Both of my parents had humble beginnings. They were both born in Lebanon, and were not able to finish primary school because of financial constraints. My father emigrated to St. Kitts in the hope of a better life at the age of 22, and with the help of an uncle and a few relatives, he worked as a clerk and then after about 25 years was able to own and run a haberdashery store, and save to buy a house, a few properties, and was ready to raise a family. At the age of 49, he returned to his homeland and married my mom, and when he returned to St. Kitts, I was born the year after. I have a sister and a brother, and our parents were able to send us to university, where we all graduated with advanced degrees and are now using our gifts and talents to serve our communities to the best of our abilities.
Looking back and trying to fathom how we got from there to here, how two “uneducated” people were able to produce a loving family with such potential, it dawned on me recently that this was not as a result of happenstance. This was as a result of our parents wanting the best for us, for us to have what they were not able to have, so that our struggles in life would be less painful and more fruitful than theirs. Our education was the number one priority for them, and they would not spare any cent in ensuring that we would get what we needed to further our studies and actualize our potentials. I still remember my dad always asking me when I wanted something, “Is it necessary?” knowing very well that if it was not necessary for my education, we were not going to get it. I remember very well an incident that occurred one afternoon at school, when I stayed after school to play basketball with the boys, and I did not come home to study after 5 pm. My dad was worried and he came down to the school and grabbed me by my ears in front of my friends and embarrassingly pulled me home.
Although as a result of this incident and several others, I was inhibited from developing my social skills and having a “normal” adolescent upbringing as I would have wanted, I did not understand that my dad only had my best interest at heart, which was my future, and he did not want anything to interfere with my education. Although I had a lot of negative feelings toward my dad when he was alive, it was only after he died that I began to appreciate the reasons for his actions. It was when I realized that my education in the latter years of my training was easy and this was as a result of the years invested in my early education, that I finally appreciated that this was the most priceless, selfless gift that a parent can give his child. He invested in my mind and made many sacrifices to ensure that I would get the best education possible.
Then it dawned upon me that he could not have done it without the support of the community. My dad was a merchant. He invested in the community by trusting his customers to pay when they could and they showed their loyalty by buying from him. If the community was not accepting of him, and he was not open and sensitive to the limitations and inabilities of the community to pay, the relationship of trust and support for one another would have not developed, and I am sure that my dad would not have been able to put us all through university to achieve what he and my mom were not able to achieve themselves. Although they came from humble beginnings and the community within which we grew up were of less than modest means, all of us were able to accomplish so much because of these trusting relationships, and I can truly say that it was each cent from each of his customers that helped us achieve a better life.
It is with this realization that our success is not of our making, but that of our parents and moreover the support of the community within which we are embedded, that I have this immense sense of gratitude to the community and my family, this immense sense of responsibility to help ensure that my family and moreover my community are served to the best of my abilities. They invested in my livelihood and it is my time now to invest in them. Hence the reason I came back home, and the reason why in the past year, I have felt it absolutely necessary to become more vocal via this medium to be a more responsible citizen as I become, like my parents and the community before me, a stepping stone in helping to create a better society for my daughter and her children and the children and the grandchildren of the other members of my extended family – the community.
To echo the words of Martin Luther King Jr, “…I am cognizant of the interrelatedness of all communities… We are caught in an inescapable network of mutuality, tied in a single garment of destiny. Whatever affects one directly, affects all indirectly….” It is my realization of this interrelatedness and my visceral sense of this interconnectedness of one to all that has guided my worldview and my thought processes over the past year, and which I will now bring to bear in providing a blueprint for nation building, in helping us navigate the uncharted waters as we move away from political tribalism to national unity.
As my sphere of expertise is medicine, and what concerns us now is the affordability and sustainability of healthcare in the face of a rising prevalence of noncommunicable diseases and its complications and its treatment in the setting of limited resources, I will use the provision of hemodialysis as a case in point. Two events served as an inspiration for this article. One was an email I received this week from a colleague asking me: “Can you please put some ideas together for me as to how you see health care moving? Would also be interested in prevention.” The other was a presentation I gave two days ago in Nevis for World Kidney Day on “Kidney Care and Prevention of Renal Failure.” The discussion that ensued was revealing for me and a testament that dialogue with open discussions is the only way in which good ideas can arise and where we can help empower each other. This should be encouraged in every sphere of our lives, and I am certain we all would be better off if we could nurture this form of openness and truthfulness protected by freedom of expression.
The issue has to do with the immense cost of hemodialysis and its provision to those who need it. We realize that it is not affordable to individuals and families, and not sustainable by hospitals and even governments, who in more developed countries have to take loans to ensure the viability of this life-saving and life-extending technology. The problem lies in the fact that countries would have to go into debt, and it is the savings of our children and our grandchildren who would directly or indirectly be responsible for picking up that shortfall. This would lead to a situation where our children would be worse off, not better off than we would have desired. The same can be said of other life-saving and extending technologies and services such as cancer, HIV and cardiovascular care.
In my mind, in order to preserve intergenerational equity and not pass the bill to the unborn generations, the only solution for us is to live within our means, so that the burden of caring rests with the present generations. How can this be achieved in an affordable and sustainable way where we maximize the provision of needs and minimise wastages? This can only be done where there are checks and balances in place, and all data ranging from the prevalence and incidence of disease, its cost and the causes are made open for all to see, along with accountability and transparency of the governance of the institutions that serve the health of the population. There should be a national health care scheme that provides universal coverage so that those patients who need the care will get it. Impeccable accounting of the cost the previous year should be provided so that the true expenditures are made public on a “dashboard” of a website. A health tax system then can be created which should be a simple percentage of our salaries in the civil and private sectors inclusive of other sectors. This would be a dynamic rate that is calculated on the previous year’s expenditure, so that we would not have to incur debt for recurrent expenditure. If we are investing in infrastructure that would also benefit the next generation, then and only then should we incur debt so that the burden be shared intergenerationally.
Since we know that 70-80 percent of our chronic diseases are preventable as they are lifestyle and foodborn in nature, we need to have negative feedback built into the system so those who benefit when they become ill can express their gratitude, and those who are responsible for the production of food and its distribution and its policies can be more responsible in their services. This gratitude can be expressed by each victim of each disease giving the disease a face, and being an ambassador to increase awareness of its causes so that many other lives can be touched and many more lives can be saved through adopting healthy lifestyle habits. So by helping those in need, we end up investing in preventing many more unsuspecting cases, which in the long run would help cut down in the incidence and prevalence of not only the complications, but also the diseases and their risk factors. Also when the supermarkets and the farmers realize that it is the provision of too much unhealthy food and the lack of sufficient provision of healthy alternatives that is responsible for the health tax rate being high, there are incentives now to provide less of the former and more of the latter. With time, a dynamic equilibrium would arise, where less people would get sick, less health expenditure would occur, more healthy food would be produced and healthier lifestyles would be encouraged, and less tax would need to be collected to ensure that all our health needs would be provided for.
This would only work, if we all live responsibly, as citizens, as patients, as providers of food and other services. This would require a coordinated effort from various industries, such as agriculture, health, education, commerce, trade, lands, water and sustainable development. This is how we can create stronger families and communities, something our generation and the next to come can be proud of, one that is less wasteful and more fruitful for one and all. I sometimes stop and ponder why such a simple idea has not been thought of or implemented before, and now I know why. The concept that has been the most destructive of our politics and our economics is that of “individualism,” which is the most divisive concept ever conceived of, as it is the ultimate “divide and rule” concept that has plagued us from the dawn of our humanity, as Charles Eisenstein has so eloquently expressed in his writings and presentations. We need now to regain our true sensibilities, regain our empathic nature that we are all more than individuals, that our true sense of self is defined by our families and our communities, and not by our politics and economics. By investing in strengthening our relationships in our families and our communities, we will help to actualize our true potentials, which truth be told, does not lie in the individual, but in our families and communities. When we die, our individual lives end, but what lives on is the memories of our contributions or lack thereof to our families and our communities. Seeing our selves in this light makes a world of difference, and not only helps in expanding our true identity and our true sense of expanded self, but also provides us with a blueprint for nation building, moving away from one fermented by political tribalism to one distilled in national unity.