Moderno
“To
keep
the
body
in
good
health
is
a
duty...
otherwise
we
shall
not
be
able
to
keep
our
mind
strong
and
clear.”
Buddha
Taking
as
a
reference
the
country
of
Haiti,
the
idea
of
giving
a
solution
to
the
problem
of
health
services
in
tremendously
poor
countries,
it
is
much
denser
and
it
is
a
lot
more
than
just
an
economic
hardship.
Haiti
is
one
of
the
countries
with
the
greatest
deficiencies
in
all
issues
in
comparison
to
many
societies,
due
to
its
lack
of
efficient
healthcare
system,
raw
materials
and
a
well
functioning
state,
it
is
almost
impossible
to
give
a
solution
that
comes
solely
and
exclusively
from
the
Haitian
government,
this
is
why
it
is
necessary
the
assistance
from
international
organizations
and
the
collaboration
of
nations
with
a
more
stable
economy.
Based
on
this,
we
believe
that
one
of
the
most
significant
factors
to
be
used
to
provide
a
comprehensive
healthcare,
is
education,
which
can
be
the
beginning
of
a
new
health
system
that
in
a
long
term,
each
country
with
financial
problems,
should
begin
to
contemplate,
since
it
is
one
of
the
basis
in
order
to
end
the
economical
and
social
dilemma
of
any
community,
for
instance
a
society
ill‐fed
and
with
healthcare
problems,
does
not
produce
or
generate
revenue
for
the
state
or
improvements
for
the
same.
Bearing
in
mind
that
the
State,
in
this
case
the
Haitian
State
is
not
able
to
provide
the
society
any
financial
aid,
international
help
is
needed,
such
assistance
as
public
and
private
partnerships
like
the
International
Red
Cross,
WHO,
UNICEF,
Other
countries,
etc.
that
their
main
purpose
is
to,
run
properly
the
healthcare
and
the
system,
like
MSF,
that
the
first
thing
that
they
have
always
do,
it
is
to
react,
then
think
and
as
a
solution
they
act
in
the
most
effective
way
to
provide
help
to
a
community.
These
private
partnerships,
whose
65
support
should
be
focused,
mainly,
on
ways
to
prevent
viral
diseases
and
the
improvement
of
hygiene
training,
bearing
in
mind
that
information
is
the
main
key
to
a
society
health,
as
Dr.
Portnoy
said.
We
fully
believe
that
a
society
without
education
is
not
suitable
to
progress
and
have
good
standards
of
health
and
social
security
because
they
do
not
have
sufficient
knowledge
to
enable
them
to
recognize,
treat
and
prevent
diseases
that
can
be
found
in
their
environment.
The
initiatives
in
favor
of
health,
in
our
opinion,
must
be
focused
on
the
transformation
of
hygiene
habits
that
any
community
has,
taking
into
account
the
factors
that
influence
human
health:
genetics,
environment
and
education.
Each
of
these
factors
may
eventually
change
or
have
a
better
use
(other
than
genetics,
since
it
is
invariant)
if
we
assume,
as
a
starting
point,
the
transformation
of
education
levels.
We
believe
that
the
labor
of
international
initiatives
toward
the
healthcare,
whose
work
for
the
progress
of
an
impoverished
society
and
should
provide,
in
a
long
term,
a
comprehensive
health
system
for
it.
Those
initiatives
should
mainly
focus
its
aid
in
the
field
of
education,
since
it
is
where
their
goals
start
on.
In
the
case
of
Colombian
coffee‐
growing
areas,
where
several
organizations,
like
Colombia
coffee
federation,
help
protecting,
serving
and
assisting
isolated
and
disadvantaged
communities,
by
changing
through
education,
their
beliefs
and
society’s
Creole
customs,
for
new
habits
of
prevention
and
care
of
some
illnesses.
There
are
a
few
cases
of
bad
“healthcare
habits”
where
certain
families
of
the
region,
believe
that
providing
the
greatest
amount
of
meal’s
protein
to
the
oldest
person
is
better
than
providing
it
to
the
child
which
is
the
one
who
needs
it
the
most.
On
the
other
hand,
citizens
are
unaware
of
the
risk
of
holding
water
collected
in
containers
and
disused
objects,
that
are
the
largest
source
of
Dengue
mosquito
production.
Moreover,
the
lack
of
knowledge
makes
people
drink
water
that
hasn’t
passed
through
a
purification
treatment,
causing
a
greater
chance
of
contracting
diseases
such
as
cholera
(reports
of
the
MSF
said
that
it
has
caused
9000
cases
and
1000
deaths
in
Haiti),
typhoid
fever,
diarrhea
and
hepatitis.
We
strongly
think
that
Chile
is
one
of
the
countries
that
prove
that
education
is
the
prime
rib
of
the
societies
organizations
plans
from
any
social
dilemma,
like
the
one
he
had
been
66
victim
of,
the
strongest
earthquakes
in
recent
years.
Chile
achieved,
through
the
education
provided
to
each
of
its
citizens,
to
act
and
to
overcome
the
situation
effectively
and
quickly.
The
government
avoided
a
higher
socio‐economic
crisis
and
more
complex
problems
that
would
have
been
more
difficult
to
solve.
The
education
provided
by
the
Chilean
Government,
was
based
primarily
on
the
public
awareness
of
the
potential
hazard
of
an
earthquake
(as
Chile
an
area
of
great
seismic
activity)
and
taught
what
to
do
during
and
after
an
earthquake.
Large
studies
promoted
by
the
Chilean
government,
have
allowed
the
possibility
of
constructing
earthquake
resistant
houses
with
systems
to
prevent
the
collapse
of
buildings.
In
conclusion,
as
Dr.
Portnoy,
president
of
MSF,
made
us
see;
we
don’t
need
just
one
solution,
we
need
a
thousands
of
those
because
every
culture
and
society
is
different
from
the
other,
that
is
why
we
certainly
need
to
think
in
each
of
the
countries
that
these
societies
and
organizations
are
going
to
work
on,
and
then
search
for
a
solution
that
involves
everyone,
this
let
us
to
know
that
the
only
factor
that
contributes
with
this,
is
the
changing
of
bad
habits,
prevention,
and
knowledge,
and
the
only
step
that
achieves
this
is
Education.
Garodia
International
Centre
for
Learning
Having
grown
up
in
India,
an
LEDC,
we
have
known
intimately
and
witnessed
the
hardships
of
those
who
work
for
improved
healthcare.
Our
discussions
revolve
around
poverty;
in
that
context
we
must
look
at
countries
being
impoverished
as
well
as
areas
or
population
groups
within
them
being
so.
Our
vision
is
comprehensive,
in
that
it
accounts
for
both
scenarios.
When
only
regions
in
a
country
are
affected
it’s
possibly
because
of:
•
Inadequate,
inaccessible
or
expensive
medicines
and
facilities
in
rural
and/or
impoverished
areas.
•
Healthcare
isn’t
available
to
the
‘urban
poor’
as
private
hospitals
are
too
costly
and
public
hospitals
are
overloaded.
When
a
country
is
poor;
e.g.
Haiti,
there
are
different
factors
that
we
consider:
67
•
In
such
countries
healthcare
doesn’t
receive
a
lion’s
share
of
the
budget,
for
the
government’s
have
many
other
commitments
and
worries
like
infrastructure
and
telecommunication
development,
water
provisions,
sanitation,
road
development
and
education,
healthcare
too!
•
Politicians
will
resort
to
populist
measures
and
prioritize
areas
that
result
in
immediate
gains
for
them.
(Though
this
is
done
by
lots
of
politicians
throughout
the
world,
in
LEDCs
it
acts
as
an
opportunity
cost.)
Common
problems
faced
would
be:
 Low
Doctor‐patient
ratio
 Selling
medicines
and
blood
in
exchange
for
necessities
 Spurious
medications
 The
lack
of
correct
and
timely
diagnosis
 Illiteracy
and
lack
of
knowledge
about
the
available
healthcare.
But
those
are
mainly
political
and
economical
problems;
we
feel
it
is
imperative
to
deal
also
with
social
problems
that
arise
in
impoverished
areas.
In
Kidder’s
book
set
in
Haiti,
he
tells
us
of
the
problems
Voodoo
creates,
in
India
such
practice
exists
as
‘mantra‐tantra’,
blind‐faith
delivers
severe
blows
to
modern
medical
facilities.
Having
said
the
above,
we
shall
now
talk
about
my
suggestions
for
a
more
‘comprehensive’
vision
of
healthcare
in
impoverished
areas/countries.
We
feel
that
modern
medicine
should
integrate
traditional
systems
like
Ayurveda,
Unani
and
Acupuncture;
due
to
their
being
affordable
more
readily
available
and
comparatively
lower
in
demand.
All
the
same
these
should
be
sensibly
used
only
in
preventing
a
disease
or
treating
symptoms
and
illnesses
in
their
early
stages.
The
urban
poor
problem
is
omnipresent
through
Indian
streets,
to
solve
this,
the
Government
must
provide
incentives
to
doctors
to
treat
the
poor,
through
schemes
etc.
The
government
could
also
consider
adopting
the
renowned
health
insurance
system
developed
by
Dr.
Deviprasad
Shetty,
making
the
insurance
cheap
and
efficient
in
its
provision
and
use.
68
To
educate
the
public,
there
should
be
health
campaigns
that
spread
awareness,
as:
Poverty
Ignorance
+
Illness
e.g.
The
polio
campaign
in
India
had
a
great
outcome,
mainly
due
to
the
T.V.
Advertisements.
On
the
same
note,
as
suggested
by
Farmer,
a
health
census
will
provide
an
epidemiological
break‐up;
on
the
lines
of
which
treatment
can
be
undertaken
and
preparations
made.
Due
to
the
small
portion
of
healthcare
spending
by
the
government,
donations
are
made
to
poor
countries
and
help
like
the
MDRI
are
provided.
But
due
to
those
funds
going
through
many
hands
they
never
reach
the
intended
people.
It
would
therefore
be
a
better
idea
to
involve
individuals
like
Farmer,
the
corporate‐sector
and
NGOs
in
such
efforts
as
they
can
focus
on
a
smaller
area
and
are
more
dedicated.
Non‐complaint
patients
and
retail
of
blood
and
prescription
drugs
for
necessities
reverses
the
desired
effect.
What
could
be
done
is
that
treatments
structures
should
be
modeled
around
that
of
DOTS.
In
addition,
Dr.
Farmers
‘Cash
Stipend
‘method
could
be
used,
where
the
patients
receive
some
money
to
buy
necessities;
mainly
food.
To
solve
the
problem
of
low
doctor‐patient
ratios,
paramedical
personnel
could
be
trained.
That
creates
and
provides
jobs
and
training
for
local
people
in
rural
areas.
Paramedics
are
trained
cheaper
and
faster
than
doctors,
can
cover
larger
areas
(and
are
more
affordable),
thereby
only
requiring
doctors
in
a
confirmed
medical
situation,
relieving
doctors
of
the
demand
strain.
The
economist
has
reported
a
solution
to
the
problem
of
spurious
or
sub‐standard
drugs
in
Ghana.
This
method
involves
checking
the
code
of
the
drug,
by
sending
an
SMS
verification
request
to
a
mobile
service
that
confirms
its
authenticity.
Therefore
we
conclude
by
saying
that
these
problems
are
deep‐rooted,
wide‐spread
and
not
easy
to
tackle.
But
to
achieve
this
utopia,
we
need
a
concerted
and
world‐wide
effort
by
agencies
like
the
WHO
which
transcend
political
systems
and
geographical
barriers.
69
Johannes
Kepler
Grammar
School
One
of
the
most
important
factors
in
the
comprehensive
vision
of
healthcare
is
global
applicability.
It
would
be
very
inefficient
to
come
up
with
a
standard
way
of
dealing
with
a
problem
that
would
only
work
in
certain
areas.
You
cannot
simply
use
a
pattern
working
in
country
A
and
apply
it
on
country
B,
expecting
the
same
results.
As
Dr.
Portnoy
said,
the
cultural
as
well
as
ethnic
differences
make
it
impossible.
That
is
why
it
is
always
important
to
adapt
and
tailor
the
health
care
to
the
particular
region,
embed
it
in
the
local
environment,
make
it
socially
and
publicly
acceptable,
and
surmount
all
the
barriers.
Yet,
it
would
be
very
helpful
to
try
to
standardize
the
system
and
infrastructure
in
individual
regions
as
far
as
the
local
environment
and
local
people
would
allow.
That
way,
the
efficiency
of
the
provision
of
healthcare
might
be
improved
while
retaining
and
respecting
the
local
traditions.
Another
important
factor
is
cooperation.
All
the
efforts
of
trying
to
be
as
efficient
as
possible
might
come
in
vain
when
another
operating
body
hampers
you
down,
like
Dr.
Portnoy
mentioned
in
his
example
with
U.S.
Army
intervention
at
the
airport
in
Port‐au‐
Prince.
Striving
for
good
results,
you
need
to
be
in
harmony
with
other
various
bodies
that
might
potentially
show
up
and
possibly
be
in
your
way.
Moreover,
to
achieve
the
best
possible
results,
collaboration
with
others
is
indispensable.
For
example,
using
shipping
companies
to
cut
down
on
the
transportation
costs
would
certainly
be
a
very
good
step
that
would
make
it
possible
to
use
more
money
on
the
healthcare
material,
equipment,
etc.
Yet
another
important
aspect
fundamental
for
an
efficient
functioning
of
healthcare
is
a
good
system
and
good
infrastructure.
There
was
virtually
no
working
infrastructure
after
the
earthquake
in
Haiti,
which
significantly
slowed
down
the
rescue
actions.
If
the
infrastructure
had
been
more
developed,
there
could
have
been
fewer
people
who
did
not
get
adequate
treatment
or
did
not
get
it
in
time,
due
to
which
they
are
now
burdened
with
lifetime
effects.
Last
but
not
least,
education
plays
a
major
role
in
prevention
as
well
as
humanitarian
aid.
In
a
very
optimistic
vision,
media
would
supplement
or
even
serve
as
the
trump
card
in
education;
however,
the
reality
is
not
that
bright
and
media
only
cover
what
is
medially
70
attractive.
Therefore,
healthcare
education
is
an
important
factor,
essential
for
every
healthcare
system
that
is
striving
for
efficiency.
Firstly,
if
people
are
not
aware
of
the
health
risks
and
health
problems,
they
cannot
seek
medical
help.
And
if
they
do
not
look
for
medical
aid,
the
healthcare
system
cannot
work
efficaciously.
Secondly,
if
people
in
developed
countries
are
not
aware
of
the
various
crises
in
developing
countries,
it
is
difficult
to
fund
the
humanitarian
organizations
and
provide
the
necessary
amount
of
aid.
Montgomery
Bell
Academy
“Zanmi
Lasante
is
an
oasis…but
it’s
not
as
good
as
here.
The
Cubans
would
have
done
a
better
job.”
(Kidder
205)
In
one
of
the
most
compelling
sections
of
Tracy
Kidder’s
Mountains
Beyond
Mountains,
the
author
travels
with
Dr.
Paul
Farmer
to
attend
a
healthcare
summit
in
Havana.
Dr.
Farmer
considers
his
own
efforts
in
Haiti
inadequate
when
compared
with
to
the
unrivaled
efficiency
of
the
Cuban
system.
Geographically,
the
two
Caribbean
islands
are
scarcely
separated
by
ninety
miles
of
sea—yet
in
development,
they
are
worlds
apart.
The
critical
divergence
is
in
government.
While
one
has
enjoyed
relative
stability
for
decades
under
communist
rule,
the
other
has
been
a
failed
state
ever
since
its
inception.
Herein
lies
the
primary
challenge
for
improving
health
care
(and
more
broadly,
quality
of
life)
in
an
undeveloped
nation
like
Haiti:
constructing
a
state.
This
task
will
be
daunting
for
a
nation
that
has,
throughout
its
history,
struggled
to
create
a
responsible
government.
The
country's
first
constitution,
ratified
in
the
midst
of
Revolution
in
1801,
firmly
entrenched
Toussaint
L'Ouverture
as
the
"Governor
for
Life".
Since
then,
the
development
of
Haitian
government
has
been
a
disastrous
combination
of
continuity
and
instability.
A
total
of
24
additional
constitutions
have
been
put
into
effect
since
the
independence,
but
the
most
broken
parts
of
the
system
remain
intact.
Toussaint’s
Revolutionary
model—
military
law
and
rule
for
life—
has
been
corroborated
by
almost
every
subsequent
Haitian
leader.
But
upon
receiving
that
mandate,
subsequent
leaders
proved
incapable
of
crafting
a
state.
In
1805,
Jean
Jacques
Dessalines
declared
himself
as
emperor
in
the
vein
of
his
European
71
contemporary
Napoleon.
His
domestic
policy
was
nothing
short
of
state
terrorism,
as
suggested
by
his
motto
"Koupe
tet,
Boule
kay"
("Cut
off
the
head,
burn
down
the
house").
This
authoritarian
model
was
furthered
by
both
Duvaliers,
who
also
believed
that
any
measure
of
reform
could
only
come
through
"enlightened"
rule.
The
citizens
themselves
were
only
important
in
the
process
insofar
as
they
facilitated
transfers
of
power
between
each
successive
regime.
Thus,
a
dangerous
tradition
was
established:
the
government
was
not
concerned
about
serving
the
people,
and
the
people,
particularly
those
isolated
in
rural
areas,
had
no
expectation
of
government
service.
Now,
Haiti
needs
a
responsible
government
more
than
ever
before.
The
present
crisis
has
made
it
painfully
apparent
that
the
country
lacks
any
system
by
which
to
distribute
social
services
like
health
care.
But
over
two
hundred
years
of
Haitian
history
preclude
progress—
the
government
has
neither
ability
nor
credibility.
Structural
reform
is
clearly
needed.
Repairing
the
Haitian
government
will
require
time,
and
potentially
the
direct
assistance
of
other
nations.
Any
attempt
at
reform
must
begin
with
a
strengthening
of
existing
institutions.
Greater
support
for
the
Haitian
National
Police
might
be
an
effective
measure
to
help
improve
the
situation
on
the
ground;
a
better
funded
and
equipped
police
force
can
provide
a
crucial
link
between
the
government
and
the
people
most
affected
by
the
current
disaster.
Only
after
a
solid
foundation
is
built
at
the
local
level
can
the
system
in
Port‐au‐Prince
can
be
reformed
completely.
A
functioning
state
would
be
able
to
coordinate
the
delivery
of
social
services
to
the
people.
By
adopting
a
role
of
greater
oversight,
the
Haitian
government
can
begin
to
build
a
health
infrastructure
for
the
country.
The
efforts
of
international
organizations
must
be
better
monitored
by
the
Haitian
Ministry
of
Health.
Dr.
Darin
Portnoy
of
Doctors
Without
Borders
described
how
the
lack
of
cooperation
between
non‐government
organizations
can
often
result
in
needless
competition
and
inefficiency.
Haiti
could
greatly
improve
the
ability
of
outside
groups
to
work
constructively
within
the
country’s
system
if
it
took
a
leadership
role
in
coordinating
these
efforts
(without
imposing
onerous
conditions).
Once
the
network
of
health
care
distribution
is
stabilized,
Haiti
will
be
more
capable
of
retaining
the
physicians
who
might
otherwise
emigrate
in
search
of
better
employment.
A
72
base
of
skilled
medical
professionals
is
an
absolute
necessity
for
any
effort
to
expand
the
health
system
in
impoverished
rural
areas.
More
indirectly,
the
state
can
improve
other
institutions
as
part
of
a
"comprehensive"
approach.
Dr.
Farmer
quickly
realized
the
link
between
employment
and
health.
A
responsible
government
can
provide
much
needed
job
opportunities
for
those
who
need
them
the
most.
Education,
too,
is
critical.
Haiti
needs
a
new
generation
of
leaders
with
a
solid
understanding
of
the
country's
rich
but
troubled
history.
Santayana
said
it
best:
"Those
who
cannot
remember
the
past
are
condemned
to
repeat
it."
Hopefully,
Haiti
and
other
under‐developed
nations
can
heed
that
advice.
Nada
High
School
When
we
consider
healthcare
in
terms
of
a
comprehensive
vision,
we
have
a
tendency
to
provide
all
the
people
with
basic
healthcare
service.
As
we
have
already
said
in
our
presentation,
the
most
important
thing
is
to
give
the
basic
healthcare
for
all
the
people
in
the
world.
In
order
to
realize
the
basic
healthcare
system,
we
often
try
to
manage
with
as
little
money
as
we
can.
Since
the
income
of
the
governments
and
international
organizations
is
so
restricted,
for
instance
the
budget
of
WHO
is
only
960
million
dollars
in
2005
and
2006,
it
is
of
course
true
that
we
have
to
reduce
the
expenditure
of
healthcare.
However,
we
must
not
forget
that
we
use
this
argument
as
one
of
the
convenient
excuses
for
the
poor
situation
of
healthcare
in
developing
countries.
It
is
clear
that
“basic”
healthcare
is
necessary.
But
“basic”
is
sometimes
a
confusing
word.
“Basic”
healthcare
is
of
course
needed,
but
this
kind
of
healthcare
shouldn’t
be
“superficial”.
Indeed,
the
very
role
of
international
healthcare,
we
think,
is
to
prevent
people
from
the
death.
Is
this
“superficial”
healthcare
really
enough
for
each
person
to
live
as
a
human
being?
Does
this
really
ensure
their
dignity?
We
have
also
discussed
these
several
days
and
emphasized
how
important
it
is
to
recognize
the
difference
between
each
regions
and
local
communities.
The
lack
of
this
recognition
might
result
in
a
bad
aspect
of
globalization.
Over
the
ages,
the
developed
countries
have
forced
the
developing
countries
to
do
as
the
developed
countries
want
them
to.
As
a
result,
people
in
developing
countries
were
forced
to
use
languages
such
as
73
English
and
French
instead
of
their
native
languages,
and
to
accept
the
Western
ways
of
living.
We
must
never
compel
developing
and
impoverished
countries
to
accept
the
system
and
belief
of
developed
countries.
Bearing
these
things
in
mind,
we
think
that
the
most
important
factor
that
contributes
to
a
comprehensive
vision
of
healthcare
is
to
build
infrastructure
such
as
jobs,
water,
and
roads
in
areas
all
over
the
world.
A
woman
in
Haiti
said
in
the
book
“Mountains
Beyond
Mountains”,
“You
want
to
stop
HIV
in
women?
Give
them
jobs.”
Even
if
we
prevent
people
from
the
death,
people
cannot
live
without
any
jobs.
And
through
the
poor
situation,
we
may
get
some
diseases
again.
We
must
keep
in
mind
that
the
“basic”
healthcare
may
not
solve
the
problem
fundamentally.
Raffles
Institution
After
listening
to
Dr
Portnoy’s
talk
and
reading
Mountains
Beyond
Mountains
by
Tracy
Kidder,
one
faces
the
challenge
of
being
inundated
by
problems
of
healthcare
around
the
world.
This
feeling
is
challenged
by
one
that
is
filled
with
optimism,
where
there
has
been
steps
taken
towards
alleviating
such
an
issue,
thereby
contributing
to
a
comprehensive
vision
of
healthcare.
Hence
it
is
crucial
for
us
to
identify
the
most
important
factors
which
contribute
to
this
comprehensive
vision
and
what
steps
could
be
taken
to
alleviate
the
problems
mentioned
above.
These
factors
are
by
no
means
the
magic
bullet
to
solve
these
problems,
however,
we
feel
that
such
'baby
steps'
need
to
be
taken
in
order
for
international
healthcare
to
move
forward.
The
first
important
factor
would
be
the
cooperation
with
local
authorities
and
understanding
of
local
traditions
and
cultures.
National
initiatives
play
a
very
important
role
in
raising
the
level
of
health
in
a
population.
After
all,
national
level
initiatives
are
the
ones
that
eventually
reach
the
locals
in
any
country.
More
often
than
not,
international
aid
(from
the
various
initiatives
and
programs)
is
distributed
via
the
national
governments,
which
would
then
distribute
the
medicine
through
its
own
channels
(usually
through
one
of
the
initiatives
that
the
Ministry
of
Health
runs).
One
may
argue
that
Non‐Government
Organisations
such
as
Paul
Farmer’s
Partners
in
Health
is
an
example
of
an
‘international
initiative’
that
works.
However,
on
closer
analysis
of
Mountains
Beyond
Mountains,
we
find
that
they
had
to
work
against
the
Peruvian
system
when
it
came
to
treating
the
MDR
74
strains
of
TB
due
to
the
limitations
of
the
healthcare
system.
Hence,
we
can
see
that
without
the
cooperation
of
national
governments
to
integrate
international
initiatives,
the
success
rates
of
the
actual
execution
of
such
initiatives
would
be
lowered
drastically.
What
we
feel
is
the
key
to
success
of
any
program
trying
to
raise
a
population’s
level
of
health
is
to
have
a
strong
central
government
to
tweak
each
national
initiative
to
suit
the
influx
of
international
aid
(whether
in
terms
of
money
or
medicine)
entering
the
country.
If
this
cannot
be
achieved,
international
organisations
then
have
the
imperative
to
take
the
initiative
and
install
relevant
healthcare
programs.
An
example
would
be
how
MSF
had
to
take
control
of
a
Haitian
hospital
in
Port‐Au‐Prince
and
revamp
its
operations.
The
second
important
factor
would
be
for
organisations
to
band
together
and
deal
with
crises
with
a
unified
front.
A
cluster
approach
which
has
clear
distinctions
needs
to
be
drawn
between
International
organisations
attempting
to
resolve
the
ideological
differences
and
organisations
dealing
with
the
'reactive',
humanitarian
aid
aspect.
There
is
no
doubt
that
a
cluster
approach
should
be
employed
in
times
of
humanitarian
crisis,
where
different
organisations
should
come
under
the
umbrella
of
a
unified
organisation
such
as
the
UN
to
disperse
aid.
This
way,
the
aid
efforts
can
be
more
coordinated
and
effectively
employed.
A
coordinated
effort
would
allow
the
aid
effort
to
target
more
specific
areas
of
need
during
a
crisis.
However,
this
cluster
approach
must
not
be
tampered
with
political
slants.
The
cluster
effort
needs
to
be
nonpartisan,
and
cannot
risk
siding
with
any
ideology.
The
primary
aim
of
these
organisations
should
be
purely
to
treat
the
sick
and
alleviate
their
suffering.
During
the
sharing
addressed
to
the
participants
today,
Dr
Darin
Portnoy
of
Médecins
Sans
Frontières
cautioned
that
crossing
this
line
would
bode
severe
consequences
for
aid
workers,
which
takes
a
more
critical
turn
when
such
organisations
are
operating
in
a
place
where
conflict
is
still
ongoing.
The
safety
of
aid
workers
would
then
be
compromised
and
the
efficacy
of
the
effort
would
be
threatened.
A
comprehensive
vision
of
healthcare
is
by
no
means
one
which
is
capable
of
being
easily
reached.
However,
two
important
and
essential
factors
are,
at
least
in
our
opinion,
critical
in
ensuring
the
bare
minimum
required
to
build
upon
to
form
a
comprehensive
vision
of
healthcare
exists.
Even
with
the
possession
of
these
two
factors
of
national
cooperation
and
a
cluster
approach,
successfully
achieving
a
comprehensive
vision
of
healthcare
would
still
be
considered
a
commendable
achievement
as
considerable
effort,
in
addition
to
the
employment
of
these
factors,
is
indubitably
required.
Indeed,
achieving
this
much
sought
75
comprehensive
vision
of
healthcare
will
definitely
entail
a
long
and
arduous
journey.
However,
nations
would
do
well
to
persevere
and
put
their
best
foot
forward,
for
the
results,
once
achieved
far
outweigh
the
cost.
Shiyan
Cooperation
High
School
There
are
nearly
200
countries
in
the
world.
However,
nearly
ten
percent
of
them
are
developed
counties;
why
are
there
developing
and
developed,
rich
and
poor
countries?
Why
rich
areas
become
richer
and
richer;
and
the
poor
still
be
stuck
in
poverty?
We
think
this
problem
is
worth
thinking
about.
And
there
also
are
many
problems
in
rural
and
impoverished
places.
For
instance,
Haiti,
located
in
the
north
of
Caribbean
,
is
a
mountainous
place.
Because
of
the
geography
position,
people
who
live
there
are
so
poor.
They
have
nothing
to
plant
and
to
develop
their
economies.
The
earthquake
has
taken
away
all
things
they
had.
All
of
these
lead
to
a
poor
life.
People
have
no
food
and
clothes
to
make
them
alive.
So
many
diseases
come
to
strike
them.
The
social
security
and
the
health
care
system
in
Haiti
are
incomplete.
So
the
problems
are
being
bigger
and
bigger.
Healthcare
in
rural
and
impoverished
areas
is
not
in
a
good
condition.
People
there
haven’t
got
enough
money
to
pay
for
their
health.
Some
days
before,
my
foreign
friend
told
us
the
story
about
his
crooked
finger.
He
used
to
live
in
the
countryside
and
live
a
poor
life.
He
broke
his
finger
when
he
was
a
boy,
but
to
cure
it
needs
a
lot
of
money
and
the
hospital
was
really
far
from
his
home,
so
he
connected
his
finger
by
himself.
Without
being
treating
well,
the
finger
is
different
from
the
others
.
But
now
he
told
me
the
story
with
a
smile.
But
this
story
makes
us
think
a
lot.
In
the
countryside,
it’s
hard
and
expensive
to
see
a
doctor.
Government
has
already
reformed
the
healthcare
system
to
help
the
poor
and
provide
more
medicine
to
countryside.
Doctors
and
many
volunteers
will
come
to
countryside
with
medicine
at
regular
intervals.
But
there
are
so
many
sick
people
waiting
for
treatment.
They
can’t
help
all
the
sick
at
once.
And
the
health
of
people
in
countryside
still
cannot
be
ensured.
They
really
need
more
help.
76
Why
are
there
so
many
differences
between
city
and
countryside?
Is
that
means
people
in
rural
and
impoverished
areas
can’t
accept
the
normal
treatment?
The
government
and
the
rich
should
care
more
about
the
poor.
I
think
that
we
all
have
our
own
family.
If
your
family
needed
help,
you
would
do
all
you
can
do
to
help
him.
And
our
country
is
a
big
family
which
consists
of
many
small
families.
The
earth
is
a
huge
family,
the
members
in
it
are
all
the
countries.
So
we
are
all
in
a
family.
We
should
help
each
other
as
possible
as
we
can.
If
we
do
something
to
change
the
situations
of
the
poor,
their
lives
will
become
better.
We
can
then
all
live
a
happier
and
healthier
life.
Winchester
College
One
most
consider
exactly
what
is
a
comprehensive
vision
of
healthcare.
There
must
be
access,
technology,
doctors
and
perhaps
even
education.
Farmer
states
‘…a
comprehensive
vision:
pathology,
social
medicine,
politics,
anthropology.
One
of
these
factors
is
the
incidence
and
rate
of
growth/decline
of
diseases
such
as
HIV/AIDS
and
tuberculosis.
TB
is
the
cause
of
the
highest
deaths
in
the
Haiti,
and
in
that
hemisphere,
cases
of
TB
are
ten
times
as
high
as
those
in
other
Latin
American
countries.
Why
is
TB
so
prevalent
in
Haiti?
When
left
untreated,
each
person
with
active
TB
disease
passes
the
bacilli
on
very
easily
through
the
air.
But
this
does
not
answer
the
question:
one
third
of
the
world’s
population
is
currently
infected
with
the
bacillus.
The
difference
is
that
in
Haiti,
other
factors
contribute
to
initiating
active
TB
in
a
person;
factors
such
as
poverty,
which
leads
to
famine,
and
the
failure
f
the
government
to
provide
education
about
prevention.
The
immune
system
does
not
dispel
the
bacilli;
it
sections
it
off
by
hiding
it
under
a
thick
waxy
coat.
The
bacillus
can
lie
dormant
for
many
years
but
when
the
immune
system
is
weakened,
the
chances
of
getting
sick
are
greatly
increased.
This
is
also
where
HIV
plays
its
own
deathly
part.
HIV
significantly
weakens
the
immune
system
and
works
in
tandem
with
TB,
increasing
the
chance
of
death.
So
far,
Haiti
looks
like
a
lost
cause;
but
there
is
a
chance
of
redemption.
The
WHO
millennium
development
goal
number
six,
target
eight,
aims
to
halt
and
being
to
reverse
the
incidence
of
TB
by
2015.
As
a
result,
new
and
effective
programmes
have
engendered
an
86%
success
in
treatment
and
it
is
estimated
that
the
TB
incidence
in
the
region
peaked
in
2004:
this
means
it
is
now
in
decline.
The
77
arrival
of
the
rainy
season
exacerbated
the
malaria
situation,
but
many
preventative
measures
were
implemented:
mosquito
nets
and
anti‐malaria
tablets
were
distributed
by
initiatives
such
as
PIH.
Haiti’s
picture
looks
a
little
brighter.
Issues
surrounding
women
and
children
should
hold
heavy
influence
in
our
view
of
healthcare
in
an
impoverished
region:
maternal
care
and
infant
mortality.
For
example,
in
Haiti
the
maternal
mortality
rate
is
approximately
14
in
every
1000
women.
The
view
is
not
so
depressing:
the
UN’s
Global
Strategy
for
Women's
and
Children's
Health
aims
to
prevent
33
million
unwanted
pregnancies
between
2011
and
2015
and
to
save
the
lives
of
women
who
are
at
risk
of
dying
of
complications
during
pregnancy
and
childbirth,
including
unsafe
abortion.
A
programme
like
this
could
be
implemented
in
Haiti,
but
unfortunately
chances
of
its
success
are
slightly
dampened
because
of
the
tribal
nature
of
the
families:
their
basic
instinct
is
to
survive
by
reproduction.
Another
key
factor
which
involves
women
is
occupation.
In
Mountains
Beyond
Mountains,
Farmer
quotes
a
Haitian
woman
saying
‘You
want
to
stop
HIV
in
women?
Give
them
jobs’
(199).
Here,
he
is
relating
to
the
uniformed
opinion
of
HIV
infected
women
that
‘desperation,
deep
poverty
and
illiteracy’
were
their
reasons
for
having
taken
real
risks
with
aid,
these
risks
being
cohabiting
with
truck
drivers
or
soldiers.
Therefore,
I
believe
that
an
impoverished
country’s
female
unemployment
figures
and
its
general
legislation
on
equality
are
an
important
factor
when
determining
a
comprehensive
view
of
its
health
care.
One
of
the
most
important
determinants,
however,
is
the
amount
of
debt
an
impoverished
country
has
accumulated.
In
many
ways
this
factor
can
be
used
to
determine
its
degree
of
its
poverty.
In
2009,
Haiti
had
taken
on
$1.2
billion
of
external
debt.
This
had
accumulated
by
unelected
governments
and
recovering
after
natural
disasters.
This
$1.2
billion
was
even
hailed
as
‘unjust’
debt
by
Jubilee
USA,
and
was
cancelled
in
June
2009
by
the
IMF,
World
Back,
and
the
African
Development
Fund.
The
subsequent
relief
of
this
debt
allowed
spending
to
be
allocated
to
healthcare,
education
and
medicine.
Funds
could
be
directed
towards
the
purchase
of
vital
drugs
needed
to
combat
life‐threatening
diseases,
but
these
medicines
held
extortionate
prices
labels.
The
problem
is
that
large
pharmaceutical
companies,
such
as
GlaxoSmithKline
and
Abbot
Laboratories
are
applying
for
patents
on
high‐demand
antiretroviral
drugs,
which
are
essential
in
the
fight
against
HIV.
This
means
that
companies
in
India
which
manufacture
cheaper
generic
drugs
will
no
longer
be
able
to
supply
these
drugs
at
affordable
prices
to
places
such
as
Haiti.
To
help
reduce
expenditure,
78
many
companies
are
rallying
against
the
procurement
of
patents
by
large
pharmaceutical
companies,
and
this
just
cause
has
recently
been
sympathetically
regarded
by
the
Indian
patent
authorities.
There
is
an
argument
for
the
big
pharmaceutical
companies:
they
require
large
funds
to
research
new
medicine,
and
they
argue
that
in
order
to
lead
the
way
into
new
technologies
and
medicines,
these
funds
are
indispensible.
In
conclusion,
I
believe
that
the
key
elements
of
a
comprehensive
vision
of
healthcare
should
include:
the
incidence
of
HIV/AIDS
and
TB,
and
how
they
wax
and
wane;
the
female
unemployment
figures
and
equality
legislation
of
the
indigent
country;
the
amount
of
debt
the
country
has
accumulated.
The
culmination
of
these
three,
most
important,
elements
will
accomplish
a
comprehensive
vision
of
healthcare.
79
Day
5,
March
30
The
MBIS
fraternity
spent
a
second
day
off
the
MBA
campus,
beginning
at
Siloam
Family
Health
Center,
and
a
seminar
led
by
Dr
Morgan
Wills.
Siloam
caters
for
predominantly
immigrant
communities,
most
of
whom
lack
medical
insurance.
Dr
Wills
and
his
colleagues
took
us
through
some
fascinating
case
histories,
and
we
were
able
to
witness
Siloam
at
work,
thanks
to
the
gracious
cooperation
of
his
doctors
and
health
professionals.
After
lunch
at
Istanbul’s
close
to
Siloam
(ending,
appropriately,
with
some
very
powerful
Turkish
coffee),
the
MBIS
participants
returned
to
VU
School
of
Medicine
for
a
presentation
on
malaria
and
the
mosquito
from
Dr
Julian
Hillyer.
Once
again,
we
saw
the
damage
wrought
by
this
disease,
and
were
privileged
to
encounter
some
of
Dr
Hillyer’s
work
on
possible
solutions
–
the
quest
for
a
vaccine,
the
possible
solutions
offered
by
modifying
the
mosquito’s
genetic
make‐up.
We
then
visited
the
university’s
mosquitarium
to
encounter
many
different
types
of
mosquito
currently
being
studied
by
Dr
Hillyer
and
his
team.
Dr
Sten
Vermund
from
VU’s
Institute
for
Global
Health
then
led
a
panel
discussion
covering
a
variety
of
the
health
issues
with
which
the
Institute
wrestles.
Once
again,
the
issue
of
behavior
and
health
–
and
thus
the
potential
role
for
education
as
a
remedy
–
was
at
the
forefront
of
this
discussion.
While
naturally
large
sums
of
money
are
devoted
to
research
at
the
chemical,
biochemical,
and
genetic
level,
behavior
would
appear
to
account
for
the
biggest
potential
healthcare
improvements
on
a
global
scale.
The
day
concluded
with
presentations
on
technology
and
ethics
in
healthcare
from
Chaitanya
Patil
and
Ankit
Datta
of
Garodia
International
Centre
for
Learning,
and
Jan
Zdenek
and
Aneta
Bernadova
of
Johannes
Kepler
Grammar
School.
80
How
far
will
technological
advance
bring
healthcare
benefits
to
society?
How
might
technological
advance
bring
with
it
ethical
dilemmas?
African
Leadership
Academy
Medical
technologies
sometimes
bring
unequivocal
benefits
to
our
society.
Use
of
general
technology
such
as
cell
phones
has
indeed
brought
indisputable
benefits
to
our
health
care
delivery
systems
as
they
have
enabled
the
average
human
being
to
have
access
to
health
care
information
and
also
call
for
assistance.
However,
due
to
the
intensive
investment
put
into
developing
medical
technology,
the
cost
has
proved
to
be
beyond
what
many
of
the
3
billion
people
in
the
world
can
afford.
Subsequently,
a
social
divide
is
created
between
those
who
can
afford
this
technology
and
those
who
cannot.
Consequently,
as
a
result
of
medical
technology
we
have
to
suffer
from
a
polarized
society.
In
addition,
the
most
difficult
ethical
dilemma
to
resolve
is
the
controversy
around
abortion
where
the
diverse
stakeholders
have
failed
to
reach
a
consensus.
The
use
of
general
technology
such
as
cell
phones
in
heath
systems
has
brought
unequivocal
benefits
to
our
communities
as
this
has
increased
efficiency
and
effectiveness
in
health
care
delivery.
Indeed,
the
growing
number
of
cell
phone
holders
in
Africa
presents
a
platform
where
mobile
phones
can
be
used
to
increase
efficiency
in
health
care
delivery.
The
decreasing
cost
of
mobile
phones
has
enabled
the
average
Zimbabwean
and
Kenyan
to
own
a
mobile
phone.
For
instance,
Vodacom
Kenya
sells
cell
phones
for
a
price
of
only
$12;
thus
many
average
Kenyans
own
a
mobile
phone.
With
a
subscriber
base
of
over
19.4
million
distributed
through
remote
Kenyan
villages,
Vodacom
Kenya
and
Safaricom
have
enabled
rural
Kenyans
to
have
access
to
information
(Telecompapers).
This
makes
communication
with
doctors
much
easier.
Communities
that
are
located
miles
from
health
clinics
can
now
easily
inform
a
doctor
of
a
pandemic
outbreak
and
get
instructions
on
how
to
act
to
prevent
further
spread.
This
has
gone
a
long
way
in
combating
Cholera
and
Malaria,
the
two
diseases
that
singly
kill
most
people
in
Africa
annually.
The
same
revolution
has
been
taking
place
in
Sierra
Leone,
Zimbabwe
and
South
Africa.
As
a
result,
it
is
evident
that
the
use
of
general
technology
like
mobile
phones
does
sometimes
bring
almost
unequivocal
health
benefits
to
the
African
communities.
81
Technological
advances
can
increase
efficiency,
accessibility
and
cost
effectiveness
to
our
healthcare.
Indeed
through
the
use
of
it
databases
health
institutions
such
as
clinics,
hospitals
and
research
facilities
can
store
their
records
on
networks
that
are
accessible
to
health
professionals
in
different
places
at
different
times.
Through
this
health
professionals
will
be
able
to
easily
coordinate
and
understand
the
health
profile
of
their
patients
and
are
able
to
deliver
personalized
treatment.
Further,
the
use
of
mobile
phones
has
helped
in
increasing
the
access
to
basic
health
care
in
developing
countries
as
patients
are
able
to
communicate
their
symptoms
to
their
doctors
miles
away.
In
very
remote
settlement
in
Sierra
Leone,
local
individuals
have
not
only
been
trained
to
diagnose
simple
diseases
such
as
headaches,
stomach
aches
and
diarrhea
and
treat
them
but
also
they
have
been
equipped
with
mobile
phones
that
they
use
to
call
nearby
assigned
doctors
to
report
complicated
cases.
Besides
providing
employment,
this
has
made
it
easy
for
locals
to
access
basic
health
care
locally
rather
than
travel
miles
to
hospitals
to
report
simple
cases
like
headaches.
In
addition,
use
of
early
disease
detection
devises
such
as
Bio‐bricks
that
detect
the
presence
or
risk
of
a
chronic
disease
such
as
cancer
can
help
in
early
treatment
of
such
diseases.
Early
treatment
prevents
unnecessary
costs
of
treating
a
full‐blown
disease.
However,
though
medical
technology
has
prolonged,
saved
and
upgraded
lives,
because
of
the
expense
incurred
in
its
development
and
use,
it
has
resulted
in
the
worsening
of
the
social
divide
between
the
poor
and
rich.
Due
to
the
large
amounts
of
resources
such
as
money
being
invested
in
developing
medical
technology—for
instance,
scanning
machines
or
eye
operation
machines—the
expense
of
using
of
this
technology
has
proved
to
be
beyond
the
reach
of
many
desperate
poor
patients,
especially
in
developing
nations
such
as
Ethiopia.
For
example,
according
to
WHO,
36%
of
the
1.2%
blind
Africans
have
cataracts,
a
condition
that
can
easily
be
treated,
but
because
it
is
expensive
many
poor
Africans
remain
blind.
In
contrast,
the
rich
benefit
from
the
privilege
of
using
such
technology.
This
means
that
the
medical
advances
catering
only
for
the
wealthy
actually
widen
gap
between
the
rich
and
poor.
Advances
in
medical
technology
do
bring
benefits
to
society
but
seldom
do
they
bring
unequivocal
benefits,
in
part
because
the
expense
of
this
technology
widens
economic
gaps
and
in
part
because
ethical
issues
can
polarize
popular
opinion.
To
advance,
society
must
seek
ways
to
bridge
the
economic
divide
and
must
pursue
consensus
on
ethical
dilemmas.
82
Colegio
Claustro
Moderno
In
the
medicine
using
nowadays,
there
have
been
many
technological
advances
that
have
brought
both
benefits
and
harms
to
the
society.
As
an
example,
there
are
medical
advances
in
the
neonatal
field
like
the
high‐resolution
ultrasounds
and
the
genetic
testing,
which
reveal
diseases
and
genetic
alterations,
and
also
give
the
knowledge
about
the
future
treatment
to
control
them.
Likewise,
there
are
new
advances
in
medicines,
that
have
become
an
enormous
business
which
has
created
a
huge
economic
impact
leaving
many
developing
countries
without
any
chance
to
buy
some
drugs
that
could
save
several
lives,
(medications
such
as
the
one
for
the
HIV/
AIDS).
Despite
the
ethical
and
economic
problems
that
have
arisen
from
the
new
medical
practices,
it
is
notable
that
the
benefits
brought
to
society
have
been
immeasurable.
New
pills,
for
example,
have
given
a
better
lifestyle
to
people
infected
with
diseases
such
as
AIDS
/
HIV
which
with
these
medication
the
infected
people
are
able
to
live
in
a
society
successfully.
Also
new
medical
procedure
called
nuclear
magnetic
resonance,
which
can
produce
laser‐quality
plates
that
doctors
interpret
to
detect
malignant
tumors,
see
ligaments
(this
is
the
only
examination
that
gets
this
part
of
the
body)
and
makes
a
dynamic
study
of
some
body
parts.
Another
benefit
is
the
creation
of
new
forms
of
reproduction
that
allow
same‐sex
couples
or
with
fertility
problems,
to
be
able
to
reproduce
and
raise
a
family.
As
well
such
techniques
generate
a
lot
of
controversy
and
generate
many
ethical
and
ideologically
disagreements
between
the
societies
because
many
citizens
think
this
practice
is
unnatural
and
unacceptable.
Advances
on
the
birth
control
are
a
helpful
idea
when
it
comes
to
family
planning,
reducing
unwanted
pregnancies
and
stopping
transmission
of
sexually
transmitted
diseases.
Besides
it
also
causes
major
altercations
among
people
because
many
cultures
believe
that
the
human
being
is
unable
to
decide
the
possible
birth
of
another
human
being.
The
enormous
scientific
research,
sponsored
by
pharmaceutical
companies,
has
resulted
in
new
drugs
and
vaccines
that
allowed
the
treatment
and
prevention
of
many
diseases,
like
malaria,
tuberculosis,
some
cancers
etc.
all
these
have
greatly
benefited
the
world
community.
Also
the
treatment
of
tuberculosis,
autoimmune
83
diseases
and
cancer,
is
based
on
the
administration
of
chemical
medication,
which
nowadays
are
still
in
use,
every
time
in
a
more
effective
way.
Although
this
treatment
has
variable
side
effects,
it
is
notable
that
it
is
one
of
the
most
important
to
manage
and
fight
cancer.
Another
important
technological
advances,
is
the
gene
therapy
that
gives
successfully
results
to
achieve
the
cancer
cure.
In
many
third
world
countries,
such
as
Colombia,
there
are
not
many
investments
on
the
technological
field
and
on
the
research
field
as
well,
because
of
the
economical
problems
or
the
disadvantages
between
other
countries.
However,
the
most
important
Colombian
doctors
recognized
worldwide,
had
created
new
ways
to
develop
and
increase
the
healthcare
area,
without
any
kind
of
high
technology.
One
of
the
biggest
examples
is
the
creation
of
a
biologically
sound
method
of
care
for
all
newborns,
but
in
particular
for
premature
babies,
with
three
fundamental
components:
skin‐to‐skin
contact
with
both
of
the
fathers,
exclusive
breastfeeding
and
support
to
the
mother
infant
dyad.
These
are
three
simple
components
that
everybody
can
do
without
using
any
kind
of
equipment
or
high‐
class
technology.
This
method
is
known
as
“Kangaroo
Mother
Care”
(http://www.kangaroomothercare.com/index.htm)
and
was
developed
by
Colombian
hospitals
and
nowadays
it
is
used
in
most
of
the
USA
hospitals
with
significant
and
great
outcomes.
In
conclusion,
we
believe
that
technological
advances
bring
many
benefits
to
the
society
because
they
help
to
improve
the
life‐style
and
to
increase
the
lifetime
expectancy
of
a
society.
But,
technological
advances
start
to
harm
the
society
and
stop
giving
great
benefits
when
it
begins
to
be
the
only
thing
that
a
society
can
use
to
provide
a
human
right
as
important
as
healthcare
is.
Therefore,
we
truly
believe
that
a
society
always
have
to
posses
a
balance,
using
technological
advances
but
no
making
them
the
only
way
they
can
provide
health
care
to
their
citizens.
Ethical
dilemmas
arise
because
of
the
various
disagreements
that
people
have,
mostly,
because
of
the
different
religions
that
they
belong
to.
Most
of
the
ethical
dilemmas
that
appear
by
using
technological
advances
are
caused
because
of
the
violation
of
the
beliefs
and
thoughts
that
many
people
have,
since
many
of
them
think
that
these
kinds
of
84
practices
hurt
them.
However
we
think
there
is
another
big
ethical
problem
when
it
comes
to
the
use
of
technological
advances.
This
problem
is
environment.
We
cannot
only
focused
in
healthcare
or
in
the
cultural
area,
we
need
to
focus
on
the
fact
that
most
of
the
diseases
people
are
facing
nowadays
comes
and
born
in
the
environment
and
because
of
the
use
of
technologies
that
somehow
hurts
and
affect
the
environment,
making
that
many
diseases
appear
and
spread.
As
an
example,
global
warming
is
heating
us
harder
everyday,
causing
natural
disasters
or
making
easier
the
conditions
for
any
kind
of
disease
to
spread.
What
we
are
trying
to
say
with
this
is
that
global
warming,
that
is
the
responsible
for
the
entire
natural
disasters
and
the
extra
cold
or
hot
weather,
is
the
actual
responsible
of
the
"healthcare
crisis".
This
is
actually
the
only
dilemma,
in
our
opinion,
that
does
not
have
a
politic
solution
and
the
only
one
that
is
not
being
treated.
Garodia
International
Centre
for
Learning
Progress
in
medical
technology
bringing
benefits‐
we’ve
discovered
in
our
discussion
that
there’s
many
ethical
problems
we
face
due
to
advancements
in
technology
like
with
insurers
and
employers,
but
we
believe
that
one
would
come
across
such
problems
only
AFTER
implementing
and
running
the
system
for
some
time.
But
those
seem
like
small
prices
to
pay
for
the
numerous
benefits
one
reaps
from
these
advances.
The
faulty/
mutated
codon
for
sickle
cell
anaemia
on
the
human
DNA
was
discovered
using
such
technology,
helping
doctors
look
into
finding
cures
and
facilitating
further
research.
We
have
also
come
across
a
largely
computerized
system
for
storing
records
about
patients
on
an
online
database,
this
too
is
a
boon
brought
to
us
from
developing
technology.
This
we
come
to
realise
makes
it
easier
and
is
very
helpful
to
patients,
as
they
are
pushed
to
be
more
aware
of
their
health
and
take
better
care
of
themselves,
this
also
overcomes
time‐constraints
that
people
face
due
to
which
they
don’t
visit
doctors,
also
as
some
patients
find
it
easier
to
talk
to
a
doctor
online
sometimes
rather
than
a
face
to
face
conversation.
One
might
argue
the
doubt
people
have
in
this
system
due
to
cyber
crime,
but
as
crime
progresses
so
does
technology
to
battle
it.
Another
great
example
is
the
85
initiative
in
Ghana,
where
spurious
drugs
till
date
wreaked
havoc,
however
a
company
implemented
a
system
by
which
people
could
confirm
the
authenticity
of
a
drug
by
SMS‐
ing
a
code
found
the
drug.
Having
said
all
the
above
we
strongly
believe
that
the
system
should
be
implemented
rather
slowly
and
in
steps
as
not
everyone
is
techno‐savvy
and
not
everyone
appreciates
or
likes
technology
for
that
matter.
The
ethical
dilemmas
we
face
are
a
subset
of
the
first
question
as
like
most
things
it
has
its
pros
and
cons.
Technology
creates
ethical
problem
in
the
future
as
a
person’s
genotype
could
be
altered
with
our
complete
knowledge
and
understanding
of
our
genotype
and
it
could
very
well
become
a
business
for
everyone
would
choose
a
shortcut
to
happiness‐
everyone
would
want
good
features,
a
brain
like
Einstein’s
and
that
creates
the
problem
of
people
‘appearing’
dumb
just
because
their
parents
couldn’t
afford
the
Mega
or
Supreme
gene
package,
even
though
they
might
having
been
destined
to
be
smart
people,
in
the
sense
that
others
have
it
all
and
have
surpassed
them
by
usage
of
technology.
Johannes
Kepler
Grammar
School
There
is
no
limit
to
how
much
the
advances
in
technology
can
bring
benefit
to
society
because
there
always
is
and
always
will
be
room
for
improvement.
However
much
the
technology
advances,
people
keep
craving
for
new
methods
and
devices.
And
when
the
desired
method
or
device
is
developed,
people
keep
on
craving,
now
for
enhanced
efficiency
thereof.
The
main
reason
for
introducing
modern
technologies,
such
as
basic
health
check‐up
via
the
Internet,
is
not
only
improvement
of
the
level
of
healthcare,
but
also
the
improvement
and
extension
of
provision
of
healthcare
to
more
people.
If
the
efficiency
of
the
system
is
improved
and
the
actual
treatment
focuses
more
on
people
with
more
serious
conditions
rather
than
people
with
common
cold,
the
society
as
a
whole
will
benefit
from
this
both
from
the
perspective
of
health
and
from
the
perspective
of
finances.
We
need
some
kind
of
filtering
to
sort
out
the
“visitors”
from
the
real
patients
and
if
everyone
had
to
undergo
an
initial
check‐up
at
home,
the
“visitors”
who
only
wanted
to
have
a
nice
and
long
chat
with
their
physician
would
not
burden
the
already
very
busy
physicians.
86
Moreover,
in
the
fast‐moving
modern
life,
many
people
avoid
going
to
the
doctor
unless
they
feel
that
something
is
very
wrong
with
them.
The
reason
is
that
it
is
rather
time
consuming.
Therefore,
if
people
could
do
the
check‐up
themselves
at
home,
more
of
them
would
be
willing
to
undergo
it,
thus
detecting
a
possible
condition
at
an
early
stage.
Thanks
to
that,
they
could
avoid
any
further
trouble
and
save
evitable
health
expenditure.
Even
if
we
achieve
a
great
improvement
on
the
field
of
treatment
technologies,
we
will
not
be
able
to
efficaciously
distribute
them
without
a
good
system
and
infrastructure.
Metaphorically
speaking,
we
cannot
build
a
beautiful
castle
on
a
crumbling
rock.
That
is
why
we
ought
to
focus
on
both
types
of
technological
improvement
in
healthcare.
The
improvement
in
the
actual
healthcare
technologies
are
essential
as
much
as
the
improvement
of
the
system.
There
are
many
possible
projects
currently
being
researched,
including
usage
of
genetic
information,
and
most
of
them
have
their
pros
and
cons.
It
is
necessary
to
limit
the
cons
to
the
very
minimum
and
a
secure
system
must
be
the
first
step.
If
the
new
technologies
are
not
misused,
they
should
bring
benefit
in
most
cases.
It
is
only
natural
that
new
technologies
come
hand
in
hand
with
fear.
Sometimes
it
might
be
unreasonable
and
caused
only
by
the
lack
of
knowledge
about
the
new
modus
operandi.
Nevertheless,
there
is
no
doubt
that
new
methods
and
discoveries
in
the
field
of
medical
science
can
be
misused
for
criminal
and
business
purposes.
Therefore,
we
have
to
be
extremely
careful
while
introducing
the
new
methods.
For
example:
it
could
be
very
helpful
and
it
could
increase
efficiency
in
health
care
if
we
used
genetic
mapping
when
making
diagnoses
and
deciding
what
treatment
to
use.
On
the
other
hand,
the
information
about
genetic
code
and
predicted
life
expectancy
can
be
easily
misused
by,
for
instance,
insurance
companies
wanting
to
know
their
risks
when
deciding
whether
to
insure
somebody
or
not.
That
would
mean
that
people
and
patients
would
no
longer
be
equal
one
to
another:
the
information
about
your
genetical
predisposition
would
decide
whether
you
would
pay
a
standard
rate,
or
whether
you
would
pay
an
enormous
fortune.
We
also
have
to
take
into
consideration
whether
or
not
to
tell
a
patient
the
information
87
about
his
or
her
predisposition
to
diseases
based
on
genetical
screening.
Of
course
we
could
leave
it
on
each
person’s
own
decision,
but
the
person,
while
deciding
whether
he
wants
to
be
informed
about
his
predicted
disease,
is
making
an
uninformed
decision.
He
or
she
does
not
know
yet
what
to
expect
and
people
are
usually
more
likely
to
expect
an
auspicious
diagnosis.
When
a
doctor
informs
the
patient
that
he
or
she
is
in
danger
of
having
a
serious
medical
condition,
it
means
a
huge
stress
to
the
patient.
This
could
endanger
the
patient’s
health
even
more
than
the
actual
diagnosis
and
it
could
even
increase
the
probability
of
the
prediction
coming
true.
Another
tricky
factor
of
such
a
procedure
as
genetic
screening
is
that
it
bears
the
risk
of
an
error.
The
best
solution
to
this
problem
might
be
that
the
doctor
would
perform
the
test,
recommend
some
prophylaxis
and
appropriate
life
style
if
necessary,
but
would
not
tell
the
patient
the
exact
results.
Montgomery
Bell
Academy
According
to
Great
Britain’s
National
Institute
for
Health
and
Clinical
Excellence,
one
year
of
“quality”
life
is
worth
£30,000.
Of
course,
that
figure
is
only
a
guideline.
The
organization,
which
assesses
the
efficacy
and
efficiency
of
new
medical
techniques
in
England
and
Wales,
uses
the
number
as
a
general
benchmark
of
cost‐efficiency
for
expensive
treatments.
But
it
does
illuminate
a
rather
serious
ethical
question
which
will
inevitably
arise
in
the
discussion
of
healthcare:
the
clash
between
human
sensibility
and
economic
reality.
In
the
business
of
medicine,
money
is
equivalent
to
life—addressing
one
will
invariably
affect
the
other.
We
cannot
escape
this
fact
if
we
hope
to
improve
the
quality
of
healthcare
in
any
system.
The
idea
that
monetary
concerns
can
be
used
to
determine
life
and
death
seems,
at
first
glance,
off‐putting.
From
an
emotional
standpoint,
we
consider
the
life
of
a
loved
one
as
more
valuable
than
any
amount
of
material
possessions.
Almost
any
expense
seems
justified
in
such
a
context.
88
Modern
technological
advances
allow
human
beings
to
prolong
life
much
further
than
we
had
previously
imagined
possible.
Techniques
like
late‐life
dialysis
and
organ
transplants
are
becoming
increasingly
prevalent
in
developed
countries.
At
the
same
time,
cutting‐
edge
drugs
are
also
pushing
the
envelope.
The
drug
Sutent,
which
slows
the
growth
of
certain
types
of
tumors,
can
cost
up
to
$54,000
per
six
months
of
treatment,
and
potentially
six
months
of
additional
life.
As
research
techniques
become
even
more
complex
(and
tailored
to
individual
genetic
profiles),
the
costs
of
advanced
late‐life
treatments
will
only
soar
even
further.
An
outside
authority’s
refusal
to
provide
potentially
life‐saving
health
services
appears
nothing
short
of
an
assault
against
individual
liberty
in
a
society
that
values
free
choice.
Rhetoric
used
in
the
recent
in
the
United
States’
recent
healthcare
debate
reflected
this
aversion
to
any
approach
that
would
“ration”
care
based
on
cost.
Barack
Obama
repeatedly
urged
supporters
of
the
bill
not
to
use
the
term
“rationing”
for
fear
of
popular
backlash.
But
despite
the
President’s
best
efforts
to
avoid
the
issue,
opponents
of
the
reform
package
quickly
seized
upon
the
topic
as
a
political
focal
point.
A
May
1,
2009
editorial
in
the
Washington
Times
succinctly
expressed
the
sentiment
of
many
fearful
conservatives,
boldly
protesting
to
the
government:
“Our
health
is
not
a
commodity
to
be
brokered.”
The
economic
side
of
the
argument
tells
a
different
story.
Costly
medical
procedures
for
some
deplete
funds
and
increase
insurance
premiums
across
the
board,
hurting
the
ability
of
other
citizens
to
receive
the
care
they
need.
A
study
published
in
the
journal
Health
Affairs
estimated
that
almost
one‐quarter
of
all
funds
from
the
United
States’
Medicare
program
(which
services
the
elderly)
go
toward
care
in
the
last
year
of
life.
Now,
many
are
starting
to
question
whether
this
allotment
is
the
most
efficient
use
of
money.
Groups
such
as
NICE
currently
weight
the
“quality”
of
life
for
the
patient
as
part
of
its
cost‐efficiency
analyses,
as
a
year
of
life
for
a
younger,
healthier
patient
may
simply
be
more
“valuable”
than
a
year
for
an
80‐year
old
cancer
patient.
And
at
this
point,
the
issue
becomes
one
not
only
of
practicality
but
also
of
ethics.
Extending
the
life
of
one
person,
in
a
health
system
this
interconnected,
will
indirectly
jeopardize
the
lives
of
many
others.
The
same
logic
can
be
extrapolated
to
a
global
context,
raising
an
even
more
troubling
dilemma.
Contemporary
skeptic
Peter
Unger
once
proposed
that
a
charitable
donation
of
approximately
$200
could
save
the
life
of
a
sickly
child
in
an
impoverished
nation.
He
89
argued
that,
if
this
figure
is
accurate,
spending
the
same
amount
of
money
on
anything
but
the
most
essential
expense
would
be
morally
indefensible
since
a
human
death
could
have
been
prevented.
In
this
light,
the
NICE
benchmark
of
£30,000
for
one
year
appears
preposterously
large.
Although
we
claim
to
believe
that
“all
men
are
created
equal”
in
our
democratic
society,
Unger’s
analysis
suggests
that
we
value
our
own
lives
far
more
than
those
of
others.
This
model
is
far
from
perfect;
it
would
be
unreasonable
to
generalize
all
new
medical
technology
as
onerous
and
inefficient.
There
is
significant
potential
for
new
developments
both
to
reduce
costs
and
save
lives
if
we
focus
on
the
diseases
and
conditions
that
pose
a
more
immediate
threat
to
people
in
both
developed
and
developing
countries.
For
instance,
more
significant
research
needs
to
be
conducted
to
develop
new
techniques
to
tackle
diseases
such
as
HIV/AIDS
and
malaria.
In
addition,
more
indirect
applications
of
technology
(such
as
electronic
records)
may
have
potential
benefits
if
applied
in
the
correct
context.
The
dilemma
posed
by
Unger
does,
however,
seriously
challenge
our
conceptions
of
healthcare
and
morality.
Advances
in
technology
have
greatly
increased
the
quality
and
length
of
life
for
billions,
but
the
most
recently
developed
treatments
may
be
inadvertently
precipitating
a
health
crisis.
The
two
driving
strands
of
the
healthcare
debate,
human
and
economic,
are
on
a
crash
course
with
one
another,
and
the
process
of
reconciling
them
will
require
a
serious
reexamination
of
our
society’s
ethical
standards.
Only
then
can
we
build
a
more
efficient,
and
egalitarian,
system.
Nada
High
School
We
human
beings
have
struggled
for
many
years
to
live
longer
without
suffering
from
diseases
and
other
handicaps.
Our
efforts
have
borne
fruit
in
many
ways.
The
life
expectancy
in
many
countries,
at
least
in
developed
countries
is
much
longer
than
it
used
to
be.
Most
people
don't
have
to
suffer
from
serious
illnesses
because
medical
technology
has
advanced.
Nowadays
people
can
even
prevent
some
diseases
such
as
flu
and
smallpox
by
vaccination.
And
now,
we
are
trying
to
play
God.
We
are
trying
to
control
people's
birth
by
abortion,
people's
ability
by
genetic
manipulation,
people's
life
span
by
organ
90
transplantation,
and
people's
death
by
assisted
suicide.
Is
it
ethical
to
do
such
things?
Aren't
these
things
beyond
the
discipline
of
science?
Before
we
get
further
into
ethical
problems,
we
would
like
to
focus
on
practical
issues
that
we
face
―
economic
problems,
problems
of
cost
that
we
have
to
pay.
This
is
a
huge
problem
that
lies
not
only
in
first
world
economies
such
as
the
United
States,
Europe
and
Japan,
but
also
or
even
bigger
in
front
of
developing
countries.
There
is
a
concern
that
it
costs
too
much
to
introduce
the
latest
system
based
on
the
latest
technology.
However,
the
most
important
point
that
Dr.
Balser
pointed
out
was
how
important
it
is
for
healthcare
to
move
from
a
reactive
to
a
proactive,
and
to
a
preventative
science.
It
is
inevitable
to
spend
a
lot
of
money
when
we
completely
change
our
system,
but
if
we
can
utilize
technology
in
any
way
to
facilitate
this
transformation,
it
must
be
encouraged
and
embraced.
It
is
obvious
that
medical
technology
will
bring
many
advantages.
Actually
there
doesn't
seem
to
be
any
demerits
in
the
improvement
of
the
technology,
provided
that
we
can
guarantee
its
security
issues.
However,
we
have
to
consider
our
behavior.
These
actions
are
exactly
those
of
God.
So
far,
we
human
beings
have
improved
ourselves
by
making
progress
in
our
technology,
starting
from
discovering
and
using
fire.
In
the
future
people
will
have
the
ability
of
gods.
What
will
happen
then?
We
cannot
imagine,
we
cannot
estimate.
We
cannot
illustrate
the
blueprint
of
ourselves
in
the
future!
We,
as
Japanese,
who
don't
believe
in
any
specific
religion,
think
that
the
lack
of
imagination
in
our
future
is
the
reason
why
we
refuse
to
continue
with
those
advance.
We
feel
that
this
ethical
problem
is
somewhat
similar
to
the
environmental
problem.
We
have
improved
technology
just
for
our
convenient
and
comfortable
lives.
As
a
result,
we
are
now
the
ruler
of
this
Earth,
except
we
are
not
caring
about
the
health
of
the
planet.
The
crises
of
the
Earth
directly
connect
to
the
well‐being
of
the
human
being.
We
are
concerned
that
the
same
thing
might
happen
in
this
ethical
issue.
Healthcare
ethics
are
surely
one
of
the
most
important
problems
we
should
solve.
Even
if
we
have
the
technology
to
live
forever,
we
have
to
think
it
over
as
long
as
we
can
think
morally.
What
makes
it
more
difficult
is
that
this
ethics
differs
fairly
with
individuals,
concerning
their
societies,
religions,
cultures
and
others.
This
means
that
it
is
almost
impossible
to
have
a
common
view
all
over
the
world
about
what
is
right
and
what
is
91
wrong.
For
a
better
solution,
we
think
that
we
should
improve
not
only
our
physical
techniques
to
live
long,
but
also
our
techniques
to
control
our
minds.
Raffles
Institution
Yes,
we
do
agree
with
the
fact
that
medical
technology
does
indeed
bring
about
benefits
to
society.
Just
taking
a
look
at
the
everyday
news
would
we
be
able
to
see
the
various
benefits
that
medicine
has
endowed
upon
us.
For
example,
the
lives
of
cancer
patients
are
being
extended
by
chemotherapy.
In
addition,
hundreds
of
thousands
of
lives
of
innocent
children
are
saved
by
vaccination
annually.
These
benefits
from
the
advances
in
healthcare
come
both
in
terms
of
cost
and
efficiency.
Technological
advances
can
improve
both
the
efficacy
of
treatment
of
diseases
and
the
infrastructure
on
which
hospitals/healthcare
systems
operate.
Both
ways,
technological
advances
reduce
the
cost
associated
with
these
processes.
Firstly,
due
to
advances
in
technology,
the
production
capacity
for
OTC
medicines
have
greatly
improved
over
the
years.
In
addition,
such
advances
have
also
resulted
in
more
blockbuster
drugs
hitting
the
market
covering
a
greater
variety
of
disease
conditions
than
ever.
As
such,
more
diseases
can
be
treated
and
more
lives
will
be
saved.
Furthermore,
these
advances
has
also
allowed
for
the
introduction
of
telemedicine
to
the
masses.
This
is
due
to
Moore's
Law
where
the
price
of
technology
will
decrease
over
time.
As
such,
even
the
poorer
developing
countries
are
starting
to
get
access
to
internet
infrastructure,
where
physicians
can
employ
mobile
technologies
to
circumvent
the
issue
of
distance.
Secondly,
with
the
advancement
in
technology,
increasingly,
hospitals
around
the
world
are
turning
to
e‐filing
systems
that
are
hosted
in
the
'cloud',
where
a
centralised
database
of
the
patients
in
a
nation
can
be
compiled
and
accessed
by
different
doctors
treating
the
same
patient,
reducing
the
red
tape
when
facing
critical
decisions.
In
addition,
this
electronic
infrastructure
will
enable
the
doctors
to
track
a
patient's
medical
history
and
address
problems
that
might
crop
up
with
the
current
prescription.
However,
every
benefit
comes
with
a
cost,
and
in
the
case
of
technological
advance,
that
cost
is
that
of
ethical
dilemmas.
With
the
introduction
of
these
new
technologies,
problems
Man
never
had
to
face
are
now
more
apparent
than
ever.
For
example,
the
Human
Genome
Project
(HGP),
a
tremendous
watershed
project
in
the
history
of
science,
brought
about
the
92
opportunity
for
scientists
to
sequence
and
map
the
human
genome
and
what/how
each
gene
codes
for.
While
the
benefits
of
such
a
project
are
apparent,
on
closer
inspection,
a
myriad
of
consequences
arise
‐
ethical
dilemmas
previously
inexistent
are
now
problems
man
has
to
deal
with.
For
example,
this
genetic
information,
for
all
its
benefits,
may
result
in
discrimination
against
those
deemed
to
possess
"inferior"
genes.
Case
in
point:
Insurance
companies
would
more
likely
than
not
hike
up
insurance
premiums
for
people
genetically
predisposed
to
chronic
diseases
such
as
diabetes,
hypertension
and
cancer,
etc.
From
their
point
of
view,
it
is
easy
to
understand
why
such
corporations
would
take
such
measures
‐
it's
simply
good
business.
Charging
potential
"high‐risk"
customers
normal
rates
would
be
a
massive
risk
on
their
part
‐
due
to
the
incredible
cost
that
insurance
corporations
stand
to
pay
should
their
"high‐risk"
customers
succumb
to
these
diseases.
This
discrimination
against
those
deemed
"genetically
inferior"
is
not
just
limited
to
insurance
companies.
For
example,
should
the
Government
increase
the
amount
of
subsidies
a
person
who
is
genetically
disadvantaged
receives?
Would
it
discriminate
against
such
a
person
by
turning
a
blind
eye
to
his
"condition"
‐
given
that
he
is
not
actually
suffering
from
an
actual
tangible
disease,
but
rather
just
a
predisposition
to
be
affected
by
it?
The
same
ethical
dilemmas
are
extended
to
the
corporate
realm,
whereby
potential
job
candidates
may
be
judged
by
their
genes
rather
than
on
merit
‐
for
example
during
job
screenings,
would
corporations
discriminate
against
"genetically
disadvantaged"
individuals
in
order
to
save
cost
on
healthcare
expenditure,
in
addition
to
boosting
company
productivity?
Indeed,
the
battle
between
good
business
and
bad
ethics
is
taken
to
a
whole
new
level
with
the
introduction
of
the
HGP,
leaving
man
in
uncharted
territory
in
terms
of
ethical
dilemmas.
Secondly,
technology
has
enabled
the
detection
of
life
at
an
early
stage
and
made
it
possible
for
a
fetus
to
survive
outside
the
womb
for
a
longer
period
of
time
than
it
was
possible
in
the
past.
This
has
resulted
in
the
question
of
when
life
begins.
Does
life
begin
at
birth?
Or
does
it
begin
at
fertilisation?
This
very
fundamental
question
will
affect
how
governments
decide
on
whether
abortion
is
legal
or
not.
At
what
age
would
killing
a
person
constitute
murder?
What
would
be
the
definition
of
a
person
in
such
a
context?
Indeed,
the
progression
of
science
to
such
an
extent
has
thrown
up
a
whole
host
of
questions
and
dilemmas
man
previously
had
no
need
to
contend
with,
fanning
the
fire
for
controversy
and
conflict.
93
Coming
to
a
close,
this
essay
has
explored
how
technology
is
able
to
both
bring
about
healthcare
benefits
as
well
as
ethical
dilemmas
to
society.
Indeed,
as
mankind
uncovers
more
about
the
world
around
him
in
the
pursuit
of
science,
he
will
indubitably
face
more
of
such
ethical
challenges
and
dilemmas.
The
onus
is
then
on
society
to
come
to
a
consensus
about
such
issues,
ensuring
that
technological
advance
fulfils
its
promise
of
bringing
about
an
overall
benefit
to
society
as
a
whole
without
disadvantaging
or
neglecting
select
groups
of
people.
These
dilemmas
that
man
is
currently
facing
are
just
a
taste
of
what
is
to
come,
for
indeed,
the
journey
has
just
begun.
Shiyan
Cooperation
High
School
As
the
high
technology
developed
in
the
past
century,
health
care
became
more
and
more
noticeable
than
ever
before.
Based
on
this
fact
we
have
developed
the
following
ideas
about
the
future
of
health
care.
First,
China
is
facing
a
serious
problem
now‐‐‐‐
the
immensity
of
the
population.
Actually
the
earth
is
growing
old,
so
there
will
be
more
and
more
old
people.
But
we
haven’t
got
enough
human
resources
to
look
after
the
elder.
In
the
developed
country
such
as
Japan,
people
have
already
manufactured
a
kind
of
nursing
robot.
They
are
not
only
convenient
but
also
very
popular
with
disabled
people
or
older
ones.
Lots
of
old
people
have
lost
the
ability
of
running,
walking
and
even
standing.
On
these
occasions,
nursing
robots
can
fetch
the
medicine
and
water.
Now,
lots
of
countries
are
trying
to
learn
this
skill,
but
obviously
we
cannot
compete
with
them.
Maybe
it
will
take
a
couple
of
years
or
longer.
We
have
to
admit
that
Japanese
are
really
talented
at
inventing
such
marvelous
genius
machines,
for
it
is
the
first
country
which
have
the
ability
to
help
people
solve
the
problem
of
human
resources.
Secondly,
we
also
hope
there
will
be
an
‘Organ
Storing
Hospital’
where
transplanting
organs
will
be
available.
Of
course
it
depends
on
the
developments
of
organ–transplanting
skills.
Maybe
the
Organ–Donating
Bank
will
be
wildly
used.
In
that
case,
we
will
deposit
our
body
parts
or
useful
organs
to
the
ill
people.
A
donated
cornea
can
make
a
blind
see
how
beautiful
the
world
is!
A
donated
kidney
can
wake
a
sick
person’s
whole
life
up.
Some
donated
marrow
will
cure
lots
of
people
who
are
suffering
from
leukemia.
94
All
in
all,
if
each
of
us
is
willing
to
donate
any
useful
part
of
our
body,
then
we’re
building
up
the
hope
for
the
miserable
patients
living
in
the
darkness.
Whatever
technique
will
be.
How
remarkable
the
technique
will
be,
we
do
believe,
that
love
and
understanding
could
be
the
most
efficient
elements
to
cure
those
poor
people
and
make
a
better
health
care.
We
must
care
more
and
do
more
to
make
the
world
a
better
place!
All
health
care
workers
make
ethical
judgments
everyday
of
their
working
lives:
some
of
these
are
obvious
and
dramatic
like
euthanasia;
others
draw
upon
deep
seated
and
often
unexplored
personal
and
communal
values.
The
study
of
ethics
is
vital
for
health
care
professionals
and
is
recognised
as
an
invaluable
discipline
in
most
professional
training
curricula.
These
courses
in
health
care
ethics
are
important
for
all
health
care
workers
‐
not
just
doctors
and
nurses,
but
managers,
administrators,
educators
and
paramedics.
To
talk
about
ethics
in
health
care,
let's
take
this
as
an
example.
A
poor
man
is
very
sick,
you
are
the
doctor.
Will
you
help
him
or
not?
The
first
answer
is
yes,
but
you
will
get
no
money,
in
the
meantime,
it
showed
you
are
an
extremely
kind
person.
On
the
other
hand,
the
answer
is
no,
you
think
no
money,
no
life
is
the
truth
in
the
society.
Ethics
begins
with
individuals’
behaviour.
We
are
talking
about
health
care,
but
we've
never
thought
lots
of
people
are
afraid
of
helping
others.
One
of
my
mother's
friends
was
driving
a
car,
she
saw
an
old
woman
knocked
down
by
a
car
and
she
was
struggling.
She
drove
the
lady
to
the
hospital.
When
the
lady
felt
much
better,
the
doctor
asked
who
knocked
her
down,
to
my
mother's
friend's
surprise,
the
lady
pointed
at
her.
She
was
asked
to
pay
the
bill
for
being
helpful;
this
is
an
ethical
problem
at
the
basic
level
but
still
very
important
to
consider.
Technology
will
bring
more
problems
of
ethics.
95
Winchester
College
Technological
advance
has
the
capacity
to
bring
long‐term
benefits
to
society.
These
advantages
include:
efficiency,
as
computer
systems
can
conflate
all
the
data
of
a
patient
on
one
screen
to
ensure
an
optimal
diagnosis;
more
personalised
medicine,
as
gene
mapping
caters
for
the
individual
on
a
detailed
basis.
On
the
other
hand,
there
are
as
many
disadvantages.
Over‐reliance
on
technology
can
lead
to
excessive
and
unnecessary
administration
of
pills
at
the
first
sign
of
a
malady.
For
example,
when
one
has
the
flu,
one
might
instantly
resort
to
taking
a
pill,
instead
of
simply
lying
down
and
keeping
hydrated.
Technology
has
the
ability
to
take
over
our
lives,
and
transform
from
a
luxury
to
a
necessity.
In
medical
applications,
this
takes
the
form
of
taking
a
pill
at
every
opportunity
instead
of
fighting
it
out
with
one’s
immune
system.
Regarding
advances
in
organisation
of
information,
a
computerised
database
seems
like
a
beneficial
idea:
it
saves
cost
and
time.
However,
when
we
examine
the
implementation
of
a
computerised
system
in
a
third
world
country,
we
realise
it
is
less
compatible
because
of
unexpected
power
outages,
slow
internet,
and
in
some
cases,
complete
absence
of
internet
facilities.
This
means
that
we
have
to
take
gradual
steps
to
ensure
such
communities
truly
benefit
from
such
technological
advances,
such
as
pushing
for
governments
to
redistribute
electricity
to
hospitals.
Dr.
Balser
introduced
the
idea
of
posting
patients’
prescriptions
on
an
online
database.
This
promotes
a
more
efficient
use
of
time
for
the
doctor
and
also
ensures
that
the
patient
can
access
the
name
of
their
medication
at
any
time.
For
example,
if
a
patient
were
to
be
involved
in
a
car
accident,
the
medics
would
know
what
drug
the
patient
is
allergic
to
by
accessing
the
patients’
prescription
page
on
their
phone.
Patients
may
not
favour
the
system
because
they
may
feel
that
they
are
being
ordered
around
by
a
robot,
and
are
not
being
given
the
‘personalised’
care
that
the
US
system
strives
to
accomplish.
With
the
introduction
of
seemingly
beneficial
systems,
ethical
dilemmas
also
appear.
One
example
of
this
can
be
seen
in
gene
mapping.
Personalised
care
will
be
more
widely
implemented
because
medicine
can
be
tailored
to
each
individual’s
genes.
The
ethical
disadvantage
occurs
when
insurance
companies
obtain
this
information
and
use
it
unfairly
to
discriminate
between
those
who
are
more
likely
to
suffer
a
fatal
allergic
attack
(say,
in
life
insurance)
and
those
who
are
exempt
from
allergies.
Abortion
is
an
issue
of
great
96
controversy.
Abortions
in
the
UK
were
made
legal
on
the
condition
that
they
were
not
made
after
a
certain
number
of
weeks
into
the
development
of
the
foetus.
However,
this
law
is
decades
old,
and
with
the
help
of
new
technology,
is
has
been
possible
to
deliver
a
baby
at
an
increasingly
early
stage
in
its
development.
Should
the
point
from
which
no
abortions
can
be
made,
be
moved
earlier?
Generic
drug
technology
has
progressed
in
the
past
few
years,
allowing
for
exact
copies
of
the
drugs
created
by
large
pharmaceutical
companies,
to
be
produced
in
substantial
amounts
by
Indian
generic
drug
companies.
The
hospitals
cannot
afford
to
pay
full
retails
price
for
all
their
drugs,
and
so
during
the
past
two
decades,
we
have
seen
some
medical
initiatives
procuring
their
drugs
from
the
generic
production
companies
in
India.
A
balance
should
be
struck
between
pharmaceutical
companies
and
medical
initiatives.
The
hospitals
and
clinics
need
to
be
able
to
purchase
drugs
relatively
cheaply
for
their
clients
and
so
should
not
be
charged
the
full
retail
price.
However,
we
cannot
drive
down
the
prices
of
drugs
too
much
because
pharmaceutical
companies
still
need
enough
profit
to
function,
and
so
they
need
an
incentive
to
discover
new
and
improved
medicines.
There
is
only
one
progressive
way
to
view
advantage
in
technological
healthcare:
to
realise
that
with
the
invention
of
new
technologies,
there
will
be
ethical
compromises
that
will
have
to
be
made.
97
Day
6,
March
31
The
day
began
with
Courage
Matiza
and
Nash
Mepukori’s
presentation
on
healthcare
in
rural
and
impoverished
areas.
Students
then
convened
in
the
library
at
MBA
to
begin
their
deliberations
on
the
Symposium
Challenge.
Each
school
was
to
draft
its
own
response
to
the
Challenge,
and
then
work
with
the
others
to
formulate
a
common
response.
Each
accompanying
teacher
gave
his
or
her
own
thoughts
on
the
process,
and
the
key
points
for
students
to
bear
in
mind.
The
discussion
was
then
facilitated
by
Mr
Keith
Pusey
of
Winchester
College.
Although
the
online
learning
had
necessarily
focused
on
topics
by
month,
the
students
embraced
a
holistic
comprehensive
vision
of
healthcare,
and
were
keen
to
examine
how
the
various
threads
they
had
examined
all
week
could
be
woven
together
to
create
an
improved
fabric
of
healthcare.
There
were
differing
emphases
in
the
debate
–
as
can
be
seen
in
the
individual
conclusions
–
as
well
as
much
common
ground.
Discussions
broke
off
for
the
final
presentation
of
the
week,
from
Mr
Paul
Zintl,
of
Partners
in
Health.
Students
had
read
of
the
work
in
Haiti
of
the
founder
of
PiH,
Dr
Paul
Farmer,
and
this
was
a
fitting
and
moving
way
to
bring
the
week
towards
its
climax.
Mr
Zintl
spoke
of
the
need
to
fit
hospitals
and
healthcare
within
a
“set
of
institutions”,
underlining
the
need
for
a
comprehensive
approach
to
health.
He
reminded
the
audience
of
the
social
complexity
of
healthcare
solutions
(for
example
TB
sufferers
might
not
take
a
full
course
of
medication
for
a
variety
of
reasons),
and
thus
that
a
cultural
awareness
was
critical
when
international
or
foreign
institutions
attempted
to
treat
problems
from
a
theoretical
or
geographical
distance.
Finally,
he
was
optimistic
regarding
the
role
of
innovation
in
healthcare,
with
comparatively
(for
developed
countries)
low‐tech
solutions
such
as
text
messaging
and
an
online
database
of
best
practice
being
able
to
deliver
markedly
improved
healthcare
outcomes
for
impoverished
and
rural
communities.
He
stressed
the
importance
of
community
health
workers
in
both
delivering
effective
treatment
and
improving
educational
outcomes
(thus
aiding
future
prevention).
98
Building
on
Mr
Zintl’s
comments,
students
returned
to
work
towards
the
final
Symposium
Accord.
This
is
the
common
statement
to
which
they
could
all
agree.
After
this
process,
all
MBIS
participants
returned
to
Pfeffer
Lecture
Hall
to
hear
the
individual
school
responses;
the
Symposium
Accord
was
read
to
the
participants
at
the
conclusion
of
the
evening’s
Closing
Banquet.
99
The
Symposium
Challenge
In
a
dynamic
world
of
inequality
and
cultural
diversity,
the
issue
of
healthcare
occupies
a
unique
place.
The
challenge
of
the
MBIS
is
to
examine
current
and
future
healthcare
approaches,
to
determine
what
practical
steps
our
countries
can
and
should
take
to
optimize
healthcare
provision
for
our
populations,
bearing
in
mind
varying
social,
cultural,
and
economic
pressures.
African
Leadership
Academy
The
steps
to
optimize
healthcare
must
ultimately
improve
efficiency
of
healthcare
delivery,
reduce
cost
of
expenditure
on
healthcare
and
have
a
great
impact
on
community
health.
These
steps
can
only
be
achieved
through
strong
collaboration
between
the
various
stakeholders
in
both
national
and
international
healthcare
despite
the
fact
each
stakeholder
plays
a
specific
and
varied
role
in
the
community.
Government
•
Standardize
healthcare
systems
by
creating
a
framework
common
to
all
healthcare
providers
and
health
organizations
but
one
that
does
not
restrict
personalized
care.
•
Offer
incentives
for
innovation
to
encourage
individual
improvement
within
countries,
hospitals
and
organizations.
•
Lead
in
provision
of
efficient
and
modern
infrastructure
ranging
from
telecommunications
to
running
water
to
enhance
efficiency
in
the
healthcare
system.
•
Ensure
strategic,
equitable
resource
allocation
in
individual
countries
taking
into
account
the
wealth
disparities
within
the
countries.
•
Develop
policies
with
notion
of
global
health
in
mind.
•
Educate
the
masses
at
grassroots
level
in
an
attempt
to
shift
from
remedial
care
to
preventative
care.
•
Collaborate
with
external
organizations
with
an
aim
to
acquire
knowledge,
skill
and
technology
to
better
healthcare
in
their
individual
countries.
•
Empower
the
media
to
address
issues
of
healthy
living
and
inform
the
public
of
worrying
health‐threatening
trends
such
as
diabetes
and
obesity.
100
Private
institutions
(private
hospitals,
pharmaceutical
companies
etc)
•
Optimize
opportunities
presented
by
the
government
with
an
emphasis
on
social
benefits
rather
than
benefits.
•
Act
as
checks
and
balances
for
the
government
to
increase
accountability.
•
Create
policies
that
allow
an
easy
process
of
acquiring
health
insurance
and
sustaining
it.
•
Provide
better
working
conditions
to
reduce
brain
drain
of
health
workers
and
engineers.
Citizens
•
Personal
responsibility
for
health
and
wellness
in
light
of
the
fact
that
40%
of
health
wellness
is
determined
by
individual
behavior.
•
Develop
a
proactive
and
compassionate
attitude
with
regard
to
the
sanctity
of
human
life.
Individuals
need
to
be
in
a
position
to
invest
their
time,
money
and
thought
into
bettering
community
health
by
for
example
volunteering
in
hospitals
and
clinics
post
retiring.
•
Take
advantage
of
opportunities
presented
by
the
government
and
private
institutions
for
example
health
fares
and
enrichment
programs
and
internships.
International
organizations
•
Facilitate
the
transfer
of
skill
and
knowledge
from
one
region
to
another.
•
Lead
in
standardization
of
health
systems
and
practices.
•
Provide
an
avenue
for
dialogue
on,
for
example,
systems
of
funding
from
the
first
world
to
the
second
and
third
worlds.
•
Advocate
for
global
awareness
for
the
environment
and
means
to
manipulate
the
environment
for
betterment
of
healthcare
outcomes.
•
Encourage
healthcare
research
through
provision
of
funds
and
support
of
individual
governments
and
NGOs.
Colegio
Claustro
Moderno
Colombia
being
one
of
the
richer
countries
in
nature
and
culture
needs
to
use
and
have
in
mind
the
importance
of
our
role
on
the
mission
of
achieving
the
perfect
global
healthcare.
101
Every
student
that
is
participating
on
the
International
Healthcare
Symposium,
are
the
agents
of
change
and
are
the
responsible
for
acting
in
a
good
way
in
our
communities
and
in
the
world.
With
this
hopefully,
we
will
make
a
positive
change
on
the
efficacy
of
the
healthcare
system.
We
strongly
believe,
that
governments
should
focus
their
help
on
the
betterment
and
the
implementation
of
the
information
of
prevention
of
diseases
that
a
population
can
suffer
from.
We
talk
about
this,
because
we
think
that
the
doctor’s
behavior
is
really
important
but
what
is
a
lot
more
crucial
is
the
patient’s
behavior.
But,
never
the
less,
there
are
a
lot
of
issues
that
we
need
to
consider
when
it
comes
to
the
healthcare
field,
in
which
we
need
to
solve
problems
like
scarce
resources,
environment,
education,
etc.
where
why
we
would
like
to
give
a
“solution”
for
all
this
kind
of
situations.
In
Colombia,
we
take
a
vision
of
the
environment
from
a
different
perspective.
Take
in
to
account,
for
a
second,
the
Amazon
Jungle
that
is
considered
as
one
of
the
world's
lungs,
because
of
the
countless
amount
of
oxygen
that
it
provides,
but
what
does
this
says
to
us?
When
we
talk
about
healthcare
the
first
thing
that
comes
to
our
mind
is
the
number
of
unresolved
problems
this
system
has.
So
instead
of
thinking
about
all
the
problems,
why
don’t
we
think
about
how
healthcare
is
always
helping
us?
Why
don't
we
think
about
how
to
improve
it
instead
of
only
talking
about
all
the
problems
that
it
has?
In
Colombia,
for
example,
the
population
is
more
concerned
for
smiling
than
for
eating.
What
we
are
trying
to
say
with
this
is
that
we
must
see
much
more
beyond
the
problem
we
are
always
trying
to
seek
for
help
or
just
for
giving
it.
With
this,
people
should
be
interest
of
finding
a
way
to
stand
out
and
make
a
difference,
as
a
clear
example
we
named
Shakira,
a
Colombian
singer,
that
is
well
known
because
of
her
singing,
dancing,
for
having
a
helping
talent,
for
has
been
able
to
managed
and
establish,
along
with
her
foundation
“Pies
Descalzos”,
5
schools
in
Colombia
in
cities
like
Barranquilla,
Altos
de
Cazucá
and
Quibdo,
where
more
than
4.000
children
had
received
education,
nutrition
and
psychological
support.
Thanks
to
this,
about
30.000
people
have
been
benefited
from
education
and
health
programs
that
the
Shakira´s
foundation,
“Pies
Descalzos”
promotes.
10%
of
the
Colombian
population
has
access
to
Internet
and
this
foundation
is
also
searching
for
the
way
to
implement
these
technologies
in
these
populations
to
make
the
education
process
102
much
faster
and
end
with
the
big
difference
between
cultures.
Back
to
the
subject
of
environment,
Colombia
has
worried
over
many
years
for
global
warming,
even
if
you
believe
in
this
or
not,
this
phenomenon
is
affecting
the
whole
world
in
an
extremely
bad
way.
Because
of
this,
many
countries
in
first
place,
like
Colombia,
have
created
recycling
programs
and
other
projects
that
help
the
environment.
But
a
lot
of
people
believe
that
all
about
global
warming
is
a
lie,
so
why
we
need
to
worry
too
much
about
this
issue?
The
truth
is,
taking
South
America
as
an
example,
which
is
facing
a
rainy
season
that
has
left
great
damage
in
different
cities
and
has
created
chaos
in
populations
with
little
infrastructure
to
cope.
Therefore
it
is
fair
to
say
that
to
avoid
certain
crises
is
best
to
know
what
affects,
from
where
different
diseases
comes
and
how
to
avoid
them,
not
just
for
the
moment
of
crisis
but
for
the
day
by
day
life.
In
this
issue,
the
biggest
and
capable
countries
should
make
a
global
effort
to
help
the
others
to
know
how
to
help
with
the
environment,
even
knowing
that
Colombia
is
not
a
developed
country
this
interest
about
the
world
has
been
consider
as
an
Global
effort
that
is
helping
a
lot
of
people.
This
help
that
we
are
asking
for
doesn’t
have
to
be
gigantic,
only
with
saving
a
forest
or
a
jungle
would
help
people
to
get
a
lot
more
oxygen,
like
Colombia
is
doing
with
the
Amazonas
jungle.
Thinking
about
what
Mr.
Pusey
said,
about
the
importance
of
environmental
stewardship
might
we
ask:
How
we
could
be
able
to
find
a
balance
in
the
misuse
of
technology
and
the
healthcare
service?
Due
to
the
global
warming
that
we
are
facing,
we
have
seen
that
natural
disasters
have
occurred
in
the
past
15
years,
this
due
to
how
hot
the
earth
is
getting.
Therefore,
it
is
good
to
think
that
if
you
can
avoid
certain
natural
disasters,
why
not
do
it?
When
we
speak
about
a
solution
focused
on
the
issue
of
scarce
resources,
we
must
be
careful
about
what
country
do
we
speak
about,
in
this
case
we
cannot
talk
as
a
world
power
as
a
developing
country.
The
developing
countries
are
having
issues
where
they
have
to
invest
much
money
such
as
corruption,
violence,
social
security,
and
healthcare
education.
In
conclusion
we
would
like
to
remember
something
that
Mr.
Pusey
say
to
us,
we
have
to
take
history
as
the
base
of
everything
but
we
also
have
to
make
it,
and
make
history
a
lot
103
better.
Every
good
idea
starts
with
a
dream
and
by
imagination,
so
we
would
like
to
end
saying
this
phrase
form
Vincent
Van
Gogh:
"For
my
part
I
know
nothing
with
any
certainty,
but
the
sight
of
the
stars
makes
me
dream",
so
lets
dream
with
a
perfect
healthcare
system.
Garodia
International
Centre
for
Learning
Firstly
we’d
like
to
start
off
by
stating
the
importance
of
a
government’s
role
in
providing
and
dealing
with
healthcare
in
its
country.
As
the
main
authorities
and
power‐
wielding
party,
making
healthcare
a
government’s
responsibility
will
all
hold
better
and
more
fruitful
results
in
the
future.
A
government
is
also
a
better
option,
as,
in
an
LEDCs,
majority
of
the
population
are
uneducated
and
still
followers
of
witch
doctors
and
similar
traditional
practices.
That
said
they
are
less
likely
to
do
as
much
as
accept
treatment
from
international
initiatives,
whereas
a
government
is
the
authority,
whom
citizens
identify
with
as
their
collective
representative.
Unfortunately
the
fundamental
economic
concept
of
opportunity
cost
prevents
that,
governments
want
to
make
the
best
possible
impression
in
their
term,
so
they
can
be
re‐
elected
hence
resort
to
populist
measures
i.e.
developing
parts
of
the
economy
that
will
increase
their
popularity
with
their
citizens.
This
may
not
be
healthcare.
Another
reason
governments
may
not
hammer
out
a
reform
or
new
healthcare
bill
is
that
they
may
not
get
to
see
the
returns
from
the
reform
until
after
their
term,
depriving
them
of
the
potential
credit
due.
While
in
Nashville,
one
concrete
fact
has
been
resonant,
scare
sponsors
for
research,
or
simply
no
money
or
subsidies
for
researchers
in
the
medical
field.
Hence
we,
strongly
suggest
that
governments
must
realise
this
and
that
milestone
in
healthcare
research
can
be
reached
faster
and
in
time
to
respond
to
world‐wide
needs,
if
they
motivate
and
financially
back
such
work
with
subsidies.
After
all
a
population
is
productive
when
healthy,
and
who
benefits
more
from
a
healthy
economy
than
a
government.
104
This
leads
us
to
our
next
point,
a
collaborative
effort
from
governments.
To
start
off,
I’d
like
to
recount
that
globalisation
is
already
implemented
to
a
point
where
it
shapes
the
way
we
lives
on
a
daily
basis
and
our
lifestyle
too.
Globalisation
also
brings
with
it
some
drawbacks,
a
new
and
faster
way
to
propagate
vectors
that
accelerate
diseases
spread,
as
people
are
always
on
the
move
from
home
to
another
country.
Hence
we
must
accept
a
tiny
disease
outbreak
in
one
corner
of
the
world
may
be
magnified
to
pandemic
scale,
in
a
matter
or
days
owing
to
globalisation.
We
strongly
feel
that
this
threat
can
be
dealt
with
a
unified
and
concerted
effort
at
prophylaxis
around
the
world,
as
well
as
some
tweaks
to
the
W.H.O.’s
power’s
an
functions.
Better
international
co‐operation
and
co‐ordination
will
prevent
duplication
of
efforts
during
a
pandemic
where
a
solution
needs
to
be
devised
fast,
hence
the
change
in
function
would
involve
the
WHO
being
the
research
Head
quarters
against
diseases,
this
brings
about
a
magnanimous
change
in
results
and
efficiency
as
all
the
resources
both
financial
as
well
as
scientific
from
the
entire
international
community
are
brought
together
at
one
location
instead
of
being
scattered
all
over
the
world.
The
power
will
prevent
clashes
between
government
decision
during
such
crucial
times,
if
the
WHO
was
left
in
charge
of
calling
the
shots
for
a
pandemic,
there
would
be
less
chaos,
as
everyone
would
know
whom
to
listen
to.
This
seems
like
something
out
of
a
fantasy,
for
sure,
but
we
believe
a
similar
course
of
action
will
bring
good
results.
Our
symposium
has
the
back
drop
of
‘Mountains
Beyond
Mountains’,
which
centred
around
the
head
of
a
NGO
Dr.
Paul
farmer,
and
his
work,
which
unanimously
we
agreed
was
excellent.
The
reason
for
such
truly
great
results
is
the
person
doing
the
work
I
believe.
An
NGO
does
not
seek
only
profits,
its
mainly
fuelled
by
its
pure
determination
and
dedicated
to
its
work,
this
amounts
to
a
greater
deal
of
efficiency
when
carry
out
its
work.
Besides
their
commitment,
NGOs
also
work
better
as
they
work
at
the
grass
roots
level,
this
close
contact
with
their
patients
as
well
as
giving
their
own
orders
and
not
waiting
for
instructions
from
the
top,
creates
a
faster
system.
Hence
we
believe
the
work
of
NGOs,
corporate
and
Individuals
should
be
set
as
an
example
for
others
to
follow
and
to
showcase
how
goodwill
benefits
everyone.
Lastly
poverty
needs
to
been
dealt
with,
I
wish
to
conclude
with
the
confusing
relation
between
poverty
and
bad
healthcare,
if
governments
are
to
solve
either
they
must
know
105
which
to
stop
but
this
creates
a
sort
of
‘what
came
first:
the
chicken
or
the
egg?’
situation;
we
believe
answering
this
dilemma
will
solve
one
of
the
major
problems
linked
to
healthcare
issues.
Johannes
Kepler
Grammar
Schoool
Trying
to
come
up
with
a
solution
how
to
improve
the
health
care
in
the
world
and
what
practical
steps
to
take,
we
must
not
forget
that
there
are
a
lot
of
aspects
we
have
to
bear
in
mind.
Many
of
them
overlap;
therefore,
we
can
put
them
into
several
main
categories.
First
of
them
is
education,
which
is
the
root
element
we
have
to
focus
on
in
order
to
bring
about
a
successful
change.
Education
works
as
prophylaxis,
and
prophylaxis
is
a
way
to
improve
the
efficiency
of
health
care
provision,
as
it
can
prevent
many
people
from
contracting
an
illness
in
the
first
place.
And
even
if
they
did
get
ill,
with
appropriate
health
care
education,
they
would
be
able
to
take
the
right
steps.
Secondly,
education
enhances
the
global
awareness
of
current
problems
in
the
world
and
it
is
a
way
to
make
people
realize
that
even
if
it
does
not
concern
them
directly
at
the
moment,
it
can
still
easily
affect
them
due
to
the
high
level
of
globalization.
Therefore,
provision
of
appropriate
healthcare
education
is
absolutely
essential.
Media
are
important
driving
factors
in
our
society;
however,
in
most
cases,
media
are
only
interested
in
medially
attractive
events
and
occurrences
and
hardly
ever
mention
long‐
term
health
issues
in
developing
countries.
One
way
to
bring
a
change
into
media
strategy
and
its
focus
is
to
bring
up
well‐educated
global
health
concerned
people
that
would
enter
the
media
world
and
change
it
from
inside.
A
faster
way
to
induce
a
change
would
be
to
encourage
the
media
to
cover
the
grave
health
issues
and
bring
awareness
thereof
to
public,
which
media
have
a
big
influence
on.
Financial
motivation
might
be
the
most
effective
method
that
has
its
pros
and
cons.
It
would,
indeed,
require
a
lot
of
money,
but
it
might
bring
back
an
even
larger
amount
of
money
into
healthcare
as
a
return,
because
people
tend
to
sympathize
with
others
and
donate
money
whenever
they
are
emotionally
struck
by
the
media.
106
A
second
major
aspect
of
healthcare
provision
is
infrastructure
and
technology.
There
are
various
research
programs
underway
in
many
countries
all
over
the
world.
They
all
cost
a
lot
of
money
and
effort,
but
in
many
cases,
they
can
lead
us
to
the
light
at
the
end
of
the
tunnel.
For
that
reason
we
must
keep
on
performing
the
research,
surmount
any
external
obstacles
along
the
way,
such
as
severe
lack
of
resources
or
stark
financial
situations,
since
it
is
the
only
hope
left
for
countless
of
people.
In
order
to
achieve
that,
governments
ought
to
find
money
in
sectors
where
they
are
less
needed
and
redistribute
them
to
finance
and
incentivize
healthcare
research
and
development.
Even
if
we
do
achieve
a
great
improvement
on
the
field
of
treatment
technologies,
we
will
not
be
able
to
distribute
them
efficaciously
without
a
good‐working
system
and
infrastructure.
Network
of
roads
is
essential
for
any
distribution
of
healthcare,
running
water
is
vital
for
hygiene
and
for
doctors
to
carry
out
their
practices,
and
electricity
is
indispensable
for
many
medical
tools
and
other
appliances
to
work.
It
would
be
extremely
helpful
for
countries
all
over
the
world
to
settle
on
and
establish
a
globally
standardized
healthcare
system
and
infrastructure
–
up
to
the
extent
which
the
local
environment
and
local
people
would
allow
–
which
would
include,
for
instance,
electronic
health
record
accessible
to
hospitals
and
physicians
in
every
nook
and
cranny
of
the
world.
This
would
indubitably
have
a
very
positive
effect
on
the
efficiency
of
healthcare
provision.
Last
but
not
least,
our
world
has
to
collaborate
and
work
in
unity
while
dealing
with
the
current
challenges.
We
have
to
realize
that
crises
in
remote
regions
affect
people
all
over
the
world
in
our
extensively
globalized
world
and
that
we
ought
to
provide
long‐term
aid
to
developing
countries
as
well
as
quick
aid
in
case
of
emergency
situations.
Establishing
a
system
of
mutual
collaboration
in
healthcare
would
improve
efficiency
in
various
fields
thereof.
First,
it
would
enhance
the
efficacy
of
treatment
of
illnesses.
Second,
it
would
enhance
the
efficacy
in
medical
research
and
in
implementation
of
new
technologies.
Third,
it
might
also
improve
the
global
financial
situation
as
it
might
reduce
the
total
cost
of
healthcare
or
redistribute
the
money
therein.
We
believe
that
the
steps
mentioned
above
would
improve
not
only
the
global
health
care,
but
that
they
would
also
contribute
to
improving
the
life
on
our
planet
in
general.
107
Montgomery
Bell
Academy
Our
world
faces
a
myriad
of
daunting
health
care
challenges.
There
will
be
no
simple
solutions;
human
nature
is
often
too
short‐sighted
and
self‐centered
to
accommodate
sweeping
reform.
But
these
obstacles
should
not
preclude
the
international
community
from
addressing
the
crisis
with
all
its
resources.
As
advocates
for
change,
we
must
implore
our
authorities
to
focus
on
specific,
practical
goals
that
will
help
better
health
outcomes
for
the
world.
Health
care
in
any
one
nation
does
not
exist
in
a
vacuum.
For
too
long,
developed
countries
like
the
United
States
have
viewed
their
domestic
interests
as
distinct
from
the
international
picture.
Brain
drain
is
one
phenomenon
that
has
been
permitted
because
of
this
neglect.
About
one‐quarter
of
American
medical
practitioners
are
educated
abroad,
and
many
of
them
come
from
nations
who
are
in
dire
need
of
medical
resources.
According
to
data
from
the
ECFMG,
an
organization
that
certifies
foreign
medical
graduates
to
practice
in
the
U.S.,
34%
of
physicians
who
immigrated
to
the
United
States
in
2009
were
from
countries
identified
by
the
World
Health
Organization
as
particularly
at
risk.
The
U.S.
could
do
a
great
deal
to
address
this
problem
just
by
adjusting
its
own
domestic
policies.
For
instance,
we
could
create
more
medical
schools
in
the
United
States
to
reduce
the
need
for
importing
graduates.
More
broadly,
there
needs
to
be
a
change
in
the
way
medical
education
is
approached.
Curriculum
requirements,
under
the
guise
of
“international
standards”,
often
prepare
young
doctors
in
developing
nations
for
advanced
technologies
and
techniques
that
are
far
too
expensive
to
implement
in
most
hospitals.
The
converse
is
true
in
nations
like
the
United
States,
where
global
health
issues
are
often
ignored.
Reformed
educational
programs
in
both
communities
can
help
foster
a
new
understanding
of
global
health
problems;
it
is
the
responsibility
of
governments
of
developed
nations
to
facilitate
these
efforts.
But
the
availability
of
health
workers
is
only
one
facet
of
the
problem—new
techniques
need
to
be
developed
as
well.
Grants
need
to
be
furnished
by
both
the
public
and
private
sector
to
mobilize
the
scientific
research
capacity
of
the
developed
world
for
the
treatment
108
of
diseases
that
affect
the
entire
world.
Financial
incentive
is
necessary;
the
power
of
human
compassion
will
only
take
us
so
far
if
we
ignore
the
economic
realities
of
the
situation.
There
must
also
be
a
fundamental
reassessment
of
drug
pricing
in
the
international
community.
The
production
and
distribution
of
generic
drugs
is
severely
hindered
by
the
structures
that
govern
international
trade,
even
though
purely
humanitarian
concerns
suggest
that
cheaper
medications
be
made
available.
This
conflict
of
interests
will
persist
unless
the
international
community
can
create
a
new
architecture
of
intellectual
property
law
that
respects
the
rights
of
both
parties
involved
through
compromises
like
tiered
pricing.
It
would
be
naïve
to
suggest
that
there
will
be
no
conflict
of
economic
and
political
interests
along
the
way.
But
the
issue
of
the
healthcare
transcends
borders:
it
concerns
the
most
fundamental,
inalienable
rights
of
mankind.
If
we
have
any
hopes
of
equitably
distributing
our
finite
resources,
we
must
live
up
to
the
great
ideal
of
being
citizens
of
the
world,
not
individual
nations.
The
wise
words
of
Mahatma
Gandhi
resonate
very
clearly:
“Earth
provides
enough
to
satisfy
every
man's
need,
but
not
every
man's
greed.”
Events
like
this
Symposium
are
a
critical
step
toward
forging
a
new
spirit
of
global
cooperation
as
we
pursue
the
ideal
of
a
better
world.
Nada
High
School
We
would
like
to
start
with
this
simple
question
―
can
we
say
that
what
Paul
Farmer
has
done
was
right?
Was
his
action
really
desirable
for
people
in
impoverished
countries?
We
admit
that
he
has
struggled
for
years
in
Haiti
and
other
countries
to
help
poor
people
who
suffer
from
various
diseases.
However,
it
is
quite
important
to
recognize
this
situation
from
other
aspects.
As
you
know,
he
has
spent
so
vast
money
and
time
for
every
person
who
has
a
serious
disease,
virtually
without
limit.
We
can
say
for
sure
that
if
he
had
spent
the
money
for
other
people
with
slighter
illness,
he
would
have
saved
much
more
lives.
Most
people
think
that
the
little
money
we
spend
per
person,
the
more
lives
we
can
save.
It
may
be
true
to
some
degree
because
the
amount
of
money
we
can
spend
for
them
is
so
109
restrictive.
From
this
point
of
view
considering
efficiency,
we
would
try
to
save
lives
which
are
likely
to
survive
with
spending
as
little
cost
as
possible.
When
we
think
about
this
matter,
we
should
consider
that
he
is
not
a
politician
but
a
doctor.
What
doctors
do
completely
differs
from
what
politicians
do.
Politicians
should
think
about
all
the
people
in
the
region
and
struggle
for
their
happiness.
However,
doctors
are
completely
different.
They
only
need
to
think
about
the
patients
in
front
of
them.
We
have
a
tendency
to
mix
the
obligation
of
a
doctor
with
politics,
but
the
obligation
of
a
doctor
is
to
do
his
very
best
for
saving
each
life
without
regard
to
profits.
The
same
thing
can
be
said
when
we
consider
the
role
of
governments,
NGOs,
and
other
organizations.
For
example,
as
Dr.
Portnoy
referred
in
his
presentation,
governments
sometimes,
or
maybe
even
usually,
hinder
what
international
organizations
try
to
do.
Actually,
MSF
is
doing
some
activities
which
otherwise
governments
should
do.
We
don’t
think
that
this
situation
is
the
situation
people
are
longing
for,
and
we
believe
that
the
role
of
a
government
is
to
ensure
the
provision
of
healthcare
for
its
citizens
to
the
extent
that
citizens
can
live
“normal”
lives,
that
is,
to
the
extent
that
they
can
live
with
good
physical
conditions
until
they
die.
It
should
try
to
protect
their
citizen's
right
to
live,
and
should
spend
as
much
money
as
it
can
for
the
healthcare
expenditure.
The
role
of
an
international
organization
is
to
help
governments
cooperate
and
collaborate
with
each
other.
Its
role
should
not
interfere
with
governments’
role.
Bearing
this
argument
in
mind,
we
would
like
to
think
about
the
practical
steps
that
our
countries
can
and
should
take.
We
believe
that
the
essence
of
healthcare
is
to
help
people
who
are
suffering
from
any
kinds
of
health
troubles.
a) Developed
countries
We
think
that
there
are
2
major
issues
that
developed
countries
face
in
their
healthcare
reform.
One
is
about
the
uninsured.
In
some
countries
such
as
the
United
States,
there
are
still
many
people
who
don’t
have
health
insurance.
Some
actions
should
be
taken
to
help
those
people.
The
other
problem,
which
almost
all
the
developed
countries
face,
is
about
the
technology.
For
developed
countries,
it
is
important
to
introduce
new
technology
in
order
to
promote
systemized,
personalized
care.
There
is
a
concern
that
it
costs
so
much
to
introduce
the
latest
system
based
on
the
latest
technology.
However,
the
most
important
point
that
Dr.
Balser
pointed
out
was
how
important
it
is
for
healthcare
to
move
from
a
110
reactive,
remedial
care
to
a
proactive,
and
to
a
preventative
science.
It
is
inevitable
to
spend
a
lot
of
money
when
we
completely
change
our
system.
If
we
can
utilize
technology
in
any
way
to
facilitate
this
transformation,
it
must
be
encouraged
and
embraced.
b) Developing
countries
It
is
quite
difficult
for
developing
countries
to
provide
people
with
adequate
healthcare.
The
cost
of
introducing
the
latest
technology
would
be
a
heavy
burden
for
developing
countries.
Moreover,
these
countries
lack
a
suitable
infrastructure,
and
the
latest
technology
would
not
always
be
effective.
However,
as
we
have
mentioned
before,
personalized
care
through
introducing
new
technology
would
surely
reduce
cost.
This
is
where
international
society
comes
in.
c) International
healthcare
The
role
of
international
healthcare
would
be
to
provide
people
all
over
the
world
with
equal
basic
healthcare.
In
order
to
accomplish
this
goal,
cooperation
between
developed
countries
and
developing
countries
through
international
organizations
is
needed
in
many
situations.
International
alliances
between
nations
are
necessary
for
improving
a
population’s
level
of
health.
Because
of
the
ease
and
frequency
of
air
travel
and
international
trade,
without
cooperating
with
each
other,
we
cannot
avoid
the
danger
of
infectious
disease
such
as
bird
flu
and
SARS.
There
are
also
some
kinds
of
non‐
governmental
organizations
helping
people
internationally.
Governments
also
should
take
further
actions.
Developed
countries
should
assist
developing
countries
in
various
ways;
financial
aid,
medical
care,
and
education.
There
are
special
times
when
international
healthcare
has
lots
to
do,
such
as
unpredictable
disasters.
As
the
globalization
goes
on,
it
goes
without
saying
that
the
need
for
international
healthcare
is
rising.
As
one
of
the
citizens
living
in
this
earth,
we
should
recognize
this
issue
as
a
global
issue.
111
Raffles
Institution
Economics
revolves
around
the
premise
that
Earth
has
finite
resources.
There
is
almost
always
an
opportunity
cost
in
whatever
we
do;
a
trade‐off
has
to
be
made.
It
is
with
this
fundamental
concept
in
mind
that
we
proceed
with
the
question
of
what
steps
should
be
taken
to
improve
the
quality
of
healthcare
(that
is,
judged
through
healthcare
outcomes)
both
nationally
and
internationally.
We
should
not
be
mistaken
–
there
is
no
single
magic
bullet
which
will
solve
our
healthcare
woes.
However,
there
are
steps
that
we
can
collectively
take
in
the
right
direction.
What
we
should
be
striving
for
is
solidarity.
Solidarity
plays
an
important
role
in
raising
healthcare
standards
internationally,
be
it
between
NGOs
or
between
NGOs
and
governments.
However,
more
often
than
not,
when
the
subject
of
solidarity
is
raised,
thoughts
of
big
and
inefficient
bureaucracies
pop
up.
To
many,
solidarity
seems
to
cripple
rather
than
strengthen.
Nimble,
singular
NGOs
efficiently
executing
their
projects
seem
to
be
the
flavour
of
the
day.
That
is
definitely
not
what
we
have
in
mind.
We
must
think
in
terms
of
spatial
solidarity
with
a
focus
on
breadth
across
many
different
players,
rather
than
focusing
on
enlarging
a
single
player.
Solidarity
is
often
underestimated
and
overlooked
in
the
grand
scheme
of
raising
healthcare
standards
internationally.
Consider
for
a
moment,
if
NGOs
and
Governments
were
able
to
fully
engage
each
other,
assimilate
their
strengths
and
reduce
their
weakness,
how
beneficial
it
would
be
to
the
public
healthcare
system
of
the
country.
Consider
the
fact
that
if
multilateral
solidarity
could
be
instilled,
millions,
even
billions
would
get
better
healthcare.
Consider
finally,
the
day
when
colonial
mindsets
could
finally
be
eradicated,
empowering
the
locals.
This
is
the
effect
of
solidarity.
Therefore,
solidarity
should
be
the
overarching
concept
which
we
should
work
in.
Our
response
to
the
symposium
challenge
should
be
viewed
through
the
lens
of
a
pyramid.
We
feel
that
the
framework
for
the
answer
to
this
challenge
could
be
structured
similarly
to
that
of
a
pyramid:
a
wide
base
with
a
narrow
top.
With
the
concept
of
solidarity
as
the
outer
structure,
the
base
of
it
begins
with
the
economy,
before
moving
up
to
education
and
finally
technology.
This
arrangement
is
based
on
the
notion
that
without
money,
no
campaigns
or
programs
are
able
to
be
funded,
resulting
in
this
pyramid
being
unable
to
be
supported,
eventually
becoming
top
heavy
and
collapsing.
112
Firstly,
the
economics
of
healthcare.
The
optimisation
of
healthcare
provision
is
a
crucial
necessity
in
order
to
ensure
the
most
efficient
use
of
limited
and
scarce
resources,
allowing
the
general
population
to
receive
a
higher
standard
of
healthcare
with
the
same
limited
pool
of
resources.
The
importance
of
the
economic
aspect
of
healthcare
provision
is
surely
one
that
cannot
be
overstated
‐
after
all,
it
is
economics
that
drives
the
healthcare
industry
through
the
basic
principles
of
supply
and
demand.
In
order
to
allow
healthcare
to
be
more
accessible
to
the
general
population
as
a
whole,
the
government
must
ensure
that
the
economic
perspective
of
the
issue
is
not
neglected.
Naturally,
funding
from
the
government
falls
into
this
category.
The
government
should
actively
provide
subsidies
of
some
form
to
the
hoi
polloi,
ensuring
that
no
one
is
denied
healthcare
‐
a
right
which
we
feel
is
inalienable.
In
addition,
government
expenditure
must
be
directed
to
the
setup
of
awareness
campaigns
with
the
intention
to
educate
the
general
populace
on
steps
they
can
take
to
reduce
the
transmission
of
sickness,
thereby
nipping
the
problem
in
the
bud.
Treating
the
problem
at
the
source
is
by
far
the
most
efficient
method
of
alleviating
the
stress
on
the
healthcare
system,
for
its
simple
premise
is
easily
apparent:
When
people
change
their
lifestyle
habits
as
a
direct
result
of
such
campaigns,
sickness
rates
will
invariably
plummet,
thereby
reducing
the
amount
of
people
the
healthcare
system
in
the
country
has
to
treat.
Bearing
in
mind
the
previous
two
measures,
a
third
important
one
must
not
be
ignored.
The
provision
of
basic
infrastructure
is
key,
if
not
necessary
to
the
optimisation
of
healthcare
provision
for
the
general
populace
as
a
whole.
Hospitals,
drugs,
medical
technology,
these
are
but
a
few
essential
components
of
the
healthcare
structure.
Without
them,
the
healthcare
industry
is
rendered
useless.
After
all,
what
is
the
use
of
going
to
the
doctor
if
the
clinic
is
out
of
medicine?
These
basic
components
that
we
take
for
granted
in
our
daily
lives
are
the
lifeblood
‐
the
heart
and
soul
of
the
healthcare
system.
Without
them,
the
healthcare
system
would
grind
to
a
screeching
halt,
resulting
in
the
inability
of
the
government
to
provide
for
its
people.
Hence,
governments
must
ensure
that
the
healthcare
system
in
their
country
has
the
required
access
to
procure
these
essential
resources,
stepping
in
and
intervening
whenever
a
paucity
of
resources
arises
in
order
to
ensure
that
the
well‐oiled
machine
that
is
the
healthcare
system
runs
at
full
speed
ahead,
effectively
and
efficiently
providing
for
its
people.
113
The
next
level
of
this
pyramid
would
be
the
provision
of
education
about
healthcare
to
the
general
populace.
The
concept
of
education
is
broad
and
covers
many
areas.
Here,however,
we
would
like
to
address
the
key
aim
of
education,
which
is
simply
to
raise
awareness
of
different
healthcare
issues.
These
issues
can
range
from
basic
sanitation
and
hygiene
practices
to
awareness
of
the
global
epidemics
that
plague
our
world.
The
simple
awareness
of
such
issues
can
result
in
the
strong
citizen
sector
movement
which
could
and
would
challenge
government
policies
which
may
not
be
in
the
best
interest
of
the
people.
Basic
awareness
also
integrates
the
concept
of
healthcare
into
people's
everyday
lives.
This
is
by
far
the
most
important
step
in
order
to
increase
basic
santitation,
where
prevention
is
truly
the
best
cure.
This
grassroots
movement
would
also
then
translate
into
real,
tangible
actions
by
the
people
for
the
people,
where
change
is
eventually
accomplished
through
advocacy.
Technology,
the
third
tier,
is
essential
in
ensuring
that
the
healthcare
system
works
exactly
as
its
name
implies
‐
as
a
system.
Through
the
introduction
of
technology,
coordinated
efforts
can
be
made
and
medical
information
can
be
pooled.
This
interconnectivity
allows
for
greater
efficiency
and
efficacity
in
the
overall
system
due
to
the
fact
that
a
larger
number
of
people
are
able
to
share
their
opinions
and
contribute
to
the
problem
at
hand
as
opposed
previously
to
a
limited
amount
of
people
due
to
the
paucity
of
technology
at
hand.
For
example,
the
availability
of
electronic
medical
records
has
the
implication
that
whichever
hospital
the
patient
travels
to,
doctors
are
able
to
pull
said
patient's
medical
records,
allowing
the
doctor
to
build
on
the
work
of
all
the
previous
doctors
the
patient
had
previously
visited,
instead
of
treating
the
problem
afresh
and
hence
running
the
risk
of
misdiagnosis
or
a
myriad
of
other
problems.
In
addition,
the
doctor
will
be
able
to
tailor
his
care
according
to
the
recommendations
of
the
other
doctors
the
patient
had
previously
visited,
thus
allowing
the
patient
to
enjoy
the
benefits
of
personalized
care.
A
second
point
to
consider
with
regards
to
technology
is
that
of
research
and
innovation.
Given
man’s
infinite
imagination
and
ingenuity,
new
innovations
will
constantly
be
made
in
the
field
of
science
for
the
benefit
of
mankind
as
a
whole.
These
benefits
are
what
constantly
improves
the
state
of
the
healthcare
system
of
the
country.
With
new
innovations
made
possible
only
through
advances
in
research,
one
will
indubitably
enjoy
greater
efficiency
and
ease
in
completing
what
were
once
seen
as
insurmountable
tasks.
Hence,
the
government
must
make
an
effort
in
ensuring
that
part
of
the
government's
114
annual
expenditure
goes
towards
the
research
and
development
industry,
for
these
investments
could
potentially
reap
huge
dividends
in
the
event
of
a
breakthrough.
An
old
nursery
rhyme
sums
our
position
on
healthcare
very
well:
The
best
six
doctors
anywhere
And
no
one
can
deny
it
Are
sunshine,
water,
rest,
and
air
Exercise
and
diet.
These
six
will
gladly
you
attend
If
only
you
are
willing
Your
mind
they'll
ease
Your
will
they'll
mend
And
charge
you
not
a
shilling.
We
believe
that
only
by
addressing
these
three
key
factors,
under
the
broad
umbrella
of
solidarity,
would
we
be
able
to
effectively
address
this
complex
issue
of
healthcare.
No
doubt,
change
will
not
arrive
easily
nor
will
it
do
so
overnight.
Only
through
firm
resolve
and
conviction,
would
there
be
progress
made.
It
is
our
hope
that
such
measures
will
create
a
society
where
the
individual
is
not
only
healthy,
but
also
treasures
his
own
well‐
being.
Shiyan
Cooperation
High
School
In
many
developing
countries,
our
healthcare
system
is
not
consummate.
Like
China,
with
a
large
population,
what
we
need
to
reform
should
be
deliberate.
As
we
know,
there
are
many
problems
in
the
present
context.
For
example,
most
of
people
in
china
now
don’t
trust
in
clinic.
No
matter
the
illness
is
slight
or
sick,
they
all
want
to
go
to
hospital
for
sure.
So
the
new
reform
has
mentioned
to
change
it,
our
government
is
trying
to
set
up
more
clinics
and
make
most
of
the
citizens
believe
in
it.
How
best
to
do
that?
We
think
education
can
plan
a
major
role.
To
tell
people
that
we
should
trust
clinic,
they
can
help
us
to
diagnose,
they
can
help
you
to
do
many
things
that
hospital
can’t
do.
115
Education
make
people
know
what
to
do,
but
their
behavior
shows
it.
And
we
think
that
not
only
in
developing
countries,
but
also
in
developed
countries.
We
all
need
education
to
make
progress.
Developed
countries
they
need
education
to
have
a
health
diet,
like
the
US
and
the
UK,
the
food
they
eat
such
as
French
fries,
fried
chicken,
they
put
too
much
fat
onto
bodies.
On
the
other
hand
developed
countries
have
already
got
hi‐technology
equipments,
but
they
need
knowledge
to
make
innovation,
to
create
new
things.
They
all
need
education.
To
many
developing
countries,
the
situation
which
we
are
facing
now
is
staff
shortage,
of
course
we
have
many
unscientific
habits,
so
what
make
us
achieve
accomplishment
is
being
well
educated.
Education
really
occupies
an
important
context.
Winchester
College
There
is
no
perfect
healthcare
system
anywhere
on
earth.
However,
there
are
a
few
key
determinants
which
one
can
use
to
optimise
healthcare
provisions.
In
1997,
when
Tony
Blair
stepped
into
10
Downing
Street,
he
stated
that
the
priorities
for
his
government
were
‘education,
education,
education!’,
and
he
could
not
have
overstated
its
value.
In
an
ever‐
changing
world,
technology
plays
an
important
part
when
considering
a
comprehensive
vision
of
healthcare,
and
what
the
future
holds
for
this
essence
of
life.
The
collaborative
efforts
of
a
huge
variety
of
cultures
and
beliefs,
and
the
culmination
of
a
multi‐faceted
perspective
of
healthcare
paves
the
way
for
a
healthcare
system
where
anything
is
possible.
Technology
was
identified
as
an
important
factor
during
the
Symposium.
We
were
faced
with
many
ethical
issues
which
arose
through
the
progression
of
technology.
We
sought
to
use
constructively
the
power
of
profit:
how
to
manipulate
the
trade‐off
between
pharmaceutical
companies
and
manufacturers
of
generic
drugs.
An
agreement
needs
to
be
made
which
satisfies
the
researchers’
financial
needs:
this
could
be
through
government
incentives
or
a
private
association
between
the
researchers
and
sellers.
A
healthcare
system
is
completely
dependable
on
a
few
pre‐requisites,
which
are
often
assumed
in
the
western
world.
Basic
infrastructure,
such
as
running
water,
functioning
roads
and
more
116
recently,
electricity
and
internet
facilities,
are
vital
in
ensuring
the
optimum
application
of
new
and
innovative
technological
advances.
Education
was
widely
discussed.
It
has
been
estimated
that
forty
percent
of
health
outcomes
are
a
direct
result
of
behavioral
issues.
Although
a
rather
vague
term,
in
this
case,
education
can
be
defined
as
an
imparting
of
knowledge,
which
recognises
the
difference
in
cultures
and
global
diversity.
Education
in
developing
countries
should
be
focused
on
creating
a
fundamental
shift
from
remedial
healthcare
to
preventative
solutions.
One
has
to
attack
the
problem
at
its
root:
taking
into
account
information
about
symptoms
of
diseases
and
a
proper
understanding
of
the
healthcare
facilities
available.
One
cannot
understate
the
importance
of
respecting
the
different
cultures
around
the
world.
Instead
of
imposing
one
country’s
healthcare
regime
upon
another’s,
one
has
to
work
hand‐in‐hand
with
local
communities,
and
integrate
the
most
efficient,
and
the
highest
quality
system
to
achieve
a
preferred
solution.
In
developed
countries,
it
is
important
to
educate
doctors
about
the
practices
of
tribes
and
communities
in
developing
countries.
This
brings
us
to
the
benefits
of
international
healthcare.
The
aim
of
international
healthcare
is
to
work
in
tandem
with
different
governments
and
initiatives
in
order
to
accomplish
healthcare
in
an
optimum
manner.
Education
of
first
world
aid
givers
is
vital
as
it
leads
to
a
true
understanding
of
the
environment
they
are
working
in.
In
a
time
of
globalisation,
and
world
air
travel,
diseases
spread
too
fast
to
be
contained.
Global
healthcare
initiatives,
such
as
Partners
in
Health,
work
in
conjunction
with
existing
governments
to
contrive
the
best
healthcare
solution
for
the
region.
They
call
this
the
‘small
footprint
approach’:
they
send
a
small
team
of
dedicated
doctors
and
nurses
to
educate
the
local
population
in
order
to
carry
out
their
work
for
them,
and
often,
the
government
is
keen
to
help.
In
this
manner,
these
initiatives
avoid
over‐exhaustion
of
resources,
and
manage
to
aid
many
regions
with
a
concerted
effort.
The
media
plays
a
substantial
role
in
the
allocation
of
funds
in
healthcare.
Whenever
a
story
of
global
concern
and
disaster
is
reported
in
the
media,
it
receives
a
flurry
of
donations
from
the
many
‘concerned’
viewers,
as
was
the
case
in
the
2011
earthquake
and
tsunami
in
Japan.
However,
many
long
term
problems,
such
as
malaria
and
starvation
are
often
overlooked
in
the
media,
and
as
a
result,
do
not
receive
as
much
concern
and
117
funding.
Corruption
is
rampant
in
India:
after
the
financial
minister
stepped
down
last
year,
he
proclaimed
that
one
in
three
Indians
were
corrupt,
and
that
the
remaining
two
were
not
angels,
either.
In
some
countries,
if
funds
are
received,
there
might
be
an
aberration
in
their
course;
they
might
be
unfairly
divided
among
politicians
or
used
to
fund
another
programme.
This
corruption
can
lead
to
the
misallocation
of
funds,
as
was
true
during
the
aftermath
of
the2004
tsunami.
Air
pollution
is
a
dangerous
problem,
as
it
is
responsible
for
many
respiratory
diseases
and
increases
global
warming.
We
cannot
continue
to
abuse
the
environment
that
we
live
in.
The
effects
of
industrialisation
were
noted
as
early
as
the
19th
century,
when
John
Ruskin,
a
pre‐Raphaelite,
wrote
about
the
effects
of
global
warming
inThe
Storm
Cloud
of
the
Nineteenth
Century.
It
seems
to
us
that
the
solution
to
all
these
problems
lies
in
education,
regardless
of
class
or
economic
prosperity.
Developed
countries
have
a
duty
to
aid
developing
nations
in
their
endeavors
to
improve
healthcare,
as
long
as
it
is
not
to
their
detriment.
Education
could
be
subsidised
by
governments
or
sponsored
by
private
medical
institutions,
but
it
should
embrace
any
cultural
complexities
and
technological
advances
to
succeed
in
the
quest
for
adequate
healthcare.
118
The
Symposium
Accord
Though
there
are
many
problems
facing
healthcare
today,
the
accord
below
provides
solutions
which
we,
the
members
of
the
Montgomery
Bell
Academy
(MBA)
Symposium
2011,
believe
to
be
of
the
greatest
importance.
Education
is
fundamental
to
improving
healthcare
outcomes
in
a
vast
majority
of
healthcare
concerns.
Health
does
not
exist
in
a
vacuum.
The
providing
of
health
services
is
inherently
related
to
other
facets
of
society,
such
as
economic
status.
We
have
chosen
to
focus
on
the
more
specific
and
controllable
elements
of
health
reform,
although
more
general
goals
of
development
can
certainly
complement
any
healthcare
efforts.
For
all
of
these
goals
to
be
achieved,
collaboration
between
all
participants,
whether
they
be
governments
or
NGO´s,
is
imperative
when
dealing
with
healthcare
both
at
international
and
national
levels.
This
ensures
that
countries
will
learn
from
each
other,
and
can
work
together
to
optimise
resources.
Regarding
individual
issues
of
health
care
ethics,
we,
as
global
citizens,
find
it
important
to
respect
the
various
cultural
beliefs
of
different
groups
of
people.
Tolerance
and
appreciation
of
diversity
characterise
the
personality
of
our
symposium.
The
effects
of
global
warming
are
becoming
more
and
more
devastating
as
we
progress
in
our
lives.
With
all
the
goals
set
out
below,
we
also
seek
to
reduce
the
amount
of
carbon
dioxide
emissions
and
waste
gases.
Air
pollution
is
problem
of
great
concern
in
the
healthcare
world:
it
is
responsible
for
many
respiratory
diseases.
This
is
yet
another
reason
to
bear
in
mind
that,
at
all
times,
we
should
strive
to
reduce
global
warming.
Considering
the
world's
finite
pool
of
resources,
international
cooperation
is
paramount.
Thus,
we,
the
members
of
the
2011
Montgomery
Bell
International
Health
Care
Symposium,
advocate
the
following:
119
Understanding
of
cultures
•
Educating
doctors
with
regards
to
the
culture
they
are
in
and
the
views
and
beliefs
of
the
inhabitants.
•
For
all
situations
that
do
not
endanger
life,
doctors
should
visit
their
destination
before
starting
their
practice.
However,
in
critical
situations
whereby
such
a
pre‐
visit
is
deemed
unfeasible
(for
example
in
a
situation
such
as
that
of
a
natural
disaster
or
an
outbreak
of
disease
whereby
the
delay
of
doctors
entering
the
country
would
result
in
a
drastic
loss
of
life),
such
a
pre‐visit
can
be
omitted.
Technology
–
Innovation:
Researching
cures
to
diseases
that
plague
mankind
•
A
strong
grasp
on
diseases
that
affect
mankind
by
invention
of
better
technology
to
tackle
them
would
greatly
increase
efficiency
of
treatment.
•
A
system
that
would
incentivise
pharmaceutical
companies
and
allow
them
to
research
new
drugs,
which
then
could
be
distributed
cheaply.
Education:
Physicians
•
The
education
of
physicians
addresses
a
mixture
of
both
developing
and
developed
healthcare
needs.
This
will
be
achieved
through
an
international
standardisation
of
education
between
medical
schools
around
the
world.
Governmental
Role:
The
role
of
the
government
in
healthcare:
•
Collaboration
between
governments
and
local
people.
•
Subsidisation
of
local
initiatives/Participation
in
local
healthcare
programs.
•
Government
grants
for
drug
companies.
120
•
Standardisation
of
healthcare
systems
by
provision
of
a
primary
framework
of
operation
common
to
all
health
professionals
that
will
serve
as
a
guide
for
these
professionals
but
at
the
same
time
allow
personalised
care
of
patients.
Government
funding
will
be
necessary:
•
to
curb
doctor
migration
•
to
encourage
research.
•
for
peer
programs
to
understand
culture
in
different
communities.
•
for
collaboration
of
initiatives:
between
NGOs
and
the
government.
•
for
the
vaccination
of
the
populace.
•
to
provide
basic
education
of
the
populace
about
diseases'
causes
and
treatments.
•
to
provide
and
ensure
the
poorest
citizens
with
any
kind
of
healthcare
service,
with
the
belief
that
every
citizen
has
the
right
to
posses
healthcare
services.
Infrastructure:
•
Strategic
redistribution
of
electricity
during
power
cuts;
for
example,
by
channeling
the
limited
available
power
to
hospitals/healthcare
providers.
•
Establishment
of
basic
and
sustainable
infrastructure
whilst
bearing
in
mind
environmental
consequences.
•
Movement
towards
more
sustainable
renewable
energy,
running
water
and
decent
shelters
for
citizens.
Drug
prices:
•
A
balance
should
be
struck
between
pharmaceutical
companies
and
medical
initiatives.
The
hospitals
and
clinics
need
to
be
able
to
purchase
drugs
relatively
cheaply
for
their
clients
and
so
should
not
be
charged
the
full
retail
price.
However,
we
cannot
drive
down
the
prices
of
drugs
too
much
because
pharmaceutical
companies
still
need
enough
profit
to
function,
and
so
they
need
an
incentive
to
discover
new
and
improved
medicines.
121
In
conclusion,
Margaret
Mead
once
said
"Never
doubt
that
a
small
group
of
thoughtful,
committed
citizens
can
change
the
world.
Indeed,
it
is
the
only
thing
that
ever
has."
122
Headmaster’s
Afterword
The
2011
Montgomery
Bell
Academy
International
Symposium
focus
on
healthcare
proved
to
be
a
beneficial,
educational,
and
memorable
experience.
I
would
like
to
thank
the
students
and
faculty
from
The
African
Leadership
Academy,
Colegio
Claustro
Moderno,
The
Garodia
International
Center
for
Learning,
Johannes
Keplar
Grammar
School,
Montgomery
Bell
Academy,
Nada
High
School,
Raffles
Institution,
Shiyan
Cooperation
High
School,
and
Winchester
College.
I
also
want
to
extend
our
appreciation
to
those
individuals
at
Karachi
Grammar
School
in
Pakistan
who
were
unable
to
attend
the
Symposium
because
of
visa
issues
but
provided
valuable
input
and
perspective
throughout
the
year
in
preparation
for
this
event.
I
am
grateful
to
the
Heads
of
School
who
provided
their
support
personally
and
financially
to
make
this
endeavor
possible.
I
am
appreciative
of
the
staff
at
Montgomery
Bell
Academy
who
tended
to
the
logistics
and
provided
the
care,
attention,
and
diligent
effort
to
insure
that
everyone
enjoyed
this
experience
and
benefitted
from
this
international
gathering.
A
special
thanks
goes
out
as
well
to
the
MBA
host
families
that
took
such
great
care
of
our
visiting
students.
I
am
indebted
to
Mr.
Tim
Parkinson
who
spearheaded
the
intellectual
dialogue
and
discussion
from
last
September
through
every
day
of
the
event
in
Nashville.
His
attention
to
detail
and
meaningful
study,
conversation,
and
writing
made
a
remarkable
difference.
I
am
grateful
to
my
colleague
Ralph
Townsend
who
conceived
this
idea
and
led
us
masterfully
and
selflessly
in
achieving
such
an
important
endeavor.
The
balance
of
discussion
and
activity
proved
to
be
a
successful
formula
for
the
week.
The
opening
comments
from
Dr.
Jeff
Balser
offered
an
excellent
overview
of
the
healthcare
model
and
debate
about
technology,
information,
and
innovation.
The
perspectives
from
Congressman
Jim
Cooper
provided
some
helpful
insights
into
healthcare
policy
and
international
investment
in
healthcare
as
well
as
some
insight
into
concerns
about
productivity
and
results
in
healthcare.
Our
three
other
major
speakers
from
Doctors
Without
Borders,
Siloam,
and
Partners
in
Health
offered
engaging
examples
and
illustrations
of
how
individuals
and
groups
can
make
an
incredible
difference
both
locally
and
internationally
in
the
healthcare
environment.
Spending
some
time
at
a
major
hospital
and
a
small
healthcare
facility
for
immigrants
opened
up
our
views
about
how
the
healthcare
system
actually
operates
and
what
technology
procedures
can
make
a
difference
in
society.
Finally,
the
great
meals
and
outings
at
the
Ryman
Auditorium
and
123
Green’s
Grocery
in
Leiper’s
Fork
allowed
our
participants
some
good
social
time
to
relax
and
to
get
to
know
one
another
informally,
as
well
as
to
enjoy
some
of
the
local
flavor
and
entertainment
of
the
Nashville
area.
Finally,
I
want
to
express
the
immense
pride
I
felt
about
the
quality
of
student
presentations,
writings,
and
intelligent
questions.
It
was
commonplace
throughout
the
week
to
hear
from
each
of
the
speakers
how
the
students’
questions
were
informed
and
excellent
and
how
they
probed
issues
in
a
way
that
they
seldom
hear
or
see.
The
quality
of
the
work
of
the
students
and
teachers
and
the
significant
discussion
and
intellectual
engagement
revealed
the
power
of
giving
students
and
teachers
this
opportunity
to
focus
in
depth
on
important
worldwide
issues.
I
believe
we
cannot
overestimate
the
potential
value
of
this
international
colloquy
and
the
ensuing
friendship
and
interaction
that
can
develop
in
such
an
intimate
but
far
reaching
setting
for
discussion,
debate,
and
understanding.
Brad
Gioia
Headmaster
Montgomery
Bell
Academy
124
Participants
Speakers
Dr
Jeffrey
R.
Balser
Balser,
a
1984
graduate
of
Tulane
and
a
1990
MD/Ph.D
graduate
of
Vanderbilt,
undertook
residency
training
in
anesthiology
and
fellowship
training
in
critical
care
medicine
at
Johns
Hopkins
and
in
1995
joined
the
faculty
at
Johns
Hopkins.
He
returned
to
Vanderbilt
in
1998
and
served
as
Associate
Dean
for
Physician
Scientists.
His
clinical
work
focused
on
the
care
and
resuscitation
of
cardiac
surgical
patients
in
ICU
settings.
His
basic
research,
published
in
Nature
and
funded
by
the
National
Institute
of
Health,
explores
the
genetic
precursors
to
life‐threatening
cardiac
rhythm
disturbances.
In
2001
Dr.
Balser
was
appointed
the
Gwathmey
Professor
and
Chair
of
Anesthiology.
In
2004
he
became
the
medical
center’s
Chief
Research
Officer,
heading
a
period
of
research
expansion
that
moved
Vanderbilt
into
10th
place
among
US
medical
schools
in
NIH
funding.
In
2009
he
became
Dean
of
Vanderbilt
University
School
of
Medicine
and
Vice
Chancellor
for
Health
Affairs.
He
is
a
member
of
the
Institute
of
Medicine
and
of
the
National
Academy
of
Sciences.
Dr
Darin
Portnoy
Dr.
Portnoy
is
an
attending
physician
at
Montefiore
Hospital
and
Montefiore
Medical
Group’s
Family
Health
Center.
He
has
had
extensive
clinical
experience
in
medical
humanitarian
aid
for
the
past
10
years.
At
present
he
is
the
President
of
the
US
section
of
Doctors
Without
Morders
/
Médecins
Sans
Frontières.(MSF)
and
has
served
on
the
organizations
Board
of
Directors
since
2001.
He
joined
MSF
in
1997
as
a
field
doctor
and
later
as
field
coordinator
for
tuberculosis
treatment
and
control
programs
in
Uzbekistan.
In
1999
he
ran
cholera
treatment
and
prevention
programs
in
El
Salvador
in
the
wake
of
tropical
storm
Mitch,
leaving
for
Georgia
the
following
year,
where
he
coordinated
emergency
health
care
for
Chechen
refugees.
In
2003
Dr.
Portnoy
worked
as
a
medical
coordinator
for
sleeping
sickness
and
comprehensive
primary
healthcare
programs
in
125
southern
Sudan.
In
2004
he
opened
clinics
and
hospitals
in
the
isolated
northern
part
of
Liberia
at
the
end
of
a
long
civil
war.
During
the
spring
of
2005,
he
worked
on
MSF’s
emergency
program
to
treat
a
massive
measles
outbreak
in
the
east
of
the
country.
Dr.
Portnoy
received
his
MD
and
MPH
from
the
Tulane
University
School
of
Medicine
and
the
Tulane
University
School
of
Public
Health
and
tropical
Medicine.
He
completed
his
residency
in
Family
Medicine
at
the
University
of
Texas
Southwestern
School
of
Medicine
in
John
Peter
Smith
Hospital.
Congressman
Jim
Cooper
Jim
Cooper
was
elected
to
his
second
term
in
Congress
in
200,
serving
a
more
urban
and
suburban
constituency
in
Nashville,
Mt
Juliet,
Lebanon,
Ashland
City,
Pleasant
View,
and
Pegram.
As
Fifth
District
Congressman,
he
serves
on
the
Armed
Services,
Budget,
and
Oversight
and
Government
Reform
Committees.
In
2007
he
was
named
Chairman
of
the
Armed
Services
Committee’s
Roles
and
Missions
Panel.
Cooper
continues
to
teach
as
an
adjunct
professor
at
the
Owen
Graduate
School
of
Management
at
Vanderbilt
University,
where
he
has
taught
a
course
on
health
care
policy
for
ten
years.
Cooper
earned
a
BA
in
history
and
economics
from
the
university
of
North
Carolina
at
Chapel
Hill
in
1975
as
a
Morehead
Scholar
and
served
as
co‐editor
of
the
Daily
Tar
Heel;
he
earned
a
BA/MA
in
politics
and
economics
as
a
Rhodes
Scholar
from
Oxford
University
in
1977;
and
a
JD
from
Harvard
Law
School
on
1980.
He
was
elected
congressman
for
the
Fourth
Congressional
District,
serving
from
1983‐1995.
Dr.
Morgan
Wills
Wills,
a
graduate
of
MBA
Class
of
1986,
Princeton
University,
and
Vanderbilt
Medical
School,
serves
as
the
staff
internist
at
Siloam
Family
Health
Center.
The
health
center
is
a
faith‐based
non‐profit
clinic
for
uninsured
patients
in
Middle
Tennessee,
primarily
focusing
on
immigrants
and
refugees
fro
all
over
the
world.
Siloam
currently
cares
for
patients
from
over
90
countries.
126
Prior
to
medical
school,
Wills
travelled
to
Africa
as
part
of
a
medical
mission
trip
to
an
indigenous
hospital
in
Ghana.
While
at
Vanderbilt,
Wills
spent
several
summers
working
with
a
non‐profit
clinic
called
Esperanza
Health
Center,
where
he
performed
door‐to‐door
immunizations
in
underserved
communities.
Wills
recently
retuned
to
Nashville
full‐time
after
earning
a
graduate
degree
at
regent
College
in
Vancouver.
Mr.
Paul
Zintl
Zintl
is
Chief
Operating
Officer
for
Partners
in
Health
(PIH)
and
Senior
Advisor
for
Planning
and
Finance
for
the
Program
for
Infectious
Diseases
and
Social
Change
(PIDSC)
at
Harvard
Medical
School
(HMS).
He
joined
PIH
and
HMS
in
January
2002.
He
is
also
currently
serving
as
the
Chair
of
the
Drug
Management
Sub‐Committee
within
the
Stop
TB
Partnership.
Prior
to
joining
PIH/HMS,
Mr.
Zintl
was
a
managing
director
of
JP
Morgan
&
Co
in
New
York,
where
he
worked
for
18
years
until
1995.
In
this
capacity,
his
responsibilities
included
management,
control,
analysis
and
evaluation
of
the
firm’s
trading
businesses.
After
leaving
JP
Morgan
he
studied
state
criminal
justice
systems
and
worked
as
a
private
consultant
for
two
years.
In
1998
he
received
a
master
in
Public
Administration
degree
from
the
John
F
Kennedy
School
of
Government
at
Harvard.
127
Schools,
Students
and
Staff
African
Leadership
Academy,
Johannesburg,
South
Africa
Courage
Matiza
Daisy
Nashipa
Mepukori
Mr.
David
Scudder
Colegio
Claustro
Moderno,
Bogota,
Colombia
Adriana
Medellin
Cano
Santiago
Pineda
Buitrago
Mrs.
Silvia
Börgmann
Medellin
Garodia
International
Centre
for
Learning,
Mumbai,
India
Ankit
Datta
Chaitanya
Patil
Mrs.
Lalitha
Rajgopal
Johannes
Kepler
Grammar
School,
Prague,
Czech
Republic
Aneta
Bernardova
Jan
Zdenek
Mr.
Jiri
Ruzicka
(Headmaster)
Mrs.
Jarmila
Skampova
Montgomery
Bell
Academy,
Nashville,
United
States
of
America
Paul
Baker
Karthik
Sastry
Mr.
Brad
Gioia
(Headmaster)
Mr.
Kevin
Hamrick
Nada
High
School,
Kobe,
Japan
Hiroto
Inoue
Yuki
Takenaka
Mr.
Mark
Aynsley
128
Raffles
Institution,
Singapore
Samuel
Ching
Bryan
Seethor
Mrs.
Lim
Lai
Cheng
(Principal)
Mr.
CJ
Ong
Shiyan
Cooperation
High
School,
Shenyang,
China
Yang
Yuwan
Sun
Chuhan
Mr.
Wang
Zhaohe
(Principal)
Mr.
Kevin
Li
Winchester
College,
United
Kingdom
Nicholas
Dagnall
Julian
Ranetunge
Dr
Ralph
Townsend
(Headmaster)
Mr.
Keith
Pusey
(Registrar)
Mr.
Tim
Parkinson
129