Salus populi suprema lex esto (The health of the people should be the highest law) wrote the Roman philosopher Marcus Tullius Cicero in around 30 BC. Since then, the lifespan and health status of people all over the world has shifted and changed as quality of life has improved for a proportion of the population. However, for the poor, voiceless and powerless, health is still a luxury.
"The right to the highest attainable standard of health should be the cornerstone of any consideration of health and human rights. … At the heart of [it] lies an effective and integrated health system, encompassing health care and the underlying determinants of health, responsive to national and local priorities, and accessible to all" - WHO, 2008
The basic elements contained within the right to health as outlined by General Comment No. 14 of the Committee on Economic, Social and Cultural Rights –availability, accessibility, acceptability and quality - are being denied to patients and health workers in low-income settings, said Dr. Meguid. Although the causes of death for many patients in the public clinic where he works are reported as postpartum bleeding or infection, Dr Meguid argued that these complications did not cause the deaths of women and children.
“This is HOW they died, not WHY they died. Why they died is because they were poor, voiceless and female.” Dr. Tarek Meguid
If we keep treating the technical pregnancy and childbirth complications as the causes of death, he argues, then we will never see change.
The recollections of Dr Meguid’s experience in Zanzibar were not surprising for many who had seen a hospital in a low-income country – underequipped, understaffed and poorly maintained, overcrowded rooms and poor environmental hygiene. However, equally disturbing were the stories of women who lost a baby and felt that they had no voice to ask why. Women having to walk to the delivery table, as they are ready to give birth – some not making it to the table at all. The status quo being that men are denied access to their pregnant wives.
“Dignity is worthiness, the moment you act like they are worth nothing – it is broken.” Dr. Tarek Meguid
The key is to not disempower, to allow healthcare staff, patients and their families to have a voice by giving them space and time.
The current conditions are not good enough, but there are no magic bullets, continued Dr. Meguid. The solutions lie in going back to basics and building simple systems that work. Creating patient centred environments and care, reinvigorating the healthcare staff, focusing on quality, and lastly, building coalitions and working together, moving beyond appearances and not stopping until everyone has the right to the highest attainable standard of health.
