Friday, June 22, 2007

A Cold Eye on the World Health Assembly

--For medicine students like us, the World Health Assembly is simply too baronial to be true.

“Every morning, like a pupa, we slowly crawl out from the sleeping bags, put up makeup, and try to look like a beautiful butterfly ready to fly into this fascinating world”
This was an artful description by Kristina someday after the World Heath Assembly (WHA). Her words left quite an imprinted impression in my head.

The first day in Palais des Nations (note 1), me, Kristina (the Chairperson of IFMSA) and Ozgur (Chairperson for Medical Education Commission) were invited to the lunch reception of World Health Professional Alliance (note 2). As the Vice-Chairperson of the IFMSA this year, it is not uncommon to attend a reception as such. The only difference this time was that I managed to have separate conversations with Health Ministers of Salvador, Costa Rica and Venezuela and the Vice Chairperson of the World Pharmacist’ Association.

I couldn’t help but thought of a line says “If throwing a stone in the street in Hsinchu, it’d at least hit one person owns a doctoral degree.”

In the WHA, it is something like this. You’d get at least one or two ministers in any of your casual snap shots. I became more certain about this theory, after I coincidentally met the Health Minister of Venezuela at the counter of a souvenir shop, and then later bumped into the Health Minister of Benin on a bus.

I was sitting aside of the assembly hall and watching those people in the seats reserved for the health representatives across the world. They had different colors of skin, and there were people in traditional costumes decorating the suit wearing crowd. In my eyes, the future health concerning 6 billion of the global population was holding right in those people’s hands. The professional and serious terminologies plus the speeches wrapped well by rhetorical words, and the world’s health leaders were taking turns to perform a drama.

That’s right! A drama, the WHA is exactly like a drama in my eyes. The Chair was reading the agenda proficiently. Then, the health ministers reading their neatly typed speeches prepared by their staff. The luxurious scenes plus the big cast, everything else seemed to be so familiar to me.

Of course, I was not much surprised by my own realization. Spending quite a few years in the medical students’ organizations, I was aware of the fact that ‘A meeting is being concluded as it begins.’ The news about the rejection of Taiwan’s application into the World Health Organization (WHO) was already spreading before the WHA even began. The speeches by the Senegalese and Panamanian health ministers, as well as the agitated accusation on Taiwan’s political intentions by the Chinese Health Minister Wu Yi, were all just ‘professional performances.’

Most of the time, the participants wouldn’t not know how the speaker looked like as the assembly hall was enormously huge. The mere connection among the participants was the headset, microphone and the thin cord. The most familiar voice would often be the simultaneous translation speaking of the participants’ language. Honestly, the interactions in the assembly did not differ much from a remote web conference. After physically being in the assembly, I believed more of that the value of the WHA was not about the assembly itself, but the grasp upon the global network. It was to shape the leading power manipulating the global health issue through the assembly.

The real progress was apparently taking place in those private meetings among those ministers. I was reading the China Times online; it reported that Taiwanese Heath Minister Chen Chien-Jen and American Health Minister Tommy G. Thompson had reached to several agreements at the WHA. Nevertheless, in the actual meeting, the participants only heard a few words from the Americans in the general discussion saying how Taiwan should not be alienated in the world health network; what really behind the luxurious scenes and actors, were some turbulent competitions on the political stances and an unseen battlefield.

Despite so, there were some interesting topics. For example, SARS had to be the best leading actor in the meeting. It was from WHO Director General Gro Harlem Brundtland to every single health minister who made a speech, and no one forgot to mention SARS in the meeting. As for the contents, they were no much differences anyway. It was mostly about how SARS has become a threat to the entire human beings in the 21st century, and no country should be exempted from the concern and so on and so for. The interesting thing was listening to the briefings by Dr Heyman, the WHO director for communicable diseases. He reported how SARS was all the way traced from the first burst out in Vietnam in February back to Guangdong Province in November last year, and also how they had to rely on the CNN to announce the spread of the disease, as they encountered problems contacting the health ministers on the weekend.

It was disappointing that all countries infected by SARS were asked to give reports, except for Taiwan. From the Philippines where the infectious situation was less severe to the world’s focus, China and even Hong Kong, gave a report for over 10 minutes. Ironically, when Liberian Health Minister proposed to have Minister Chen Chien-Jen to give his report on Taiwan’s SARS epidemic control, WHO Director-General Ms Brundtland then using ‘only SARs, no politics’ as an excuse of her refusal. When China was making their report, my emotions were intertwined when looking at the little “red” Taiwan on the map.

Another reason why I was disappointed with the WHO was due to its complexities and diversities over the discussions on global health issues. The topic often lost its main focus after a several discussions, and the representatives would start to give their own opinions. In the roundtable discussion of “Healthy Environment for Children,” the health minister of Iceland started to tell a fatal accident happened in Iceland this year that two children were killed after falling down from a soccer gate as they played, and therefore, Iceland Government decided to allocate more budgets in strengthening Children’s safeties in the playgrounds. The next speaker, Ghanaian Health Minister was talking about ‘XXX (I don’t remember the precise number) children died of vertical infection of HIV from their mothers; YYY children died of malaria; and ZZZ children had nutrition problems. The participants immediately heard of two obvious contrasts sharing different heath issues. I couldn’t help but imagined when listening to Iceland’s health minister talking about safeties in the playgrounds, the Ghana health minister might have whispered to himself ‘er…the issues seem to be different in Ghana.’

In the technical conference of ‘Risks for Health,’ when the WHO director for non-communicable disease was reporting how WHO advised all member countries to promote exercise activities, to reduce over-weighted population and to actively prevent chronic disease, a representative who came from Inter-African Committee was showing a number of projections of all sorts of unimaginable taboos. In some African countries, men were not allowed to have vegetables and women were allowed to eat vegetables only, as they believed meats make people strong and vegetables make people weak. Hence, males from those countries frequently suffered from high blood pressure and high blood illness, and as for women, they suffered from malnutrition. The situation was even worse in some African countries, since many children were suffering from severe dehydration, as those countries believed water would make children become stupid.

The similar situations happened over and over again in most of the meetings. As a bystander, it was indeed an eyes wide shut experience when listening to health representatives from different regions reporting their current issues and future resolutions. However, different countries might have completely different health issues, and I just couldn’t see how it was possible to seek common resolutions through the global networking system. Surely there were global issues such as AIDS, tobacco hazard prevention, and etc. Nonetheless, there were 10 something meetings everyday, and the meetings often ended without much consensus in the conversations and discussions.

After attending the WHA, it once again proved that enormous patience and huge wills are required when it comes to political and public health progress. We see messy steps, complicated obstacles and too much of the formality. Well, this is human nature, the corollary of community cooperation, and when we learn to get used to the phenomenon, we wouldn’t find it too weird at all.

Prior to various health issues, there should be a balance of welfares on the individual country and the human being as a whole. Throughout these years, I have witnessed the efforts made by Taiwan’s government and the NGOs about joining WHO. I sincerely hope that the 23 million Taiwanese people would not be absent in the WHO, no matter what challenges Taiwan and the WHO would be facing.

Note 1: Palais des Nations is United Nationa’s Headquarters in Europe. It is beside Lake Geneva and owns extensive areas with great architecture. Palais Des Nations is neighboring the WHO building, where the WHA meeting takes place every year.
Note 2: World Health Professional Alliance (WHPA) is funded by the World Medical Association, World Nurses Association, and World Pharmacist’ Association. WHPA aims at consolidating the medical workers across the globe in promoting global health.

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