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From Togo to the World
A Critical Perspective on the Global Health Policies Tomás Macedo Sopas de Melo Bandeira ANEM/PorMSIC - Portugal
tomasmelobandeira@gmail.com
Togo is a small country in West Africa with a size approximately similar to Croatia or Costa Rica. It was colonized by the Germans and the French and today there are around 6 million people living in this thin portion of land. Despite Togo’s small geographic size, it possesses great cultural, religious, and climatic diversity. Togo’s climate ranges from tropical to savannah. There are more than 40 different languages spoken. It is a multireligious country with a large diversity of Animistic religions - including a well-known one called Voodoo-, Christianity and Islam. The lack of cultural diversity in education does not prepare students to practice global medicine. Science is to medicine, like the human body is to the human being. Western medicine is nothing without modern science. But it is much more than the simple knowledge of the biochemical reactions or the pharmacological effects at the human receptors. Medicine needs facial expressions. It needs moods and affection. And the reason is because medicine is a human creation for a human consumption.
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When a doctor is working on the emergency service in Togo, he is usually called to care for a patient who is in coma. Frequently, this patient comes accompanied by his sister who doesn’t speak the official language of the country. After a great effort to understand what has happened, the doctor finds that the family lives far away and that the patient was unresponsive for an indefinite period of time. The patient needs ventilatory support. And then, the doctor will need to ask for some clinical analysis. However, to do it, the patient’s sister must pay before any laboratory test could be requested - from the blood collection tubes to any other supplementary investigation. Furthermore, his sister tells that before he fell into a coma, he has consulted a traditional healer
who had given him some plants that no one knows. It’s hard to be a doctor in Togo. The problem of traditional healers is not the traditional healers itself, but the fact that western medicine doesn’t know how to accommodate with them. Western medicine around the globe is taught with a very limited epidemiology and little awareness about world diversity. If theories about the human genetics are increasingly defending the inexistence of races but the similarities within our species, medical science frequently forgets about the huge multiplicity of human cultures, which necessarily have a tremendous influence on the medical approach and treatment. In Togo, or in any other country, people experience similar types of suffering while they are in the hospital. Even when cultures change the way medicine is practiced, all doctors remember their patient’s tears or their longing for relief to the end of their lives. However, we are now living in an increasingly global world, and medicine must follow its steps. If global health policy should make an international pressure in governments like the Togolese to invest more on the health system, those policies might also not forget that medicine, to be efficient and useful to the people, must be adapted and conformed with the environment where it is practiced. And the answer to that is not simply applying scientific knowledge indifferently all over the world, but mostly research all over the world. For this reason, we need a global research, we require an adapted medicine. And for this reason, even if it’s hard today to be a doctor in Togo, it is worth being a doctor in Togo!
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