Health, illness and the factors which determine both have never been great respecters of national boundaries.
In the 13th century, the black death took three years to travel across Europe; early this century it took the Sars virus three days to traverse the globe. We are becoming increasingly aware of the ways in which global issues affect us and the way in which we, as individuals and countries, have an impact on the world.
The Scottish Government, along with others around the world, has declared a climate emergency. This recognises that not only is this a problem which will impact Scotland and all parts of the world, but that we in Scotland have our own role to play in reducing our negative impacts and actively engaging to increase our positive ones.
We call this Active Global Citizenship. To be an Active Global Citizen, we must recognise the inequalities which mean that Scotland, together with other high-income countries, has a number of assets, in terms of skills, institutions and finance, which many countries lack.
Problems such as climate change also have a disproportionate impact upon those parts of the world with the least resources to relieve them.
Within the Scottish health service, staff engage in global issues in different ways.
For some, this can mean using their annual leave to go to countries such as Malawi, Rwanda and Zambia to assist local partners to develop and maintain their health systems, provide services and train local professionals.
For others, it can mean trying to reduce carbon emissions in their organisations and personal lives, finding alternatives to single-use plastics or raising money for projects to benefit other countries. Doctors in one of our children’s hospitals hold a weekly telephone advice clinic for doctors in Malawi – and are always amazed by the care that they provide with limited resources.
Spirit of partnership
The NHS in Scotland has provided enough equipment (which was being replaced) to completely fit out the only children’s operating theatre in Rwanda – co-ordinated and transported by Scottish children’s charity KidsOR. Also, 10,000 theatre masks have been collected as well as 30 surplus beds from NHS Lothian for a much needed additional cancer ward in Malawi.
In the past, much work with low- and middle-income countries has been undertaken in the spirit of charity; motivated by feelings of pity or paternalism.
However, we now recognise the benefits of international work do not only accrue to those with fewer resources and so we must enter into such work in a spirit of partnership.
Speak to those NHS staff who have worked in places like Malawi and Zambia and they can immediately tell you of the many advantages the experience has given them.
It would also be a mistake to believe we in wealthy European countries have all the answers to health and social problems.
Many low- and middle-income countries have been successfully providing quality care with few resources for decades. In terms of community-based approaches to health and wellbeing, connection to nature and place, and a number of other areas, we have a great deal we can learn from countries with much experience to share.
I met a palliative care doctor from Rwanda recently. She told me that her patients sometimes died in pain because of lack of medicines.
“But in my country,” she said, “it is different than yours – people never die alone without their family.”
We agree there are very many aspects to good care. There is always something to learn from others.
Catherine Calderwood is Scotland’s Chief Medical Officer and she is grateful to Paul Southworth, NHS Shetland, for his contribution.