By Dr Tafataona Mahoso
THE Daily News on Sunday, for November 10 2019, carried two long items on the long strike by junior ‘doctors’.
The first item was an interview with Dean Ndoro, vice-president of the Zimbabwe Hospital Doctors Association, who confirmed some important facts about the stay-away from the point of view of the public:
λ First, that the association did refuse to appear before a disciplinary hearing where they were fully entitled to representation.
λ Second, that when the employer took them to the Labour Court and the same court ordered the strikers to return to work, they defied the court’s ruling.
λ Third, that when the employer increased their allowances, they also rejected the offer.
λ Lastly, that the junior ‘doctors’ are not yet qualified doctors as such but still interns doing their housemanship.
Given these facts, our readers might be interested in just the language used by the representative of the junior doctors in the interview with the Daily News on Sunday, such as the following:
“It’s a breach of contract to fire a person for requesting a living wage, more so something which is a right.
It’s totally unfair and complete madness to fire doctors at such a moment when crucial elements are needed to fix our healthcare system.”
The labour relations implications of the preceding facts are probably the reason the Labour Court ruled against the strikers. But it is not the purpose of this instalment to go over such matters.
This instalment seeks to go behind and beyond the strike, asking the following questions:
λ What is the mission of the medical school attended by the junior ‘doctors’ and how does it relate to Zimbabwe’s overall mission and vision for the entire health sector and the people it is supposed to serve?
λ What is the mission and vision guiding the curriculum of the medical school? Does it encompass moral philosophy, both African and general?
λ Apart from competitive grades, what sort of aptitude does the medical school seek in youngsters who apply to train?
λ What is the ideal orientation of the medical doctor which the school seeks to turn out using the curriculum?
λ When was the medical school curriculum last reviewed for future effectiveness, by whom and in terms of which values?
These questions become pressing, especially in light of the loud NewsDay cover story ‘UK lures fired (junior) doctors’ on November 11 2019.
The linearised Western medical curriculum under attack for the last 50 years
The linearised male-dominated Western medical curriculum has been under attack and review for more than 50 years.
Among the pioneering assaults was the publication in 1970 of Our Bodies, Ourselves, a self-help book on reproductive health and obstetrics by the Boston Women’s collective which included female doctors.
From Ghana, there was the 1981 publication of Kofi Appiah-Kubi’s Man Cures, God Heals: Religion and Medical Practice among the Akan of Ghana, which demonstrated how the overwhelming majority of the people of Ghana depended for health on a poorly supported system of African indigenous medicine while the state continued to pour the bulk of its health budget into an elitist and ineffective Western medical establishment catering for the few.
In 1985, Professor Tarek H. A. Hassan of Egypt published a critical paper called, The Current Crisis of Medicine and Science and the Place of Music.
Professor Hassan was a world renowned medical scientist and surgeon who had risen in his country, in Europe and North America to become a trainer of trainers of medical doctors.
It was from the pinnacle of the medical profession that he began to realise that so-called modern science and Western medicine had reached a dead-end, a crisis situation where the most prestigious medicine and science institutions, including universities, had lost any grasp of their original reasons for existence; had lost any sense of the real needs of society and were therefore existing to serve and glorify themselves at the expense of human beings and society.
For the medical schools and for the doctors they certified, prestige and wealth had replaced the original and core functions of medicine and healthcare:
“The totality that science disintegrates and fixes for study, measurement, description and observation and then cannot re-integrate the parts into the whole and certainly not into a living whole keeps emerging as a continuous reminder to science of its limits and limitations.
For wise men this totality is a continuous source of learning, admiration, respect and insight.
It is (however) a continuous threat and humiliation to arrogant scientists who refuse the humility of wisdom.”
What at first shocked Professor Hassan’s European and North-American audiences was the fact that he was a Western-trained Egyptian scientist of Arabic extraction recommending ancient African relational philosophy and science as a solution to the crisis of ‘modern’ science and medicine in general and to the training of medical doctors in particular.
Hassan demonstrated that he could improve the performance of medical doctors in the real world of medical practice by changing the medical school curriculum to include painting, the playing of music instruments and the learning of any arts which enhanced the trainee doctor’s capacity to listen, to observe the minutest movements and actions of others in order to co-ordinate one’s own movements and actions with those of clients and team-mates in order to achieve a common goal.
Hassan learned of this integration of clinical medicine with music and arts therapy by studying ancient African health and medical philosophy from the age of Aknaton, 5 000 years ago.
The underlying principle to this approach was that of African relational philosophy and science as opposed to Eurocentric linear philosophy and science.
Professor Hassan described the linear curriculum as follows:
“In their first year (students) are bombarded with hours and hours of didactic information, they are locked up in laboratories manipulating chemicals in bottles and test tubes.
They are made to spend hours dissecting cockroaches, frogs and homing pigeons!
Each of their victims must be killed before it is scientifically examined.
In the second year and third years, they are at last introduced to human beings.
Dead bodies!
And they are made to go into dead bodies in minute disintegrating detail.
Promoted to the fourth year, they are made to go back to test tubes, slides, jars and bottles of illnesses, parts of humans in jars and pots and on slides.
By the fifth year when: for contact with human beings and the drama of their life, health, illness, death and birth, crisis, regeneration – they have instead had intensive contact with jars, bottles, test tubes, rats, dogs, frogs, cockroaches, corpses and mountains of didactic information – they are now deemed fit to relate to living human beings!”
λ Professor Hassan’s own experience as a doctor and trainer of trainers of doctors was that, half of the medical practitioner’s clinical work consisted in ensuring effective communication with other doctors, with nurses, with nurse aids and especially with clients, patients.
λ But in practice, within the Western system:
λ “I have frequently demonstrated what I came to refer to as the gradual expropriation (removal) of the sensorium (feeling) as well as the gradual expropriation of expression potential.
λ This (training) situation is associated with gradual breakdown of communication with self and the outside world.
λ Vision is now absolutely focused onto the system, blinkered to all else.
λ Sensitivity to life is nil.
λ (Yet) this is the time to shower them (trained doctors) with laurels and graduate them as fully fledged doctors!”
Hassan, like the Boston US Women’s Collective, found that the conventional medical curriculum produced mostly doctors who were arrogant, impatient, intolerant and poor at communicating with people with the sorts of diverse backgrounds whom the doctor was likely to serve.
The MD, that is medical doctor, produced by such a system, was likely to be a dictator within his premises:
“How deeply I feel the continued perpetuation of the disorientation and unjustified denial of (Western) medicine’s real crisis when I see the shy, embarrassed, hesitant, ‘auxiliaries’ and paramedics, vital others in the health or handicapped care situation, when the MD makes his pronouncements.
All these: nurse, nutritionist, social worker, psychologist, physiotherapist, music therapist, art therapist, drama therapist, story teller, assistants, students, relatives, friends, healer and the PATIENT blush and disappear into nothingness in the classical confrontation scene with the MD.
Let this (study) paper be a reminder to them that they must never be intimidated or purely subservient to the MD.”
In contrast, many countries have adopted evolving medical training curricula in response to the basic needs of the majority of their communities.
Among these, the Cuban system features among the best; so that by 2015, more than 84 countries were learning from or borrowing and adapting one aspect or another of Cuba’s healthcare.
According to a study by Clare Cole, Jose Luis Di Fabio, Neil Squires, Kalipso Chalkidou and Shah Ebrahim:
“The concept was to train doctors who would understand, integrate, co-ordinate and administer the treatment of each patient’s health needs, as well as the community at large. For the first time, the population’s health needs were the starting point, not the end-point, for training. Patients’ needs were to be understood holistically rather than as fragmented organ systems diagnosed and treated by different hospital specialists.”