|PRACTICE STORY / INTERVIEW
|Year : 2017 | Volume
| Issue : 4 | Page : 302-304
Health advocacy as freedom of expression
Former Principal, St. Stephen's College, Delhi and Former Member of the National Commission for Minority Educational Institutions, New Delhi, India
|Date of Web Publication||17-Nov-2017|
26, MG Nagar, Vazhayila Road, Peroorkada, Thiruvananthapuram, Kerala - 695 005
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Thampu V. Health advocacy as freedom of expression. Curr Med Issues 2017;15:302-4
| Introduction|| |
The role of a physician is not confined to the curative and preventive aspects of medicine-health advocacy is an integral aspect of healthcare, and every health professional is an advocate whether he or she is aware of it or not. Advocacy is not just speaking for the ones who cannot speak, it is an expression of hope, an agent of transformation and disturbs the status quo. Every Christian health professional, indeed every professional, is called to both preach and to heal, to speak in favor of the poor and the marginalized and to affirm the intrinsic worth of every human being. This article is based on a talk given at the Christian Medical College, Vellore, looking at the implications and role of advocacy in the contemporary health-care scenario, especially in the context of Christian mission hospitals.
| Health Advocacy|| |
Mk. 10: 51. “What do you want me to do for you?” Jesus asked Bartimaeus. The blind man said, “Rabbi, I want to see.”
The saving grace of Bartimaeus was his faith in a different possibility. This is the hallmark of the Kingdom of God; as Aunt Ida knew only too well.
Advocacy hinges on hope. We believe in the desirability and attainability of what we advocate. Second, what is advocated exceeds the scope of the status quo. That was Bartimaeus' strength. Though blind, he could see a new horizon with the eye of faith. He sensed that he did not have to go on begging because Jesus was at hand.
The mandate Jesus has given us is to “preach and heal” (Mtt. 10: 7,8). “And” is conjunctive. It holds “preaching” and “healing” inseparably together. Preaching lacks fruitfulness, isolated from healing. And healing suffers a reduction in scope, sans preaching. Beasts of burden, not human beings, are required to work without freedom of expression.
Jesus is the Supreme Advocate. He intercedes continually on our behalf – that is to say, advocates our cause – before God the Father. Christian mission being modeled on Jesus, necessarily has an advocacy dimension. The goal of mission is transformation. To transform is to experientially advocate the cause of an alternative. In the words of the book of revelation: a new heaven and a new earth.
Aunt Ida knew this well. Why else, would she define the shaping goal of CMC as manifesting the Kingdom of God? She knew she was not starting an institution, which can stay confined to itself as a self-contained, prestigious world. By its inception, CMC is the incarnation of advocacy. This is the essence of its continued relevance and vitality.
| Preconditions for Advocacy|| |
The precondition for advocacy – given its potential to disturb the status quo – is freedom of expression. But why is freedom of expression a fundamental right, globally? From time immemorial, two things have been deemed basic to human freedom and dignity: Freedom of expression and freedom of action. Speech and action are the two legs on which humanity walks.
This is of particular relevance to the biblical faith, which is the Word become flesh. The Holy Spirit is, inter alia, the Spirit of Communication, as is evidenced by the Pentecost (Acts 2). When the risen Christ promised to be with his disciples unto the end of the world, it was not his presence in flesh and blood, but in Spirit as the Word, that he meant.
He who is denied freedom of expression is a slave and a prisoner. In all societies and cultures of the world, denial of the right to speak and to be heard has been deemed the insignia of slavery and derecognition as a human being.
The second aspect is the right to act significantly or to act in ways that bring about personal and social transformation. The power of Christian advocacy is that it combines the two dimensions holistically. To advocate is to speak and to act, significantly. That is why the Roman Centurion says, “Only speak the word and my servant will be healed.” (Lk. 7: 7). In respect of Jesus, it is impossible to separate speaking from doing. His words healed, which is significant action. That is the ultimate measure of human stature!
Alienation from God has driven a wedge between speaking and doing, consigning the world to a morass of hypocrisy. We preach, butdo not heal. Hence, we have healing ministries which are, often, crusades of commercialization. This sort of healing is inimical to preaching, even if the Bible or the name of Jesus is invoked loudly and repeatedly. What is thus mouthed is not preaching, but covert advertisement. Not surprisingly, the merchants of faith healing do not preach the full gospel. They have their pet texts, which are used repeatedly, and in a distorted manner, to manipulate the desperation of the vulnerable.
| An Age of Propaganda|| |
Christian advocacy has attained unprecedented urgency and relevance because of the stridency of secular and commercial propaganda. The most effective preaching happens today, not in religious circles, but in temples of consumerism.
Secular advocacy is driven by profit motive. While the Gospel seeks “to set the captives free” (Lk. 4: 18), commercial advertisement seeks to enslave the free. It is in such a context that health services are organized and offered to people today.
We need to, hence, mind the meaning and scope of health advocacy. Biblically, health is the capacity to attain and celebrate “life in all its fullness” (Jn. 10. 10). You are healthy/healed, even if you are not cured; Paul being a classic example. The thorn in his flesh did not undermine the fullness of his life (2 Cor. 12: 7).
| Health Advocacy in Today's Context|| |
We have, according to St. Paul, two options: To conform to the pattern of the world or to be transformed (Rom. 12: 2). One cannot be a Christian advocate in health without being transformed; for it is God's agenda that we advocate. Mission belongs to the Lord; we are mere sowers and reapers. The agents of Christian advocacy need to be transformed because the goal of such an advocacy is not mere change or some paltry gain, but transformation.
What, then, is transformation?
One practical implication of transformation is liberation: Liberation from the reigning assumptions, purposes, and patterns of the times. Whatever man envisages and implements are vitiated by a hierarchical notion of human worth. Human beings, unless transformed by God, are incapable of equality. We are flattered by inequality when it is loaded in our favor. How honoured we feel, when we are treated preferentially!
When the young Ida decided to become a missionary doctor in Tamil Nadu, she was not embracing social service or pietistic charity. She challenged and changed existing assumptions and practices, the details of which are too numerous to be detailed here. This is an important aspect of transformation. The CMC community can never afford to forget that this institution is a monumental witness to the relevance of advocacy.
Social structures and public systems being weighted in favor of the rich and the elite, resulting in the gross neglect of the needs of the poor, characterizes the present-day India as much as it did the Tamil Nadu of Ida's times. She confronted it!
Sure enough, CMC embodies “Advocacy by Being”. By our idea of, and approach to, healing, by our commitment to the poor, and by our renunciation of the profit motive, we are a living, but silent, advocate for a reorientation of health services in India. This is an unmatched heritage, and if and when this is compromised, CMC will cease to be the institution that we have known it to be.
Health advocacy, as relevant to CMC, must have a few hallmarks.
The preferential option for the poor
It is commendable that CMC endeavors to make affordable, quality care available to the poor. Admittedly, hi-tech medicine, with its genius for escalating cost of treatment, hinders us. Hence, it is imperative that our advocacy implies critiquing the dogmas that undergird the world of medical technology and the almighty drug industry, which is more powerful than even oil cartels. It is surely not the mission of Christian advocacy in health to argue that the rich and the poor should be given the same kind of treatment. It is becoming increasingly clear that the present practice of medicine is no good news even for the rich. Can CMC and the many mission hospitals in partnership with it, set for themselves the task of evolving an alternative health-care model, honouring Jesus' preferential option for the poor?
-Christian health advocacy has a duty to profess, practice, and preach (cf. Article 25 of the Constitution). This model of health care distinguished by a preferential option for the poor. Traditionally, we believed that “what the right hand does, the left should not know” (Mk. 6:3). However, we overlook the fact that our good works are to shine before men, so that they give glory to our Father in Heaven (Mtt. 5: 16). Here, we have a brilliant distinction between propaganda and advocacy! If we use the godly things we do as means for self-advertisement, we are propagandists for ourselves. However, being advocates of the Kingdom, refusing to articulate the meaning of what we do and why we do it is dereliction of duty. Significantly, Matthew's Gospel ends with the Great Commission, enjoining on us to preach to the nations.
Holism is basic to Christian advocacy. A patient is, to say the least, a human being! If so, the total context in which he lives should concern us. This was basic to the emergence of public health/community medicine. Now, we have family medicine, without much concern, perhaps, for the nexus between family and healing. The healing potential of the home needs to be reappropriated. After all, many of the healings that Jesus did was in homes!
Environmental issues also need to be our concern; especially at a time when environment-related health issues are coming to the forealarmingly. As it is, responsibility for the environment is written clearly into our spiritual mandate. Adam was assigned the task of tilling the land and taking care of the garden.(Gen. 2:15). It is not enough to till and toil. Without this “taking care” part, we toil in vain.
To take care is to respect the worth of what we care for. This is where the world goes grievously wrong. It has no intrinsic worth for persons. Human worth is determined by status and paying capacity. From the perspective of Christian advocacy, all are equal in worth in the sight of God. In terms of meeting needs, therefore, the poor, whose needs are most neglected and resources systemically degraded, need to be the priority. Treating unequals as equals is to favor the richer of the two. Social justice is, hence, basic to Christian advocacy. Justice is key to a spiritual understanding of health. Most of our health problems stem from our inability or unwillingness to do justice to ourselves, which includes treating the environment caringly. Doing justice to oneself also means, in light of the parable of the talents, engaging fully and enthusiastically with whatever we are entrusted with and using these resources, howsoever meager, as the ladder to climb out of the dark well of deprivation. We are, incidentally, advocates because we have “faith, hope and love” (I Cor. 13: 13).
The patient's role in healing
At the heart of our health advocacy is the crucial importance of the role that patients play in their own healing. The central biblical illustration of this fact, increasingly overlooked today, is the healing of the invalid, some 38 years of vintage, beside the pool of Bethsaida. It was not medicine or surgery he needed. It was liberation from within, as is indicated by the question, “Do you want to be healed?”. Strange, the fact that someone is waiting to be healed does not prove that he is willing to be healed! If so, what can medical sciences do, unless this reality is addressed? 90% of his patients, Karl Jung wrote, did not need medicine. They needed forgiveness.
The physician's role in healing
Finally, the advocacy role, as against the traditional curative role, puts the focus on the person of the doctor. Physician, Jesus urged, “heal thyself.” Only a healed person can be a vehicle and advocate of holistic healing. Hi-tech medicine will belong increasingly, even exclusively, to the rich as years go by. The poor stand a chance only with holistic healing, which shifts the emphasis from the hospital to those who need healing.
At its inception, hospitals were meant only for the poor. The word “Hospital” meant a “place of welcome.” It was a place, in 12th Century Italy, to which the poorest of the poor, who did not have roofs over their heads to die in dignity in the terminal stages of their lives, could come and find help and hospitality. They were given loving care and a sense of personal worth. The merit of the hospitals we run must be assessed with reference to this historical yardstick, “a place of welcome”! How can mission hospitals be otherwise? If this is taken care of, our healing ministry will attain an unmatched relevance that will draw millions back to the service we wish to render; for, the one thing that modern world cannot offer is loving care.
Who can forget the recent sordid spectacle of the poor man in Odisha, carrying the dead body of his wife from a hospital on his shoulders to his village some sixty kilometres away, simply because he could not afford to do it any other way? Do we need a cry louder than this to wake up to the injustice heaped on the poor and the indigent? Mars is the destination of pride for India. However, we are too poor, it seems, to send the dead body of a tribal woman to her home some 600 km away.
We cannot afford to remain mute and go about mechanically with our work, even if we are working our fingers to the bones as, I know, many in CMC and mission hospitals do.
As the old chorus says, “Go, tell it on the mountains…”
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Conflicts of interest
There are no conflicts of interest.